- BrightSpring Health Services (Valdosta, GA)
- …accounts list, code and comment prior to monthly Critical Account call.* Rebill claims for any outstanding AR that is collectible. Provide detail comment in aging ... balancing and reporting.* Maintain open communication with Billing Specialist, Cash Application Analyst and Operations.* Send cash transfer & check requests to the… more
- CVS Health (Atlanta, GA)
- …Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM ... our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more
- CVS Health (Atlanta, GA)
- …to work EST time zone hours.** **Position Summary** We are hiring a Senior Analyst to support the Complaint, Grievances and Appeals (CG&A) team. This position will ... and answering ad-hoc requests + Work closely with analysts and other business partners to gather requirements and understand the reporting needs for ad-hoc… more
- 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 ... in varied and complex data; and articulates analytic findings, business implications, and recommendations to realize identified opportunities. **ESSENTIAL… more
- CVS Health (Atlanta, GA)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- CVS Health (Atlanta, GA)
- …setup, essential for online viewing and processing, related to customer service, claims , enrollment, billing, and reporting, in support of internal and external ... manual processing and disruption for the clients. + Uses business knowledge and experience to make plan design and...align with industry coding (ICD 10, place of service, healthcare reform, etc.), similar to entry-level IT programming. +… 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
- BrightSpring Health Services (Valdosta, GA)
- …Ensures all batches/checks, denials, and adjustments are keyed and posted within 2 business days of receipt. + Meets productivity standards for keyed payments and ... related in health care administrative, financial, or insurance customer services, claims , billing, call center or management regardless of industry. + Proficient… more
- Molina Healthcare (Augusta, GA)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 7 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** ** Business Leadership & Operational Ownership**… more
- Molina Healthcare (GA)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... meet data analysis and database development needs. + Reviews, evaluates, and improved business logic and data sources. + Resource to staff for mentoring, coaching,… more