- Molina Healthcare (Savannah, GA)
- …and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution ... coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Waystar (Atlanta, GA)
- …hospitals and health systems, and is connected to over 5K commercial and Medicaid /Medicare payers. We are deeply committed to living out our organizational values: ... honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun. Waystar products have won multiple Best in KLAS(R) or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book… more
- Molina Healthcare (Columbus, GA)
- …with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other ... groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid , National Committee for Quality Assurance… more
- Humana (Atlanta, GA)
- …well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, including ... residency or similar pharmacy practice experience + Board Certified Pharmacotherapy Specialist (BCPS) + MBA, pharmacoeconomics or health outcomes training + An… more
- CVS Health (Atlanta, GA)
- …the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, ... coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. +… more
- Molina Healthcare (Savannah, GA)
- …(HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical ... guidelines, Medicaid , Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. *… more
- Banner Health (GA)
- …with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General ... least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Certified… more
- Molina Healthcare (Columbus, GA)
- …(LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical ... or other health care or management certification. * Leadership experience. * Medicaid /Medicare population experience. To all current Molina employees: If you are… more
- Molina Healthcare (Savannah, GA)
- …with advanced written and verbal communication. + Required knowledge of Medicaid , CMS, NCQA and other credentialing regulations. Required License, Certification, ... Association: Preferred Certified Provider Credentialing Specialist (CPCS) or participation in a CPCS progression program. Preferred Education: Associate or… more
- CenterWell (Marietta, GA)
- …advanced practice professionals, Pharm D, Care Coach Nurse, MA, Behavioral health specialist , Quality based Coder, Referral Coordinator and more. Our approach allows ... + Active and unrestricted DEA license + Medicare Provider Number/ Medicaid Provider Number + Experience managing Medicare Advantage panel of patients… more