- Elevance Health (Atlanta, GA)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...They are how we achieve our strategy, power our business outcomes and drive our shared success - for… more
- Deloitte (Atlanta, GA)
- …wants to work in a collaborative environment? As an experienced Epic Professional Billing Analyst you will have the ability to share new ideas and collaborate on ... hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay… more
- Centene Corporation (Atlanta, GA)
- …J-1, OPT, or CPT ._** **Position Purpose:** Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data ... Analysts. + Provide advanced analytical support for business operations in all or some of the following...operations in all or some of the following areas: claims , provider data, member data, clinical data, HEDIS, pharmacy,… more
- CVS Health (Atlanta, GA)
- …reviewer is accountable for the validation of existing fraud waste and abuse business rules and leads designed to detect aberrant billing patterns and reviewing ... to determine the impact of the scheme on Aetna business . + Keep current with new and emerging fraud,...analysis experience. + Healthcare background. + Experience with internal claims data and healthcare coding. + Must be able… more
- Molina Healthcare (Macon, GA)
- …work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, etc. +… more
- Highmark Health (Atlanta, GA)
- …degree + 10-15 years experience in support of a Marketing function or Data Analyst role or in a business environment with responsibility for application of ... Support Analyst or equivalent training and experience in a business , specialty pharmacy, clinical pharmacy or clinical environment with direct responsibility for… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ Seven (7) years of experience in implementing technical requirements to support business applications as an Application Analyst ; OR a Bachelor's Degree and ... in includes Resolute Hospital and Professional Billing including SBO, as well as Claims and Remittance. This IT technologist role contributes as the highest level… more
- AIG (Atlanta, GA)
- …is achieved from product capabilities What we are looking for + Master's in business administration preferred + Claims or Insurance background is preferred + Gen ... GenAI Product Manager with Claims ExperienceBe part of something groundbreakingAt AIG, we...vision of the future and the core of our business offering. We will incorporate best-in-class engineering and product… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …as a provider on record for appropriate managed care intervention claims with responsibility for appropriate documentation, implementation, and monitoring of autism ... + Master's degree in related field, Board Certified Behavioral Analyst (BCBA) Certification AND approved as a Board Certified...Emory University on a flexible weekly schedule based upon business needs. Schedule is based on agreed upon guidelines… more
- Molina Healthcare (Atlanta, GA)
- …data analysis and database development needs. + Reviews, evaluates, and improved Company business logic and data sources. + Resource to Pharmacy Department staff for ... mentoring, coaching, and analysis questions. + Reviews Pharmacy analyst work products to ensure accuracy and clarity. + Reviews regulatory reporting requirements and… more