- Molina Healthcare (Atlanta, GA)
- …teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, ... and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen. Experience in… 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
- Molina Healthcare (Macon, GA)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- Sedgwick (Atlanta, GA)
- …for completed and partial stays. + Audit hotel folios and related claims for billing accuracy, compliance, and documentation. + Investigate and resolve billing ... with hotels and internal billing teams. + Support Hotel Coordinators by processing overnight and early-morning hotel extensions and new bookings. + Conduct … more
- IQVIA (Atlanta, GA)
- …Education & Experience:** + High School Diploma or equivalent + Experience in claim processing required + Required to have active Medical Billing Certification ... The **Care Navigator** is primarily responsible for receiving medical claims from HCPs or patients and vetting the ...claims from HCPs or patients and vetting the claim against program specific business rules to determine if… more
- CCMS & Associates (Dalton, GA)
- …effectively with adjusters, insurers, and repair facilities to ensure seamless claims processing . + Maintain professional, customer-focused interactions with ... costs, and delivering high-quality appraisals for auto and heavy equipment claims . Job Responsibilities: + Conduct field inspections and appraisals of automobiles,… more
- Molina Healthcare (Augusta, GA)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Create succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...for all PI solutions. + Lead efforts to improve claim payment accuracy, claim referrals, adjustment analysis… more
- Molina Healthcare (Atlanta, 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)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- Centene Corporation (Atlanta, GA)
- …Complies with all policies and standards **Education/Experience:** Associate's degree and claims processing , billing and/or coding experience preferred. Three ... updates to key provider groups and model contract + Research and identify any processing inaccuracies in claim payments and route to the appropriate site… more