- Humana (Atlanta, GA)
- …Qualifications** + Bachelor's degree + Previous experience in prior authorization, claims , and/or utilization management in healthcare, health insurance, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical...evaluating medical necessity and appropriateness of care + Health Plan experience + Previous Medicare/Medicaid Experience a plus… more
- Textron (Augusta, GA)
- …safety culture\. Implement corrective actions for stresses that impair employee health and efficiency\. Interpret OSHA standards and regulations and maintain ... process for incident investigation and failure analysis of environmental, health and safety incidents\. Conduct health and...compensation and act as a liaison to 3rd party claims management group\. Implement and monitor the effectiveness of… more
- Walgreens (Conyers, GA)
- …of a pharmacist assists with healthcare service offerings including administering vaccines, health screenings, and any health services allowed by law. + ... Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with… more
- Molina Healthcare (Augusta, GA)
- …and complies with applicable laws and regulations pertaining to the Health Care environment **Job Duties** The Operational/Regulatory Oversight Sr. Analyst works ... with health plans and operations departments to assess, oversee, and...experience working in Medicare + Must have experience analyzing claims . **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree and/or equivalent… more
- Walgreens (Douglasville, GA)
- …to medical provider as needed to ensure medication is taken correctly, health needs addressed, and satisfaction with service. + Performs pharmacist tasks including ... to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows- up with… more
- Molina Healthcare (GA)
- **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider ... serves as the primary point of contact between Molina Health plan and the for non-complex Provider Community that...2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working… more
- Molina Healthcare (Atlanta, GA)
- …and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
- Waystar (Atlanta, GA)
- …+ Experience working with **healthcare data** and understanding RCM processes ( claims , billing, payments). + Familiarity with data orchestration tools (eg, ... Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial...The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and … more
- Trustmark (Atlanta, GA)
- …necessary. + Learns to underwrite pending files received for review and contestable claims files for underwriting. + Works with reinsurer on cases that require ... to compensation, we offer a comprehensive benefits package that includes: Health /dental/vision, life insurance, FSA and HSA, 401(k) plan, Employee Assistant Program,… more
- Evolent (Atlanta, GA)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...preferred + Previous healthcare experience with a focus in claims and prior authorization data is preferred **To comply… more