Community Medical Group Jobs & Careers (Now Hiring) Jul 2026 — Page 2 | Clera

Jobs at Community Medical Group (Now Hiring) — 24 open — Page 2

Community Medical Group

Contestation Specialist

Miami-Dade County, Florida, United States · On-site

Mid level

Summary The Contestation Specialist will review medical and pharmacy claims, eligibilities and supporting medical documents to identify contestation and recovery opportunities with the Health Plans. Will also monitor, tr…

Skills: Claims Analysis, Healthcare Analytics, Microsoft Excel, Power BI, Tableau

Community Medical Group

Center Medical Director

Miami, Florida, United States · On-site

Senior

Summary Physicians diagnose and treat acute, episodic, or chronic illness, independently or as part of a healthcare team. May focus on health promotion and disease prevention. Duties and Responsibilities Performs annual …

Skills: Medical Diagnosis, Patient Treatment, Preventative Healthcare, Prescription Management, Diagnostic Testing

Community Medical Group

Medical Assistant

Miami, Florida, United States · On-site

Entry level

Summary Medical Assistants work alongside physicians and perform services in accordance with the physician’s orders. Medical assistants are trained to perform administrative as well as clinical duties under the sup…

Skills: Patient Assessment, Vital Signs Monitoring, Venipuncture, Phlebotomy, Medical Terminology

Community Medical Group

Virtual Care Support Service Medical Assistan

Miami, Florida, United States · Remote Solely

$20/hr

Entry level

About the Role: The Virtual Care Support Service Medical Assistant plays a critical role in delivering high-quality healthcare services through virtual platforms. This position is responsible for supporting healthcare pr…

Skills: Electronic Health Records, Virtual Care Technologies, Medical Terminology, Patient Communication, Clinical Workflow Management

Contestation Specialist

Community Medical Group

Miami-Dade County, Florida, United States • On-site

Mid level

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Full-time
bachelor degree, professional certificate
Posted 40d ago
~40 hrs/week

Responsibilities

The specialist reviews medical and pharmacy claims to identify contestation and recovery opportunities with health plans. They are responsible for tracking recoveries, maintaining policies, and reporting financial impacts to the Network and Contracting department.

Requirements

Requires 3-5 years of professional experience in claims-based healthcare analytics and a preference for a bachelor's degree in business, finance, or a related field. Proficiency in advanced Excel and familiarity with healthcare reimbursement methodologies like DRGs and CPT codes are essential.

Full job description

Summary

The Contestation Specialist will review medical and pharmacy claims, eligibilities and supporting medical documents to identify contestation and recovery opportunities with the Health Plans. Will also monitor, track and report success of the contestation process.

Duties and Responsibilities

Review medical and pharmacy claims data, eligibility files, and medical documents to identify opportunities for contestation.
Responsible for creating, improving and maintaining contestation Policy and Procedures.
Responsible for tracking and monitoring on a weekly/monthly basis eligible claim for contestation.
Establish good and effective communication with Health Plans.
Submit contestation requests and support documentations to Health Plans within established filing deadlines and contractual requirements.
Work closely with Network and Contracting department to review and recommend changes based on claims behavior.
Report to Network and Contracting open contestation cases, recoveries, aging, trends, and financial impact.
Create and maintain a set of tracking reporting.
Analyze complex healthcare claims, eligibility, and pharmacy data regarding healthcare costs and utilization and make recommendations based on relevant findings.
Keep record of contestation submissions, supporting evidence, correspondence, recoveries, and payment outcomes.
Ensure compliance with Health Plan requirements, contractual obligations, regulatory guidelines, and internal policies related to contestation activities.
Perform other duties as assigned.

Qualifications

Education/Experience:

Bachelor’s degree in business, finance, computer science, engineering, economics or related field preferred.
At least 3-5 years of professional experience in claims-based healthcare analytics with a payer, provider, or related healthcare entity. Value-based care experience preferred.
Certified Subrogation Recovery Professional (CSRP) certification is a plus.
Familiarity with healthcare reimbursement methodologies and calculations such as DRGs, Revenue Codes, CPT Codes, bundled payments, etc.
Knowledge of health insurance financial business cycle, healthcare quality reporting, and benchmarking.
Knowledge of healthcare claims; differences between institutional vs professional billing and various sites of care/service
Advanced or higher proficiency in Microsoft Excel.
Experience with Power BI, Tableau, or Microsoft SQL preferred.
Bi-lingual Spanish/English preferred.

Skills:

Possess personal qualities of integrity, credibility, and commitment to corporate mission.
Thoroughness and attention to detail.
Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices.
Excellent people skills, with an ability to partner with a dynamic leadership team.
Flexible and able to multitask; can work within an ambiguous, fast-moving environment, while also driving toward clarity and solutions; demonstrated resourcefulness in setting priorities and guiding investment in people and systems.
Ability to work with individuals within and outside the organization, in professional and courteous manner.
Demonstrated ability to successfully plan, organize and manage projects.
Organized and able to manage competing priorities.
Resourcefulness in problem solving.
Detail and financial oriented.
Strong written and verbal communications skills.
Must be highly flexible; able to accommodate changing needs of the department.

Nature of Work

Job duties require exercise of discretion in selecting from established alternatives to situations which arise on the job.
May be required to perform duties and responsibilities not listed in this description, on a temporary or long-term basis.

Related keywords

Claims AnalysisHealthcare AnalyticsDRGsRevenue CodesCPT CodesBundled PaymentsValue-Based CareCSRPPower BITableauSQLMicrosoft ExcelInstitutional BillingProfessional BillingSubrogation RecoveryHealth Insurance Financial Cycle

About Community Medical Group

LinkedIn Visit site

Dedicated to Healthcare Excellence

Industry: Hospitals and Health Care
Company size: 501-1,000 employees
Headquarters: Miami, FL
LinkedIn followers: 8,664

As one of the largest, most recognized and respected providers of Medicaid and Medicare health services in Miami-Dade County, healthcare excellence is always close to you when you need it. We operate 18 centers throughout Broward County to Miami-Dade and an additional five centers in Hillsborough and Polk county located in central Florida. Each medical center offers high-quality primary and specialist care as well as comprehensive diagnostic testing and laboratory services in one convenient location. Our team of highly experienced physicians, along with our caring, multilingual staff, is dedicated to giving high-quality, personalized care you can trust. We offer convenient extended hours and each medical center is fully automated with electronic medical records. Community Medical Group is here to meet the needs of the community at large. We are an Office of Economic Self-Sufficiency partner, which helps families in need apply for Medicaid, Food Stamps, Temporary Cash Assistance and more through the Department of Children and Families (DCF). We also have WIC (Women, Infants and Children) offices on-site at several of our locations, which help provide healthy food, nutrition education, and referrals for community services.

Offices: 6100 Blue Lagoon Dr., Suite 365, Miami, FL 33126, US · 743 NE 167th St, North Miami Beach, Florida 33162, US · 321 Opa Locka Blvd, Opa-Locka, Florida 33054, US · 3805 W 20th Ave, Hialeah, Florida 33012, US · 1490 NW 27th Ave, Miami, Florida 33125, US

Health Care

View all jobs at Community Medical Group

About Community Medical Group

LinkedIn Visit site

Dedicated to Healthcare Excellence

Industry: Hospitals and Health Care
Company size: 501-1,000 employees
Headquarters: Miami, FL
LinkedIn followers: 8,664

As one of the largest, most recognized and respected providers of Medicaid and Medicare health services in Miami-Dade County, healthcare excellence is always close to you when you need it. We operate 18 centers throughout Broward County to Miami-Dade and an additional five centers in Hillsborough and Polk county located in central Florida. Each medical center offers high-quality primary and specialist care as well as comprehensive diagnostic testing and laboratory services in one convenient location. Our team of highly experienced physicians, along with our caring, multilingual staff, is dedicated to giving high-quality, personalized care you can trust. We offer convenient extended hours and each medical center is fully automated with electronic medical records. Community Medical Group is here to meet the needs of the community at large. We are an Office of Economic Self-Sufficiency partner, which helps families in need apply for Medicaid, Food Stamps, Temporary Cash Assistance and more through the Department of Children and Families (DCF). We also have WIC (Women, Infants and Children) offices on-site at several of our locations, which help provide healthy food, nutrition education, and referrals for community services.

Offices: 6100 Blue Lagoon Dr., Suite 365, Miami, FL 33126, US · 743 NE 167th St, North Miami Beach, Florida 33162, US · 321 Opa Locka Blvd, Opa-Locka, Florida 33054, US · 3805 W 20th Ave, Hialeah, Florida 33012, US · 1490 NW 27th Ave, Miami, Florida 33125, US

Health Care

View all jobs at Community Medical Group

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