- Molina Healthcare (Atlanta, GA)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to organize,… more
- Molina Healthcare (Augusta, GA)
- …medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- Elevance Health (Atlanta, GA)
- …systems/tools to accurately document determinations and continue to next step in the claims lifecycle. + Researches new healthcare related questions as necessary ... abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Molina Healthcare (Columbus, GA)
- …work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical ... software program(s) proficiency. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive… more
- Molina Healthcare (Augusta, GA)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission… more
- Molina Healthcare (GA)
- …services, pharmacies, and health plan providers in resolving member prescription claims , prior authorizations, and pharmacy service access issues. * Articulates ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Columbus, GA)
- …care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Augusta, GA)
- …member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Macon, GA)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Savannah, GA)
- …member inquiries, questions and concerns in all areas including enrollment, claims , benefit interpretation, and referrals/authorizations for medical care. + Provides ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more