- SitusAMC (Atlanta, GA)
- …Approve system generated reporting, queries and related client deliverables for compliance , adherence, accuracy as determined by supporting information + Manage ... + Design and build spreadsheet templates and/or financial models, including the coding of interrelated excel formulas, data tables and macros, to analyze the… more
- CenterWell (Rome, GA)
- …lab to doctor, make a copy for the Case Manager, and route to Medical Records Department. Initiate Employee / Patient Infection Reports as necessary. + If clinical, ... + Prior packet review / QI experience preferred. + Coding certification is preferred. + Must possess a valid...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Sedgwick (Atlanta, GA)
- …support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques ... client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management.… more
- Galileo Financial Technologies, LLC (GA)
- …with superior fraud detection, security, decision-making analytics and regulatory compliance functionality combined with customized, responsive and flexible programs ... high-quality products and demonstrable excellence in software implementation and coding . You have expert-level proficiency in building modern user interfaces… more
- Molina Healthcare (Columbus, GA)
- …schedule) Looking for a RN with experience with appeals, claims review, and medical coding . JOB DESCRIPTION Job SummaryProvides support for clinical member ... Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes clinical… more
- CVS Health (Atlanta, GA)
- …data to provide insights into configuration management metrics, trends, and compliance issues. + Applies in-depth knowledge of configuration management tools and ... ClaimsXten, Cotiviti PPM & CV) + Extensive knowledge of CPT, HCPCS, ICD-10 coding **Preferred Qualifications** + Prior Relevant Work Experience 3-5 years + Working… more
- Molina Healthcare (Atlanta, GA)
- …coverage audit policies and be able to apply them in ensuring program compliance via payment integrity programs. The position must have the ability to determine ... correct coding , documentation, potential fraud, abuse, and over utilization by...providers and recipients. The position will review claims data, medical records, and billing data from all types of… more
- CVS Health (Atlanta, GA)
- …governance policies related to Salesforce development and deployment** + **Ensures compliance with security standards and best practices** + **Works closely with ... technical leadership and guidance to development teams, ensuring best practices, coding standards, and overall quality of deliverables** + **Mentors administrators… more
- Molina Healthcare (Macon, GA)
- …for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. To all current Molina employees: If you are interested ... + Engages with operations leadership and Plan Support functions to review compliance -based issues for benefit planning purposes. **Recoveries & Disputes** + Review… more
- Walmart (Lithia Springs, GA)
- …daily administrative tasks including pass down reports billing user access coding filing etc Systems OperationsData Processing Maintains operation of system hardware ... with Integrity Maintains and promotes the highest standards of integrity ethics and compliance models the Walmart values to support and foster our culture holds… more