- Elevance Health (Atlanta, GA)
- …restrictions. Process prior authorization requests from healthcare providers to ensure compliance with Medicare requirements, and inform relevant parties of ... determinations. + **Collaboration** : Work closely with healthcare providers, insurance companies, and pharmacies to resolve complex medication access cases. + **Education and Communication** : Inform members about pharmacy-based rules, alternative… more
- PruittHealth (Norcross, GA)
- …for health plans * Knowledge of CMS required contracting language for Medicare Advantage Plan agreements * Demonstrate compliance with CMS regulations ... and articulate them effectively to providers and teammates. * Complete annual Medicare Fraud, Waste and Abuse Training and Model of Care Training **MINIMUM… more
- Prime Therapeutics (Atlanta, GA)
- …fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal - Remote **Job Description** The Compliance Principal is ... execution of the Regulatory Intelligence communication strategy. This position acts as Compliance and regulatory liaison for all lines of business with internal… more
- Prime Therapeutics (Atlanta, GA)
- …fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal (Performance and Oversight) - Remote **Job Description** The ... Compliance Principal is responsible for supporting Oversight and Monitoring...or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... situations or data requires an in-depth evaluation of variable factors. **Regulatory Compliance - State Enterprise Intake and Implementation - Senior Compliance … more
- Baylor Scott & White Health (Atlanta, GA)
- …lessons are completed in a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance resource to BSWH ... JOB SUMMARY The Third Party Compliance Consultant Sr performs ongoing activities related to...of, and adherence to established policies and procedures in compliance with federal, state, and local laws and regulations.… more
- Cardinal Health (Atlanta, GA)
- **_What Ethics & Compliance contributes to Cardinal Health_** Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to ... compliance . This function implements strategies and processes to ensure...facility fee coding and auditing. + Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines;… more
- Prime Therapeutics (Atlanta, GA)
- …our passion and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior ... Compliance Analyst assists in the implementation of Prime's ...organization, or other highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Highmark Health (Atlanta, GA)
- …This job is responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within ... responsible for the administration, interpretation, and enforcement of the Compliance Program including auditing/monitoring operational processes, conducting or overseeing… more
- State of Georgia (Fulton County, GA)
- Compliance and Reporting Analyst (State Based Exchange) Georgia - Fulton - Atlanta ... Share this Job Sign Up for Job Alerts Under general supervision, the Compliance and Reporting Analyst coordinates the rollout of new or updated reporting… more