- 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
- The Cigna Group (Atlanta, GA)
- …have a background in customer service or experience in healthcare, specifically benefits and claims processing, you might be the perfect fit to join our team as a ... Care Navigator Representative. As a Care Navigator,...driving a consistently accurate quality of service. **QUALIFICATIONS:** + Associate degree or higher required and/or 4+ years' work… more
- Abt Global Inc. (Atlanta, GA)
- …career and their experience conducting research on post-acute care , nursing home health care policy, and health care claims data to play key technical ... homes or other post-acute care settings, health care policy. + Use Medicare claims data...Abt Global will never ask candidates for money in exchange for an offer of employment. _ _\#LI-CO1_ #LI- Remote … more
- Molina Healthcare (Atlanta, GA)
- …Technicians** who are State Licensed/Certified and/or PTCB certified. This role is 100% remote , and the hours will be **Mon-Fri 10am to 630pm Eastern Standard ... medical necessity for medications along with assisting with pharmacy claims . **Highly qualified candidates for this role will have...work within several computer systems at once + Managed care experience + High level of communication skills, both… more
- Molina Healthcare (Atlanta, GA)
- …who is **BOTH** State Licensed/Certified and Nationally certified. This role is 100% remote , and the hours will be **Mon-Fri 11am to 730pm Central Standard Time** ... at once, MS Note experience a plus + Managed care experience + High level of communication skills, both...High School Diploma or GED equivalent **Preferred Education** : Associate degree **Required Experience** : 2 years' experience as… more
- Molina Healthcare (Atlanta, GA)
- …to, and the appropriate approvals and escalations are achieved. Coordinates with both the Associate Vice President of Fraud, Waste and Abuse (FWA) and Associate ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims *...Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS,… more
- Molina Healthcare (Atlanta, GA)
- …projects as assigned; and serves as a "mentor" to newly hired Associate Specialists. **Job Duties** + Processing Credentialing Applications * Evaluates credentialing ... and regulatory requirements, while meeting production goals. * Communicates with health care providers to clarify questions and request any missing information. *… more
- WTW (Atlanta, GA)
- **Description** As an Absence, Disability Management and Life Insurance Senior Associate , you will be at the forefront of managing projects for large, complex ... + Strong financial skills; prior experience in group disability underwriting or claims management strongly preferred + Proven experience creating project plans and… more
- Humana (Atlanta, GA)
- …and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are ... payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes,...**What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company… 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
- Amgen (Atlanta, GA)
- …in the public or private third-party access arena or pharmaceutical industry in managed care , clinical support, and/or sales OR Associate degree AND 10 years of ... insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution + Educate offices using approved materials + Review… more
- BayCare Health System (Atlanta, GA)
- …largest employers within the Tampa Bay area. **Position Details:** + **Location:** Fully Remote (must reside in the State of Florida, Georgia, South Carolina, or ... - 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)
- …first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... 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 \#LI- Remote **Scheduled Weekly Hours** 40… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …our academic community. **Description** We are looking for a motivated postdoctoral research associate to join Dr. Huiwen Xu's research team in the Nell Hodgson ... on nursing homes (R01AG081282 and R01AG087296), in addition to other long-term care projects. The candidate should have strong analytical and writing skills, a… more
- Humana (Atlanta, GA)
- …Degree + CAS, MTV, PAAG, or APEX systems experience + Claims experience + Provider data management data loading/analysis/review **Additional information** ... ongoing interruptions to protect member PHI / HIPAA information. This is a remote position \#PPNO **Scheduled Weekly Hours** 40 **Pay Range** The compensation range… more