- Elevance Health (Columbus, GA)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... federal health programs. The **Audit and Reimbursement Senior** will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for … more
- CVS Health (Atlanta, GA)
- …with provider engagement, relations, or account management. + Working knowledge of Medicare contracts. + An understanding of value based contracts, how they work, ... what is the value. + Strong presentation skills, the ability to communicate effectively. + Mastery of problem solving and decision making skills + Strong MS Office skills. Preferred Qualifications: + The ability to use data to tell a story. + Mastery of growth… 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
- PruittHealth (Norcross, GA)
- …* Must be knowledgeable of medical necessity review guidelines for commercial, Medicare , and Medicaid insurance products. * Uses knowledge of insurance criteria and ... regulations in order to expedite appropriate use of resources and compliance with third party payer contracts. * Demonstrates the ability to communicate effectively via phone and email with our internal and external customers. * Strong organization and ability… more
- Humana (Atlanta, GA)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.… more
- CenterWell (Stone Mountain, GA)
- …Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum of two to five ... years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care… more
- CenterWell (Marietta, GA)
- …for TB. **Preferred Qualifications:** + Active and unrestricted DEA license + Medicare Provider Number/ Medicaid Provider Number + Experience managing Medicare ... care environment in a value based relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators. **Additional… more
- Molina Healthcare (GA)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health...or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience… more
- CenterWell (Scottdale, GA)
- …Medicine or Geriatric Medicine preferr + Active and unrestricted DEA license + Medicare Provider Number + Minimum of two to five years directly applicable ... experiencepreferred + Experience managing Medicare Advantage panel of patients with understanding of Best...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- Elevance Health (Atlanta, GA)
- …on data related to Pharmacy cost of care, pharmacy trends, and other Medicare book of business' related issues/metrics. **How you will make an impact:** + ... to identify cost drivers and trend patterns within the Medicare Part D Individual and Group markets + Identifies...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more