- Intermountain Health (Atlanta, GA)
- **Job Description:** The Pharmacy Government Specialist II is responsible for the day-to-day operations of Government programs, providing superior customer ... benefits support role. + Demonstrated ability to meet performance standards for a Pharmacy Government Specialist II + Demonstrated ability to provide superior… more
- CenterWell (Atlanta, GA)
- …of our caring community and help us put health first** The Eligibility Specialist role reviews insurance eligibility for patients referred for Home Health services. ... The role is fast-paced, requires attention to detail, and knowledge of Medicare , Medicare Advantage, Medicaid, and Commercial insurances. As a **Healthcare… more
- Prime Therapeutics (Atlanta, GA)
- …our passion and drives every decision we make. **Job Posting Title** Client Audit Specialist , Sr. - Remote **Job Description** The Client Audit Specialist Sr is ... regulatory, client, and/or functional audit expectations. The Client Audit Specialist Sr provides consultation and strategic advice regarding audit management… more
- CenterWell (Atlanta, GA)
- …and help us put health first** As an **RCM Healthcare Claims Denials Specialist /Accounts Receivable Specialist ** , you will: + Ensure the coordination of ... Guide/instruct and support agency personnel encompassing all aspects of insurance and non- Medicare claims processing. + Prepare input data forms to update computer… more
- Cardinal Health (Atlanta, GA)
- …streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, ... a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred +… more
- Highmark Health (Atlanta, GA)
- …requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy , HOS, PQA, PQRS. + Supportdevelopment of the overall conceptualization, ... share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing… more
- CenterWell (Atlanta, GA)
- …has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary ... Identify and act on opportunities to better manage & coordinate with high-quality specialist , hospital, and community partners to serve patient needs and deepen our… more
- Molina Healthcare (Atlanta, GA)
- …or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy , etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Molina Healthcare (Atlanta, GA)
- …or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy , etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more