- Elevance Health (Atlanta, GA)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Location:** Atlanta, GA **Description** + Reporting to the Director, Compliance Audit and Analysis, oversees audits, monitoring, and education for hospital and ... and provides billing providers with relevant and timely information regarding audit results and risk areas. + Evaluates hospital and professional billing… more
- Molina Healthcare (Columbus, GA)
- …and improvements. + Provides oversight of research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit ... **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage… more
- Axis (Alpharetta, GA)
- …request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims Specialist to join ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims management...practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the implementation of Management… more
- CRC Insurance Services, Inc. (GA)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- CRC Insurance Services, Inc. (GA)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- Elevance Health (Atlanta, GA)
- …Indices), complex clinical guidelines and maintaining objectivity in the performance of medical audit activities. + Draws on extremely advanced ICD-10 coding ... including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit...environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines,… more
- Elevance Health (Atlanta, GA)
- … chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Sedgwick (Atlanta, GA)
- …work restrictions/accommodations. + Performs standard disability clinical reviews of referred medical claims based on client requirements to ensure accurate ... the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- Highmark Health (Atlanta, GA)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more