- Molina Healthcare (Atlanta, GA)
- …activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors + Maintains professional and technical ... knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies + Contributes to team effort by accomplishing related results as needed + Other duties as assigned + 2… more
- Molina Healthcare (Atlanta, GA)
- …member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job ... Qualifications** **REQUIRED EDUCATION** : HS Diploma or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment… more
- Molina Healthcare (Columbus, GA)
- …skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. ... Collaborates with actuarial and operational staff to analyze, understand, modify, and communicate models and results. Makes recommendations to management based on relevant findings. Utilizes Power BI to display relevant reporting within a refresh cycle.… more
- Molina Healthcare (Atlanta, GA)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions. + Monitors and enforces compliance with… more
- Bowman (Atlanta, GA)
- …and resolve any issues that may arise as it relates to disputes, or claims + Act as liaison between operations and many corporate accounting functions including but ... not limited to accounts payable, financials, timesheets, etc. + Assist with annual financial audit preparation as needed. **Success Metrics and Competencies** + Ability to work both independently and within a team environment. + Ability to effectively… more
- Molina Healthcare (Atlanta, GA)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff + Coaches and mentors direct staff, including goal setting and score card development + Monitors and enforces compliance… more
- Molina Healthcare (Savannah, GA)
- …team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data ... to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings.… more
- Mass Markets (GA)
- …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, ... Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse… more
- Molina Healthcare (Atlanta, GA)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- NDCP (Duluth, GA)
- …for growth and development. Location: Hybrid in Duluth, GA or Remote Compensation: Competitive Salary + Bonus potential The Workers' Compensation Manager ... (WC) is responsible for all WC-related claims management, including proactive management of WC ... claims management, including proactive management of WC claims to accelerate claim closure, mitigate risks, and manage… more