- Morley (Atlanta, GA)
- …parts markup percentages and effective labor rates + Scan and upload documents needed for claims review + Review mailed-in documents + Offer timely and ... role)_ + See _Skills for Success_ below Tasks: + Review dealer submission of all job cards (repair orders)...your total compensation package. **_Health & Wellness Benefits_** + Medical and prescription coverage, including free annual physicals +… more
- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...hospital setting, including at least 1 year of utilization review , medical claims review… more
- Molina Healthcare (Atlanta, GA)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
- Elevance Health (Atlanta, GA)
- …+ Travels to worksite and other locations as necessary + BA/BS preferred + Medical claims review with prior health care fraud audit/investigation experience ... you will make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- CVS Health (Atlanta, GA)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
- Cognizant (Atlanta, GA)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical… more
- Evolent (Atlanta, GA)
- …+ Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review determinations and contacts ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Sedgwick (Atlanta, GA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior Medicare-set-aside (MSA) experience highly ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager I** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager I** is responsible for telephonic care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisor's on the development of… more
- Travelers Insurance Company (Alpharetta, GA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- GE Vernova (Atlanta, GA)
- …responsible for analyzing Projects risk to develop mitigation plans and support claim development / resolution. Project Controller is also responsible to perform an ... based on allocated weightage + Participate in the Constructability review to make sure project schedule is aligned with...deliverables and ensure no impact to contract dates. + Claims (EOT, etc.); perform delay analysis to support extension… more
- Molina Healthcare (Atlanta, GA)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Molina Healthcare (Atlanta, GA)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Atlanta, GA)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Molina Healthcare (Atlanta, GA)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Elevance Health (Atlanta, GA)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- GE Vernova (Atlanta, GA)
- …the purchase orders within budget * Supports Commodity Manager in contract claim management and ensures vendor recovery * Supports GCL/CSL/Buyer in invoices release, ... participation of project quality manager, PEM, lead engineers, scheduler and PM/PD to review procurement progress and generates the weekly PO progress review … more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities This is an open continuous ... duty hours and while on-call. The incumbent will provide clinical supervision of nurse anesthetists (CRNAs) and participation in clinical teaching of medical … more
