- AIG (Atlanta, GA)
- …expertise to assist with pricing the Commercial Property business. The Actuarial Analyst will be responsible for profitability studies, portfolio deep dives, working ... partner with reserving actuaries in assessing the impact of loss trends and claims emergence, and partner with underwriters in assessing the impact of changes in… more
- Cardinal Health (Atlanta, GA)
- …data from multiple sources (eg, Salesforce, Trella Insights, Definitive Healthcare, claims feeds, internal CRM/ERP) to deliver clear, actionable insights that ... gaps + Ensure HIPAA/privacy safeguards and appropriate minimum necessary use of PHI/ claims . + Define and operationalize Reach (# of targeted HCPs/accounts touched)… more
- Intermountain Health (Atlanta, GA)
- …documentation requirements, and reimbursement policies, as well as ensures claims meet medical necessity for procedures performed. **Essential Functions** + ... providers for clarification or additional information when needed. + Submits coded claims to billing department or third-party payers in a timely manner. +… more
- Highmark Health (Atlanta, GA)
- …Utilize robust, data-driven insights from complex healthcare datasets (eg, claims , clinical, utilization, pharmaceutical) to inform policy development, identify ... 7 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 5 years of project leadership… more
- CVS Health (Atlanta, GA)
- …and security requirements. **Required Qualifications** + 1 year minimum of claims processing experience + Experience with system testing and post go-live ... validation + QNXT Experience + Familiarity with clinical and code editing concepts and products (Example: ClaimsXten, Cotiviti PPM & CV) + Extensive knowledge of CPT, HCPCS, ICD-10 coding **Preferred Qualifications** + Prior Relevant Work Experience 3-5 years… more
- Molina Healthcare (Columbus, GA)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems into clear system requirements and process improvements. + Proficiency in… more
- State of Georgia (Fulton County, GA)
- …Oversees the planning and development of systems and data in support of claims and policy management. Participates in the development of financial policies, plans, ... parties such as lawyers, judges, auditors, or public officials. Settles negotiations on claims and coordinates litigated claims Associate degree in a related… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …in includes Resolute Hospital and Professional Billing including SBO, as well as Claims and Remittance. This IT technologist role contributes as the highest level ... with the EMR and/or other applications. + Serve as most senior level Analyst supporting clinical &/or revenue cycle teams and assist respective Director to ensure… more
- Highmark Health (Atlanta, GA)
- …with a general understanding of data flows from various corporate systems (eg, claims , billing, lab, and Rx), to solve complex issues and problems. A comprehensive ... data including, but not limited to: medical/surgical physician and institutional claims and encounters, clinical data, prescription drug data, membership data,… more
- State of Georgia (Fulton County, GA)
- …Serves as job expert and resource in assigned areas. + Primary point of contact, analyst , and responder for civil litigation and claims against the Department: + ... with DOAS/RMS and AGO for tender of lawsuits, ante-litem notices, and claims . + Serves as the Department's designated employee resource and handles notices… more