- CVS Health (Atlanta, GA)
- …goals._** **Position Summary** This position will support the several parts of the Medicaid provider management team with focus on assignment, reporting, project ... on coordination and collaboration amongst of work for Network Operations-Intake and triage, provider data assignments, claim pend assignments. Will be lead for… more
- Humana (Atlanta, GA)
- …Horizon's ( Medicaid ) network development market entry strategy for its Medicaid growth markets. This strategist will lead data -driven research oriented ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Mathematica (Atlanta, GA)
- …related to monitoring and improving the following Medicaid programs: Medicaid payment and financing policies (fee-for- service base and supplemental payments, ... rigorous analytic thinking to the collection and interpretation of quantitative and qualitative data , including analysis of Medicaid administrative data and… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...federal and state government to define health plan covered service packages and eligible cohorts. + Communicate covered services… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... This role will work horizontally across the organization, coordinating with Medicaid and Medicare leadership and clinical subject matter experts to synthesize,… more
- Public Consulting Group (Atlanta, GA)
- …new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, ... achieve strategic goals to serve the public better. We provide the full spectrum of technology consulting services to...Business Enablement + Business Solutions + Project Assurance The Medicaid marketplace is changing, and PCG is at the… more
- Humana (Atlanta, GA)
- …problems and issues using data from internal and external sources to provide insight to decision-makers to support Medicaid HEDIS reporting and quality ... data from multiple sources including claims, clinical and provider data , ensuring data integrity...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and… more
- Prime Therapeutics (Atlanta, GA)
- …the implementation and support of all activities related to developing and maintaining service provider contracts. Interacts with all areas of the Prime ... empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If… more
- Highmark Health (Atlanta, GA)
- …to evaluate the medical necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic peer to peer discussions ... as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA,… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... caring community and help us put health first** The Supervisor, Provider Engagement develops and grows positive, long-term relationships with physicians, providers… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... us put health first** Join our team as a Data Visualization Engineer 2 and revolutionize how we interact...the US without Humana sponsorship as Humana does not provide work visa sponsorship for this role._** **Location/Work Style:**… more
- Humana (Atlanta, GA)
- …is an Enterprise Shared Services team focused on data , reporting and data science supporting Humana's Service Operations. The team is focused on converting ... cause analysis + Demonstrated ability to problem solve and provide solutions for business or data issues...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and… more
- CenterWell (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... play critical role in defining and executing Integrated Health data strategy and oversee the creation of trusted, cross-domain...Please be aware that applicants may be asked to provide their Social Security Number, if it is not… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... health first** The role of the Vice President, Enterprise Data Governance & Protection is to lead Humana's ... capabilities are effectively integrated into business execution. + Provide expertise, consult and lead innovation, tap into new… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... to work in optimizing testing strategies and ensuring robust data accuracy, making you the cornerstone of successful software...achieve their best health - delivering the care and service they need, when they need it. These efforts… more
- Humana (Atlanta, GA)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The...services, requested level of care, and/or requested site of service should be authorized. All work occurs within a… more
- Humana (Atlanta, GA)
- …procedures. + Assist with government audits to support Centers for Medicare and Medicaid Service (CMS) and Department of Health Services (DHS) to comply ... + Assist Operations staff with daily claims, enrollment and provider services issues in a manner to help them...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and… more
- Sutherland Global Services (Atlanta, GA)
- …+ Status Inquiries + Interpreting Medical Benefit Grids + Verification of Provider Participation + Credentialing Inquiries + Documentation + Provider Inquiries ... provided on the phone call + Routing Pathways + Self- Service Options + Assisting providers with education on available...+ 1-2 years of experience with healthcare insurance + Medicaid experience highly favored + 1-2 years of experience… more
- Humana (Atlanta, GA)
- …Communicate insights and analytical findings to a broad range of audiences * Ensure solutions provide the highest quality of data * Contribute to moving the team ... towards cloud-based analytical platforms Member and Provider Analytics, the department this role is a part...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and… more