- Highmark Health (Atlanta, GA)
- …and/or create analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality of ... to identify, develop and/or monitor actionable opportunities for improving health and healthcare outcomes and clinical quality and costs of care, efficiently and… more
- CVS Health (Atlanta, GA)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- Elevance Health (Atlanta, GA)
- …and Experiences:** + Scaled Agile Framework Training preferred. + 5+ years of claims editing experience with healthcare payers and/or claims editing ... meet financial and operational targets. As a Clinical Content Analyst , you'll research and interpret CMS, CPT/AMA and other...highly preferred: CCS, CCS-P, CPC, CPB. + Experience in claims adjudication and application of NCCI editing… more