- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** Senior Technology Lead for Anaplan Operational Workforce Planning. They work closely with business ... and ensuring the successful delivery of high-quality Anaplan models and dashboards. Anaplan Senior Tech Lead focus on the Anaplan platform plays a crucial role in… more
- AdventHealth (Rome, GA)
- …by obtaining critical demographic elements and ensuring accuracy. + Performs Medicare compliance reviews, eligibility checks, and completes Medicare Secondary ... Payer Questionnaires. Qualifications **The expertise and experience you'll need to succeed:** + High School Grad or Equivalent Required + 1 Year of Revenue Cycle Experience Required + 1 Year of Customer Service Experience Required + Associate in business,… more
- CVS Health (Atlanta, GA)
- …data analysis to strategize and achieve operational targets for NCQA HEDIS and Medicare Stars * Provide analysis support for PIP reports to regulators, including ... internal and external stakeholders **Preferred Qualifications** * Medicaid and/or Medicare managed care experience **Education** * Master's degree or equivalent… more
- Molina Healthcare (GA)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... excellent problem-solving skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting,… more
- Datavant (Atlanta, GA)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Banner Health (GA)
- …coding experience in Surgical Hematology & Oncology and/or Radiology Oncology. This Senior Complex Coder will be supporting very busy providers/surgeons and is very ... and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health… more
- Molina Healthcare (Columbus, GA)
- …+ Resolves complex provider issues that may cross departmental lines and involve Senior Leadership. + Serves as a subject matter expert for other departments. + ... various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for… more
- Humana (Atlanta, GA)
- …in both traditional machine learning and emerging generative AI technologies. As a Senior Engineer, you will play a key role in developing and deploying innovative ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Atlanta, GA)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... Investigative experience + Marketplace Broker Investigative experience + Medicaid and Medicare experience **Education** + Bachelor's degree in Criminal Justice or… more
- Prime Therapeutics (Atlanta, GA)
- …decision we make. **Job Posting Title** Clinical Pharmacist (Algo), Professional- Senior - REMOTE **Job Description** Maintains the inventory of clinical algorithms. ... based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal partners.… more
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