- Molina Healthcare (Atlanta, GA)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Lincoln Financial Group (Atlanta, GA)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information...this role you will provide coaching and guidance to claims regarding medical management **What you'll be… more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64040/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
- Elevance Health (Atlanta, GA)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Elevance Health (Atlanta, GA)
- ** Nurse and CPC - Clinical Fraud Investigator II -...control. + Review and conducts analysis of claims and medical records prior to payment. Researches ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Molina Healthcare (Atlanta, GA)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- PruittHealth (Norcross, GA)
- …Coordination (DEAC), the Episode Assessment Coordinator (EAC) is responsible for prospective review of episode related documents. The EAC ensures all services and ... utilization meets needs for improved patient outcomes and appropriate claims reimbursement in accordance with regulatory billing guidelines. **KEY… more
- CVS Health (Atlanta, GA)
- …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.… more
- GE Vernova (Atlanta, GA)
- …Negotiate terms and conditions and transmit information to Procurement. Manage claims . Includes commercial sourcing management such as data analysis, negotiations ... and precedents or are covered by well-defined policies or review of end results. The job allows modification of...130% of salary in certain areas. Healthcare benefits include medical , dental, vision, and prescription drug coverage; access to… more