• Provider Reimburse Admin Sr

    Elevance Health (Atlanta, GA)
    …of education and experience, which would provide an equivalent background. + RN; Medical billing and coding certification strongly preferred. Please be advised ... Reimburse Admin Sr ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and… more
    Elevance Health (09/30/25)
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  • Investigator II

    Elevance Health (Atlanta, GA)
    …health plan, line of business and/or state + Claim reviews for appropriate coding , data mining, entity review, law enforcement referral, and use of proprietary data ... experience strongly preferred + Fraud certification from CFE, AHFI, AAPC or coding certificates preferred + Knowledge of Plan policies and procedures in all… more
    Elevance Health (09/30/25)
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  • Clinical Documentation and Claims Integrity…

    Elevance Health (Atlanta, GA)
    …of 5 years of related experience, including 3 years of hands-on HCC coding , chart review, and RAF calculations; or any combination of education and experience ... systems within a healthcare payer or RCM organization and associated coding / claim integrity certifications strongly preferred. + Experience working with Medicare/… more
    Elevance Health (09/24/25)
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  • AI Agentic Experience Design Director

    Elevance Health (Atlanta, GA)
    …experience features strongly preferred. + Hands-on mindset with comfort using light coding /prototyping ("vibe coding ") to validate ideas, run rapid design ... and incentive bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits, 401(k) +match,… more
    Elevance Health (09/17/25)
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  • Care Coordinator Tier II

    ChenMed (Decatur, GA)
    …patient referrals with specialists and/or hospitals, completes referral requests and transmits medical records and correspondence via mail and/or secured fax or ... with training on new processes with direction from Referral Manager . + Manages approval flows and follows up with...as assigned. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of medical terminology, CPT, HCPCS and ICD coding … more
    ChenMed (09/19/25)
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  • Primary Care Physician

    CenterWell (Stone Mountain, GA)
    …Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators ... accordance with standards of care. . Follows level of medical care and quality for patients and monitors care...manner working with a quality- based coder to optimize coding specificity. . Follows policy and protocol defined by… more
    CenterWell (08/29/25)
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  • Investigator Assistant

    Elevance Health (Atlanta, GA)
    …Assists in preparation of statistical and financial analysis reports + Requests medical records and additional documentation required for investigation + ... + Strong Excel Experience strongly preferred + Knowledge of Healthcare, coding , billing procedures strongly preferred Please be advised that Elevance Health… more
    Elevance Health (09/30/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Atlanta, GA)
    …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS...+ Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager … more
    Molina Healthcare (09/26/25)
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  • Patient Services Coordinator LPN Home Health

    CenterWell (Griffin, GA)
    …for normality, fax a copy of lab to doctor, make a copy for the Case Manager , and route to Medical Records Department. Initiate Employee / Patient Infection ... + Prior packet review / QI experience preferred. + Coding certification is preferred. + Must possess a valid...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
    CenterWell (09/30/25)
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  • Nurse Audit Senior (Operating Room)

    Elevance Health (Atlanta, GA)
    …accounting and control principles and a working knowledge of CPT/HCPCS and ICD 10 coding and medical policy guidelines strongly preferred. + Travels to worksite ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending." The **Nurse Audit Senior** is responsible for identifying,… more
    Elevance Health (09/30/25)
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