- Highmark Health (Atlanta, GA)
- …charges; will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance , and Fraud Hotlines; will alert Investigators of ... the need for further analysis; will perform claims system extracts and create reports, graphs and charts to support case documentation; will prepare necessary correspondence to set and monitor provider and member claim system flags; will work with external… more
- Humana (Atlanta, GA)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana ... experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Atlanta, GA)
- …medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents ... experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Atlanta, GA)
- …to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and ... analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures. * At… more
- Molina Healthcare (Macon, GA)
- …to meet critical needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management + Consultative role, develops business case ... methodologies for programs, develops and coordinates implementation of business strategy + Collaborates and facilitates activities with other units at corporate and Molina Plans. **JOB QUALIFICATIONS** **Required Education** Bachelor's degree or equivalent… more
- Prime Therapeutics (Atlanta, GA)
- …specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Gentiva (Bainbridge, GA)
- …+ Demonstrated ability to apply hospice principles, industry standards, and regulatory compliance ( Medicare , Medicaid, JCAHO, ACHC) + Knowledge and compassion ... and developing staff to uphold the highest standards of patient care and regulatory compliance . **As a Hospice Patient Care Manager, You Will:** + O versee and… more
- Gentiva (Martinez, GA)
- …ensuring compliance with state, federal, and accreditation standards (CMS, Medicare , Joint Commission, etc.) + Provide clinical oversight and ensure timely and ... health, or healthcare operations leadership + Strong understanding of hospice regulations, compliance , and Medicare conditions of participation + Proven ability… more
- Humana (Atlanta, GA)
- …Key Responsibilities: + Develop, draft, and update provider contracting templates for Medicare and Medicaid programs, ensuring compliance with federal, state, ... and decision making on complex issues related to our Medicare and Medicaid provider contract templates. Key responsibilities include...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Sandy Springs, GA)
- …of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team ... Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical… more