- Elevance Health (Atlanta, GA)
- …related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment...+ Requires a AA/AS and minimum of 3 years medical coding /auditing experience, including minimum of 1… more
- Datavant (Atlanta, GA)
- …and compliance with payer regulations. This role requires in-depth knowledge of healthcare revenue cycle processes, HIM coding practices, and proficiency in ... in health data exchange. Our vision is that every healthcare decision is powered by the right data, at...denials throughout the entire revenue cycle, including registration, eligibility, coding , billing, and medical necessity. + Analyze… more
- Humana (Atlanta, GA)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- Elevance Health (Atlanta, GA)
- …advanced analytics-including machine learning and large language models-and leveraging healthcare claims data to generate meaningful scientific insights. ... healthcare analytics. + Experience leveraging LLMs/AI tools for data exploration, coding , or reporting. + Experience working with claims databases +… more
- Waystar (Atlanta, GA)
- …industry changes and compliance issues, focusing on government/payer requirements for claims billing & coding /authorization * Leverage analytical tools (Excel, ... planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and industry experience to advise clients in… more
- Elevance Health (Atlanta, GA)
- …Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator II** will be responsible for the ... identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Atlanta, GA)
- …Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent ... identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on… more
- Elevance Health (Columbus, GA)
- …complex audits. + Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding , member and provider inquiries, ... billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1 year related experience… more
- PruittHealth (Norcross, GA)
- …supervisor oversees a team of billing professionals, maintains compliance with healthcare regulations, and drives continuous improvement in revenue cycle processes. ... all home infusion services. * Oversee the preparation and submission of insurance claims , verify patient benefits and payer contracts, and manage follow-up on denied… more
- Elevance Health (Atlanta, GA)
- …by law._ The Provider Reimburse Admin Sr ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... of education and experience, which would provide an equivalent background. + RN; Medical billing and coding certification strongly preferred. Please be advised… more
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