- Molina Healthcare (Macon, GA)
- …and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the standards and requirements established by ... and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for reviewing and resolving contracted… more
- Humana (Atlanta, GA)
- … Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Molina Healthcare (Savannah, GA)
- …and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You ... entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the...Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team… more
- Highmark Health (Atlanta, GA)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more
- Norfolk Southern (Atlanta, GA)
- …of railroad operations and long-term business goals. **Principal Duties** * Handles appeals of claims and grievances and disputes involving collective bargaining ... Relations Officer * Senior Labor Relations Officer * Assistant Director Labor Relations * Deputy Director Labor...Conditions** Environment: Hybrid on-site 3 days per week and remote 2 days work per week. Shift Work: No… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …card distribution, accurate provider directories, performance on VBC contracts, benefit adjudication, appeals , and grievances . + Collaborate with the TPA to ... corrective action plans. FINANCIAL MANAGEMENT: + In conjunction with Sr. Director , Finance, oversee financial performance, manage budget and costs, and identify… more