- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures ... sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations Professional work assignments involve moderately complex to complex… more
- CenterWell (Atlanta, GA)
- …community and help us put health first** As an **Accounts Receivable Specialist/Healthcare Claims Denials Specialist** , you will: + Ensure the coordination of claim ... timely reimbursement of receivables. + Research, resolve, and prepare claims that have not passed the payer edits daily....at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of… more
- CenterWell (Marietta, GA)
- …to either the Kansas City or Atlanta market. As the **RCM Healthcare Claims Denials (Accounts Receivable) Supervisor** , you will: + Supervise daily billing and ... and initiate correspondence to insurance companies for reconsideration of claims . + Supervise accounts receivable management functions and maintain assigned… more
- Humana (Atlanta, GA)
- …focus of this role is Medicare Pharmacy and Part D. The Senior Compliance Professional will analyze business requirements, provide research and regulatory ... caring community and help us put health first** The Senior Compliance Professional ensures compliance with governmental...care industries + Strong communication skills + Experience with pharmacy operations and/or claims processing in a… more
- CVS Health (Atlanta, GA)
- …people on their path to better health as part of the largest integrated pharmacy company in the United States. Through the company's more than 7,600 CVS/ pharmacy ... a market leader in mail order, retail and specialty pharmacy , retail clinics, and Medicare Part D Prescription Drug...be responsible for: Managing a high volume of medical claims that have denied by refuting the denials within… more
- Humana (Atlanta, GA)
- …informaticists to define various clinical concepts and extract clinical information from medical, pharmacy , and lab claims for analytics and modeling purposes + ... + Healthcare or managed care working experience + Experience working with medical, pharmacy , lab claims + Experience working with big data and using… more
- Elevance Health (Atlanta, GA)
- … claims processing, enrollment, and benefit administration. + Experience with pharmacy prescription drug claims testing, benefits and clinical testing + ... work here will be Test Program Management for our pharmacy business system integrations. **Location:** This position will work...skills. + Ability to prepare status and metrics to senior leadership team. + Ability to work in a… more
- Elevance Health (Atlanta, GA)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for identifying and ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- Cardinal Health (Atlanta, GA)
- …a deep understanding of healthcare reimbursement (managed care and specialty pharmacy operations). In addition to stewarding relationships with the pharmaceutical ... + Knowledge of the specialty drug product marketplace, health insurance claims processing, and commercialization of products and working with pharma manufacturers… more