- Molina Healthcare (Augusta, GA)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials ... Qualifications** * Customer/provider experience in a managed care organization ( Medicaid , Medicare , Marketplace and/or other government-sponsored program), or… more
- PruittHealth (La Fayette, GA)
- …home and methods of payment for those services including but not limited to Medicare , Medicaid , insurance and private pay 3. Verifies accuracy of patient ... records in a timely manner; reconciles facility petty cash 7. Assists with Medicaid pending procedures including assistance with the Medicaid application 8.… more
- Humana (Atlanta, GA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… more
- Waystar (Atlanta, GA)
- …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... thorough fashion + An understanding of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct… more
- Humana (Atlanta, GA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains… more
- Cognizant (Atlanta, GA)
- …Director based on the review of clinical documentation in accordance with Medicare , Medicaid , and third-party guidelines. . Effectively document and log ... to referral, preauthorization, medical necessity, non-covered services, investigational/experimental and billing resulting in denials and/or delays in payment. .… more
- Waystar (Atlanta, GA)
- …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and industry experience to… more
- Vatica Health (Atlanta, GA)
- …both verbally and written + Understanding of health insurance benefit structure; especially Medicare and Medicaid + Must be technically savvy; this is critical ... in critical care (ie, ICU/CCU/MICU) and/or ED) + Proficiency with Diagnosis, Billing , and Quality Measures Coding a plus + Excellent interpersonal skills that… more
- Highmark Health (Atlanta, GA)
- …duties as specified. + Identify and report improper coordination of benefit billing practices through paid clams review. + Participate as pharmacy representative in ... formulary terminology + Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They… more
- Molina Healthcare (Columbus, GA)
- …observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. ... standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/ billing (UB04/1500 form). * Advanced understanding of key managed care concepts… more