- Molina Healthcare (Atlanta, GA)
- … Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of … more
- Elevance Health (Atlanta, GA)
- …spending. The **DRG CODING AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Elevance Health (Atlanta, GA)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... issues and to audit claims adjudication for accuracy. + Perform pre-adjudication claims reviews to ensure proper coding was used. + Prepares correspondence… more
- Intermountain Health (Atlanta, GA)
- …Classification of Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital. It ensures accurate ... codes in support of the provision of value-based care by Intermountain Healthcare to appropriate populations. It ensures compliance and accurate submission of… more
- Ortho Sport and Spine Physicians (Atlanta, GA)
- …DUTIES: Remain HIPAA and OSHA compliant. Translate patient information and alphanumeric medical code entries. Electronic "clean" claims submissions to Insurance ... account payments. Sort and file paperwork. Analyzing and correcting coding errors. Ensure healthcare facilities are reimbursed...for all procedures. Follow Up on accepted or denied claims . Review denied claims for denial reasons… more
- IQVIA (Atlanta, GA)
- **Patient Support Medical Claims Processing Representative** _Contract Remote Role - Location (Open to Remote US)_ As the only global provider of commercial ... a 100% remote (work from home-WFH) contact **Patient Support Medical Claims Processing Representative** to join our...or equivalent + Experience in claim processing required + Medical Billing Certification required + Coding Certification… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid, and Medicare Advantage requirements… more
- Waystar (Atlanta, GA)
- …understand the vocabulary used in hospital & professional revenue cycle operations, including healthcare coding such as DRGs, CPT/HCPC, Revenue Codes, APG and ... reports, and assessing strengths and weaknesses of competitors + Studying healthcare industry standards and staying up-to-date on industry changes and compliance… more
- Molina Healthcare (Atlanta, GA)
- …different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding /billing (UB04/1500 form) + Demonstrated understanding of key managed ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
- Molina Healthcare (Savannah, GA)
- …to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical ... in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific… more