- Humana (Atlanta, GA)
- …and identify opportunities to for provider education. + Ensures compliance with Oklahoma's Managed Care Contractual requirements for provider relations, such as ... first** Humana Healthy Horizons in Oklahoma is seeking a Claims Research & Resolution Lead to lead a team...+ Experience with Oklahoma Medicaid. + Thorough understanding of managed care contracts, including contract language and… more
- AIG (Atlanta, GA)
- …are reimagining the way we help customers to manage risk. Join us as a Claims Law Firm Panel Director to play your part in that transformation. It's an opportunity ... valued member of the team. Make your mark in Claims Supplier Management Our Claims team are...ensuring all contracts, rates, billing processes are implemented and managed correctly. The role will be responsible for managing… more
- Molina Healthcare (Atlanta, GA)
- …success in Payment Integrity; preferably leading content development. + 5+ years Managed Care payor experience, preferably Medicare / Medicaid experience. + ... Claims Adjudication accuracy including configuration in QNXT (ie Claims Production, Audit, Production Vendor Oversight) for...all lines of business, which may also include the Care Management application for UM functions within QNXT: +… more
- Molina Healthcare (Atlanta, GA)
- …healthcare vendor , commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft Excel ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Humana (Atlanta, GA)
- …regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional ... interpretation. The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work various tasks or… more
- Prime Therapeutics (Atlanta, GA)
- …is client facing, and acts as a strategic liaison between the business and vendor partners to ensure the Strategic Solutions roadmap is created, managed , and ... platforms and products + Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data; highly… more
- Elevance Health (Atlanta, GA)
- …a BA/BS in a related field and minimum of 5 years of experience in a managed care setting with extensive risk adjustment experience with a focus on CMS audit ... to day operations for risk adjustment programs including both prospective and retrospective, claims , vendor quality, and audits + Develops metrics, policies, and… more