- Lincoln Financial Group (Atlanta, GA)
- …**Requisition #:** 72954 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... Group Protection in a remote environment. Background Details The Claimant Excellence Team will...development to perform in this fast-paced environment. As a Claims Customer Care Associate , you… more
- Trustmark (Atlanta, GA)
- …the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner ... in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments.… more
- Sevita (Atlanta, GA)
- …more than 50 years, our team members have provided home and community-based health care for adults, children and their families across the United States. As a member ... lives of others? In the Employee Safety and Risk Claims Consultant role, you will contribute to the company's...achieve overall claim cost reduction. This role is 100% remote and can be performed from anywhere in the… more
- Humana (Atlanta, GA)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized at the Inpatient ... communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or… more
- Takeda Pharmaceuticals (Atlanta, GA)
- …in order to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the ... labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- Houston Methodist (Atlanta, GA)
- …2 years of experience.** Revenue Cycle experience is a plus.** 100% remote .** At Houston Methodist, the Ambulatory Payment Classification (APC) Coordinator position ... is responsible for reviewing and correcting all claims edits related to the APC grouper, National Correct...Apprentice (AAPC) **OR** + CPCA - Certified Professional Coder Associate (AAPC) **OR** + CCS - Certified Coding Specialist… more
- Ankura (GA)
- …excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and ... and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations....develop project work plans as requested . Understands health care compliance concepts, issues, and how to research and… more
- CVS Health (Atlanta, GA)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. This is a full-time telework position.… more
- Sevita (Atlanta, GA)
- …more than 50 years, our team members have provided home and community-based health care for adults, children and their families across the United States. As a member ... and experience a career well lived. **Litigation and Risk Associate General Counsel** Do you have a law degree...help develop systems and procedures to assure optimal quality care for the individuals we serve. This role is… more
- Mass Markets (Savannah, GA)
- …+ Be a subject matter expert on your client's business + Manage remote employees as needed. + Other duties and responsibilities as assigned CANDIDATE QUALIFICATIONS ... REQUIRED QUALIFICATIONS + Minimum of 3-yearscall center managementexperience + Associate 's degree or equivalent combination of education and relevant work… more
- Molina Healthcare (GA)
- **_ Remote and must live in United States _** **JOB DESCRIPTION** **Job Summary** Provider Network Administration is responsible for the accurate and timely ... validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of… more
- Humana (Atlanta, GA)
- …operational efficiency, reduce manual processes, and improve accuracy in insurance claims processing, policy management, and other key areas. A strong background ... solutions to streamline and automate insurance-related processes, such as claims processing, policy administration, and customer service operations. + **Technical… more
- Humana (Atlanta, GA)
- …**Use your skills to make an impact** **Required Qualifications** + A minimum of an Associate 's Degree + 5 or more years of experience in medical auditing & coding ... 6 or more years of work experience related to claims with an understanding claims lifecycles/healthcare revenue...team of offshore associates **Additional Information** **Work Style** : Remote **HireVue Statement** : As part of our hiring… more
- Humana (Atlanta, GA)
- …for our members and providers, all while driving health outcomes and cost-effective care for our members. We are seeking a Clinical Investigation Lead to provide ... strategic direction to drive appropriate care , with the aim of reducing waste and overuse...to bring forth a pipeline of potential initiatives. **Location:** remote In this lead role you'll have the opportunity… more
- Humana (Atlanta, GA)
- …first** Humana's Clinical Analytics Team is seeking a Lead Research Scientist ( Remote ). Healthcare is rapidly changing, and our members are living longer, often ... clinical concepts and extract clinical information from medical, pharmacy, and lab claims for analytics and modeling purposes + Translates analytic results into key… more
- BayCare Health System (GA)
- …largest employers within the Tampa Bay area. **Position Details:** + **Location:** Fully Remote (must reside in the State of Florida, Georgia, or North Carolina) + ... - Friday The **Inpatient** **Coding Auditor** is a full-time remote position. This team member must currently reside in...Performs special audits for specific issues within facility Inpatient claims . + Acts as the Liaison for coding issues… more
- Humana (Atlanta, GA)
- …populations served in target growth markets. **Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key ... Medicaid programs and subpopulations.** Areas of focus include Care Management, Quality Improvement, Utilization Management, Population Health, Social Determinants… more
- Mass Markets (Garden City, GA)
- …+ Be a subject matter expert on your client's business + Manage remote employees as needed. + Other duties and responsibilities as assigned CANDIDATE QUALIFICATIONS ... of total call center experience or 1-year ofcall center managementexperience + Associate 's degree or equivalent combination of education and relevant work experience… more
- Humana (Atlanta, GA)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products...protect member PHI / HIPAA information This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- Elevance Health (Columbus, GA)
- **Title: Grievance/Appeals Analyst Lead** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50 miles of a ... non clinical services, quality of service and quality of care issues to include executive and regulatory grievances. **How...and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize… more