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Job Information Humana Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US in Atlanta Georgia Description The Fraud and Waste Professional 2 conducts investigations of allegations of ..
Job Information Humana Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US in Augusta Georgia Description The Fraud and Waste Professional 2 conducts investigations of allegations of ..
Job Information Humana Pharmacy Claims Specialist, Remote in Atlanta Georgia Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs ..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Job Information Kindred at Home Revenue Specialist Home Health in Marietta Georgia As a Revenue Specialist , you will: Daily audit of admission, discharge and other source documentation to ensure revenue ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
Job Information Kindred at Home Accounts Receivable Specialist in Marietta Georgia As an Accounts Receivable Specialist , you will: Ensure the coordination of claim activities and designated agencies, and the timely ..
Description The UM Compliance Letters Specialist/Coordinator 2 contributes to administration of utilization management in the Compliance department. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. ..
Job Information Centerwell Revenue Specialist Home Health in Atlanta Georgia As a Revenue Specialist , you will: Daily audit of admission, discharge and other source documentation to ensure revenue is recognized ..
Job Information Kindred at Home Accounts Receivable Specialist Home Health Full Time in Marietta Georgia As an Accounts Receivable Specialist , you will: Ensure the coordination of claim activities and designated ..
Job Information Humana Senior Integration Specialist - Cloud in Atlanta Georgia Description The Senior DevOps/Cloud Solutions Engineer Enables the automation of software code deployment by eliminating functional silos existing between development ..
Description The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 conducts quality assurance review of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Job Information Kindred at Home Accounts Receivable Specialist Home Health in Marietta Georgia As an Accounts Receivable Specialist , you will: Ensure the coordination of claim activities and designated agencies, and ..
Description The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
... Qualifications Minimum 5 years of healthcare fraud investigations and/or auditing experience ... of Florida and Wisconsin Medicaid healthcare payment methodologies Strong organizational, interpersonal, and ... the required qualifications. Understanding..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
