- Molina Healthcare (Columbus, GA)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding . **Job Summary** Utilizing clinical knowledge ... refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. **JOB QUALIFICATIONS** Graduate from an...two years of experience in Claims Auditing, Medical Necessity Review and Coding experience +… more
- Molina Healthcare (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 (Augusta, 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 health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... with various internal customers (eg, Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation… more
- CVS Health (GA)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... and is ideal for a data professional with strong coding skills in SQL and Python who can transform...skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,… more
- Grant Thornton (Atlanta, GA)
- …excel. The ideal candidate will have exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and ... of successfully managing projects related to revenue cycle optimization, including billing, coding , reimbursement, and claims processing, with a focus on… more
- Elevance Health (Atlanta, GA)
- …paid claims . **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Cardinal Health (Atlanta, GA)
- …and/or hospital (technical) services, including: detection and correction of documentation, coding , and billing errors and/or medical necessity of services ... field preferred. + 5+ years of experience in physician and/or hospital technical coding /auditing, medical necessity reviews, or related work, with oncology and… more
- VetsEZ (GA)
- …platforms, we enable smarter decisions, seamless patient engagement, and more efficient claims management. Together, we are shaping a healthcare ecosystem that ... Intelligent Document Processing (IDP) pipelines to extract and validate data from claims , authorizations, and medical documentation. + Integrate LLMs and… more
- PruittHealth (Norcross, GA)
- …and coordination of benefits * Familiarity with medical terminology and the medical record coding process * Knowledge of principles, methods, and techniques ... related to compliant healthcare billing/collections * Familiarity with Insurance Claims ...Demonstrates experience and a proven track record in Insurance Claims in a medical setting of moderate… more