- Elevance Health (Atlanta, GA)
- …but are not limited to: + Researches and synthesizes detailed clinical data related to pharmaceuticals. + Prepares information for network physicians. + Prepares ... and implements custom medical necessity criteria for Medicaid business to meet State contract requirements + Support the health plan approval, oversight and annual… more
- Elevance Health (Atlanta, GA)
- …GA** **Hours: Monday - Friday** **Travel:** **(Hybrid 1-2 days onsite per manager discretion)** **Position Overview:** Develops the provider network through ... + Ensure that network composition includes an appropriate distribution of provider specialties + Conducts more complex negotiations and drafts documents **Required… more
- Elevance Health (Atlanta, GA)
- …within SQL, SAS, Excel, or equivalent preferred. + Proficiency in analyzing Medicaid claims data preferred. + Experience analyzing and building valued ... **How you will make an impact:** + Performs varied data analyses which may include developing moderately complex ROI... accuracy preferred. + Experience working with claims and provider contracts for the Medicaid line of… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Manager , Medical Coding in Payment Integrity leads a team that reviews clinical information from ... codes (eg, ICD-10-CM, ICD-10-PCS, DRG, APR-DRG) were billed. The Manager , Medical Coding works within specific guidelines and procedures;...+ RHIA, RHIT and/or CCS Certification + Experience with data analysis tools such as Power BI + Able… more
- Elevance Health (Atlanta, GA)
- …pertinent to healthcare data and quality reporting + Experience working with Medicaid and Medicare plans a plus. Please be advised that Elevance Health only ... JR132653 HEDIS Clinical Quality Program Manager **Location:** This position requires you to reside...meetings, develops a workplan, and ensures management of supplemental data processes. + Develops performance improvement plans and oversees… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** Waystar is seeking a smart and creative Senior Product Manager with hands on experience in Healthcare Revenue Cycle Management. We are ... closely with User Experience team and Technology teams. The Senior Product Manager will lead cross departmental strategic product initiatives coordinating with key… more
- Humana (Atlanta, GA)
- …moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Portfolio Management ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. They...the US without Humana sponsorship as Humana does not provide work visa sponsorship for this role. + Bachelor's… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Business Transformation Manager will lead large, cross-functional transformative initiatives and is responsible for ensuring projects are ... feet to "in the weeds". Finally, the Business Transformation Manager will work hand in hand with key stakeholders...in hand with key stakeholders and their teams to provide insight and accelerate various internal strategic initiatives as… more
- Philips (Alpharetta, GA)
- Territory Manager - RespirTech (Sacramento, CA) RespirTech's Territory Managers represent the InCourage airway clearance therapy medical device, calling on but not ... and obtaining medical record documentation. + Be an expert on Medicare, Medicaid and private insurance coverage-criteria for InCourage vest therapy. Be able to… more
- Public Consulting Group (Atlanta, GA)
- …preferred + 8+ years of relevant work experience, including: working with clients, people manager + Knowledge of, or experience in, Medicaid is preferred + ... intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts +… more
- Elevance Health (Atlanta, GA)
- …contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs._ The **Audit and Reimbursement Senior** ... with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health...independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings… more
- Waystar (Duluth, GA)
- …new payer connections as directed by the Trading Partner Operations Sr. Manager following established departmental procedures + Provide insight and direction ... non-technical individuals. Coordinators will audit EDI transactions to ensure accurate data processing for our clients. Support payer activities and system changes.… more
- Elevance Health (Atlanta, GA)
- …Utilization Management & Drug List setup using Test Claims/Query testing. + Review & provide the testing timelines to be included in the project plan. + Ensure the ... globally dispersed. + Ensure the compliance with mandates and project implementations. + Provide the latest status and metrics to the Test lead/project teams. + Acts… more
- Elevance Health (Atlanta, GA)
- …Business Operations org is looking to hire a PBM Test Program Manager / Quality Control Test Architect. This high-performing individual contributor will be ... status as defined in the test plan with supporting data . + Manages both onshore and offshore test execution...planned stay on track and under budget. + May provide direction and guidance to team members and serves… more
- Humana (Atlanta, GA)
- …standards. This role works closely with Marketing & Product Analytics teams to provide data -driven guidance for marketing efforts. The ideal candidate will have ... the ability to provide guidance on performance measurement, KPIs, test and learn...campaign performance. **Key Role Functions** + Works with Campaign Manager and Campaign Strategy roles to define the measurement… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to reach new heights in your career and be what you want to be. We provide : + Comprehensive health benefits that start day 1 + Student Loan Repayment Assistance & ... and its programs remain compliant with Centers for Medicare and Medicaid Services (CMS), Organ Procurement and Transplantation Network (OPTN)/United Network for… more
- Fresenius Medical Center (Duluth, GA)
- …blood flow (QB) and dialysate flow (QD). + Evaluate intradialytic problems and provide intervention as prescribed by physician order or as directed. + Monitor ... vascular access during treatment including arterial and venous monitoring pressures, provide appropriate intervention as needed, document and report any unusual… more
- Elevance Health (Atlanta, GA)
- …new or existing process, methodologies and practices through observation, research, and data analysis. + Monitors adoption and use of processes, tools, and practices ... practices; or any combination of education and experience, which would provide an equivalent background. **Preferred skills, capabilities, and experiences:** +… more