- Molina Healthcare (Atlanta, GA)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Atlanta, GA)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Elevance Health (Atlanta, GA)
- …** is responsible for providing support, configuration, design, testing and implementation for claims systems . Ensures accurate adjudication of claims , by ... **Pre-Pay Editing Analyst Sr ** **Location:** This role requires associates to be...and the vendor to ensure quality and timeliness of systems /project deliverables. + Configures new designs/updates in the system.… more
- Evolent (Atlanta, GA)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (Atlanta, GA)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs * And more **Work Location:** Atlanta, GA **Description** A Senior Manager of Hospital Billing oversees the entire hospital billing operation, ... ensuring accurate and timely submission of patient claims , managing a team of billing specialists, resolving complex billing issues, maintaining compliance with… more
- Elevance Health (Atlanta, GA)
- **Business Consultant Senior - Commercial Claims Data Mining** **Hybrid 1:** This role requires associates to be in-office 1-2 days per week, fostering ... and adaptable workplace. Alternate locations may be considered. The **BUSINESS CONSULTANT SENIOR ** is responsible for translating the most highly complex and varied… more
- Intermountain Health (Atlanta, GA)
- …of actual and budgeted contractual allowances and variances, monitoring of individual claims (logs), etc.). Interacts with HIM, PAS, and hospital finance staff as ... **Qualifications Required** + Demonstrated experience in a role requiring data analysis. + Demonstrates computer skills including spreadsheets, databases, word… more
- Chick-fil-A (Atlanta, GA)
- …lead's knowledge and fend off inflationary asks that are not supported by market data + Develop a bank of knowledge, strategies, and training to arm sourcing leads ... with skills to counter supplier's claims and identify the middle ground + Help sourcing...building, and interpersonal skills + Proficiency in risk management systems including reporting and execution + Knowledge of supply… more
- MetLife (Atlanta, GA)
- …and possess in-depth knowledge of plan designs, benefit features and how claims are paid * Strong understanding of industry marketplace and legal developments. ... all levels of the organization * Ability to analyze data to influence and execute on renewal decisions *...computer navigation skills and ability to work in multiple systems simultaneously (Microsoft suite, different company platforms) * Strong… more
- Highmark Health (Atlanta, GA)
- …evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for ... disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services)… more
- Axis (Alpharetta, GA)
- …+ Background in designing, developing, and implementing IT systems within claims operations. + Solid understanding of data analysis, budgeting, and business ... Claims Value Stream Lead will collaborate closely with Claims senior leadership to translate their needs...learn and share knowledge. + **Making Disciplined Decisions:** Use data and analytics to form plans and actions, exercising… more
- Axis (Alpharetta, GA)
- …specialty insurers + A good working knowledge of the workstreams, workflows, processes, and claims systems , in aP&C claims organization, for both North ... multiple departments. The Product Owner would focus on managing and enhancing claims -related products, systems , and processes. Their role involves translating… more
- Cardinal Health (Atlanta, GA)
- …and enhance the overall healthcare experience. We are seeking a highly motivated and experienced Senior Data Scientist to join our team as a thought leader and ... data to solve complex business problems on large data sets, integrating multiple systems . At Cardinal...Extensive knowledge of healthcare data , including clinical data , patient demographics, and claims data… more
- Turner & Townsend (Atlanta, GA)
- … data center design and construction processes, including MEP systems , and structural elements. + Excellent communication, negotiation, and interpersonal skills. ... **Job Description** **Turner & Townsend is** seeking an experienced ** Senior Cost Manager / Quantity** to join our team,...join our team, leading cost management for a high-profile data center campus project for a major technology client.… more
- Datavant (Atlanta, GA)
- …designing, developing, and maintaining robust data pipelines for healthcare data including prescriptions, medical claims , MAO4, patient demographics, and ... with the other engineering teams to troubleshoot issues with API's and data exchanges between multiple systems . **What You Need to Succeed** + 5+ years Data … more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- **Position Summary** The Senior Manager of Field Technology will lead the design, optimization, and delivery of field sales reporting platforms and tools. This role ... in ensuring that our field teams have seamless access to accurate, actionable data to drive performance. The role focuses on managing field-facing technology … more
- Elevance Health (Atlanta, GA)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Evolent (Atlanta, GA)
- …SAS, SQL, or similar analytical software to analyze clinical authorization and healthcare claims data * Using analytical tools to integrate various data ... care data including medical, pharmacy and ancillary claims data , membership data , clinical...feasible given data limitations * Understanding of data systems and the critical thinking skills… more
- Highmark Health (Atlanta, GA)
- …overall business targets or assigned volume of new applications or RFP's.Utilize various systems and tools to obtain necessary data and accurately complete and ... quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of… more