- Molina Healthcare (Savannah, GA)
- **Job Description** **Job Summary** Responsible for collecting, storing, processing , and analyzing large sets of data. The primary focus will be on choosing optimal ... tools such as Python, Ruby or Perl. * Experience in building stream- processing systems, using solutions such as Kafka, Storm or Spark-Streaming * Experience… more
- PruittHealth (Norcross, GA)
- …variances, make corrections, and take appropriate corrective actions to ensure timely claim resolutions. 8. Evaluates accounts, resubmits claims , and performs ... all Insurance billing services by final/higher level auditing, correcting, and submitting claims . Ensures that billing services are timely, accurate, and allow for… more
- Sedgwick (Atlanta, GA)
- …documentation. Efficiently manages a case load using technology for efficient claim processing . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Evaluates ... efficiently. + Utilizes technology and automation tools for efficient claim handling. + Sends claims exceeding $15,000...tools for efficient claim handling. + Sends claims exceeding $15,000 gross loss amount to leadership for… more
- GE Aerospace (Atlanta, GA)
- …Microsoft Office Suite and ability to navigate other business-related software, including claim processing systems and applications. + Excellent written and oral ... In this high-impact role, you'll deliver sharp insights, adjudicate complex claims , and collaborate across teams using advanced analytics and emerging technology.… more
- Molina Healthcare (Atlanta, GA)
- …concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems ... or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation… more
- Highmark Health (Atlanta, GA)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly… more
- Cardinal Health (Atlanta, GA)
- …+ Mails all paper claims . + Acts as a subject matter expert in claims processing . + Manages billing queue as assigned in the appropriate system. + Manages ... done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will...company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with… more
- Molina Healthcare (Savannah, GA)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments...years operational managed care experience (call center, appeals or claims environment). + Health claims processing… more
- Molina Healthcare (Atlanta, GA)
- …payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is ... maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates...**Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims … more
- Molina Healthcare (Atlanta, GA)
- …pricing configuration, claim adjudication or reimbursement processes + Experience processing or reviewing facility claims + Prior professional experience ... vendor, operations, health plan representatives, and other business teams involved in claim processing . Maintains expertise in all forms of reimbursement… more
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