- Sutherland Global Services (Atlanta, GA)
- …regulatory guidelines + Follow up on claims needing additional information + Refer problem claims to a Lead and/or auditor for additional review + Make ... performance. Delivering measurable results._ This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much… more
- Elevance Health (Atlanta, GA)
- …service written and verbal inquiries. **How you will make an impact:** + Assists higher level auditor / lead on field work as assigned and acts as auditor in ... **Pharmacy Internal Auditor ** **Location:** This position will work a hybrid...in pre and post implementation audits ofpharmacy operational processes, claims processing and payment, member and provider inquiries, enrollment… more
- Elevance Health (Atlanta, GA)
- **DRG Coding Auditor (DIAGNOSTIC RELATED GROUP)** _This position will work virtually._ _Alternate locations may be considered._ _The Ideal candidate must live within ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG Coding Auditor ** is responsible for auditing inpatient medical records and generating… more
- Elevance Health (Atlanta, GA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Elevance Health (Atlanta, GA)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location:_ Alternate locations may be considered. This position will work in a ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- CVS Health (Atlanta, GA)
- …convenient and affordable. The Special Investigations Unit is seeking a Manager to lead our team of Certified Professional Coders (CPC). The Manager is responsible ... strategies to manage workload, quality of reviews and process improvements. **Responsibilities:** Lead and mentor a team certified coders who support fraud detection… more