- Molina Healthcare (GA)
- …standards and requirements established by the Centers for Medicare and Medicaid . **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal into ... to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists with interdepartmental issues… more
- Evolent (Atlanta, GA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Specialist , Provider Data Management will be a dynamic role that will encompass overall ... + General understanding of US health care, Managed Care Organizations, and/or Medicaid . **To comply with HIPAA security standards (45 CFR sec. 164.308 (a)… more
- Molina Healthcare (Columbus, 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
- Molina Healthcare (Augusta, 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
- Cardinal Health (Atlanta, GA)
- …participating health plans + Cultivate and maintain on-going payer relationships and Medicaid enrollments. + Adhere to cyclical renewal, retrieval, and updates per ... Pharmacy Technician experience a plus, not required + Familiarity with Medicare and Medicaid + Proficient in Microsoft Office (Excel VLOOKUPS) + Strong written and… more
- TEKsystems (Atlanta, GA)
- …prior authorization, inbound call, administrative support, customer service, Medicare, Medicaid Additional Skills & Qualifications Required experience: * Customer ... Service: Minimum 2 years of experience in healthcare required. * Call Center Experience: At least 2 year of previous experience. * Remote Work Experience: Proven ability to work effectively in a remote setting. * Computer/Technology Proficiency: Comfortable… 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
- Cardinal Health (Atlanta, GA)
- …center or customer service environment, preferred + Clear knowledge of Medicare, Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred + Excellent written and oral communication, mediation, and… more
- Prime Therapeutics (Atlanta, GA)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...department are achieved. + Works with Quality and Training specialist to refine and improve any processes that effect… more
- CVS Health (Atlanta, GA)
- …internal teams prior to the submission to the Centers of 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