- Elevance Health (Atlanta, GA)
- ** Medical Claims Data Integrity Consultant** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). This role ... position is not eligible for current or future visa sponsorship._ The ** Medical Claims Data Integrity Consultant** (Business Information Developer… more
- ABM Industries (Atlanta, GA)
- …reduce claim duration, improve return-to-work outcomes, and control claim costs. + Analyze claims data trends and lead cost containment initiatives. + Establish ... collaboration. Skills & Competencies + Analytical Ability: Proficiency in interpreting claims data and driving actionable insights. + Regulatory Knowledge:… more
- Cognizant (Atlanta, GA)
- …established quality assurance instruments and standards + Verifying if the processed claims have all data updated accordance with accepted coverage guidelines, ... ** Claims Auditor** (remote) This is a remote position...+ High Attention to detail + High Level of Integrity and Ethical Behavior **Salary and Other Compensation:** Applications… more
- Waystar (Atlanta, GA)
- …Provided leadership on a team that designed, built, or used RCM Revenue Integrity products + Ability to interpret regulatory guidelines from CMS, Tricare, and ... Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data , and unparalleled client support to streamline workflows and improve… more
- CGI Technologies and Solutions, Inc. (Atlanta, GA)
- …review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity , and provider data management. * Leverage advanced analytics, ... review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity , and provider data management. Leverage advanced analytics,… more
- Elevance Health (Atlanta, GA)
- …-expense spending. The **Business Consultant** is a member of our **Carelon Payment Integrity 's Data Mining Team** , where we utilize advanced analytics to ... in uncovering claims overpayments and guiding clients through implementation of data -driven insights. This individual will be data mining, finding anomalies… more
- Elevance Health (Atlanta, GA)
- …-expense spending. The **Business Analyst III** is a member of our **Carelon Payment Integrity 's Data Mining Team** , where we utilize advanced analytics to ... accommodation is granted as required by law._ **Carelon Payment Integrity ** is a proud member of the Elevance Health...claims overpayments and guiding clients through implementation of data -driven insights. This individual will be data … more
- Elevance Health (Atlanta, GA)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Elevance Health (Atlanta, GA)
- …background. **Preferred Skills, Capabilities, and Experiences:** + Healthcare experience preferred; medical claims experience a plus. + Extensive hands-on ... **Application Architect Senior - Payment Integrity ** The **Application Architect Senior** creates architectural solutions that articulate the business context,… more
- Humana (Atlanta, GA)
- …and reporting. Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data . Maintain dashboards to communicate key ... trends to stakeholders. The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of… more
- Cognizant (Atlanta, GA)
- … Quality & Governance Developer, you will make an impact by ensuring the integrity , accuracy, and compliance of healthcare data across enterprise systems. You ... will be a valued member of the Healthcare Data Engineering team and work collaboratively with cross-functional stakeholders...in developing audit controls and automated reporting for healthcare claims and payment systems. + Expertise in SQL, Hive,… more
- Norstella (Atlanta, GA)
- …* 3-5 years in Product Marketing or Product Management; experience with real-world data ( claims , labs, EMR/EHR, Rx, hub/specialty pharmacy) strongly preferred. * ... Product Marketing Manager, Real-World Data (RWD) Company: Norstella Location: Remote, United States...success at Norstella:** 01: Bold, Passionate, and Mission-First 02: Integrity , Truth, and Reality 03: Kindness, Empathy, and Grace… more
- Elevance Health (Atlanta, GA)
- … medical guidance across multiple enterprise transformation initiatives, including: + ** Medical Cost Management** + **HealthOS and enterprise data platforms** ... payer, managed care, or healthcare leadership preferred. + Experience advising medical cost management, utilization management, payment integrity , or provider… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Senior Payment Integrity Professional uses technology and data mining, detects anomalies in data ... within a managed care/health care environment + Familiarity with Medicaid contracts, claims , and/or process flows + Skilled in data and/or situational analysis… more
- Molina Healthcare (Atlanta, GA)
- …criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data … more
- Norstella (Atlanta, GA)
- …the demand for Norstella's newest service offerings leveraging Norstella's unified Real World Data asset, NorstellaLinQ, a combination of claims , lab, SDOH and ... databases, ensuring data accuracy and quality. *Perform in-depth analyses on healthcare data sources, including claims , lab, EMR/EHR, and SDOH data , to… more
- CVS Health (Atlanta, GA)
- …inquiries and complaints. + Monitor and reconcile system activity to ensure data integrity and financial accuracy. **Required Qualifications** + 1-2+ years ... continuous improvement of work processes that impact customer satisfaction, medical cost management, and operational efficiency. The specialist collaborates… more
- CVS Health (Atlanta, GA)
- …perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity . + Stay informed about changes in Medicaid policy, ... investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate...findings to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in… more
- CDM Smith (Atlanta, GA)
- …claims . This role is critical in evaluating and analyzing financial data related to disaster-related claims , including property damage, business interruption, ... investigations to identify discrepancies, detect potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting,… more
- ZOLL Medical Corporation (Marietta, GA)
- …innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and ... as well as support activities to promote consistent use (Local Medical Education Programs, Tradeshows, clinical symposiums and conferences). Call points include:… more