- Elevance Health (Costa Mesa, CA)
- …for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical ... policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD or DO and Board certification approved… more
- Sacramento County (Sacramento, CA)
- …Service Commission, 700 H Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days after notice of the ... adverse action was mailed to the candidate. FOR MORE INFORMATION PLEASE VISIT OUR FREQUENTLY ASKED QUESTIONS (FAQs): https://personnel.saccounty.net/Pages/EmploymentServicesFAQs.aspx OTHER INFORMATION VETERAN'S PREFERENCE: Military veterans who have served… more
- TEKsystems (San Bernardino, CA)
- …closure. These services may be provided for both the hospitals. Reviews appeals and denials Audit collections and review aging reports Skills collector, healthcare, ... medical, commercial, insurance, medicare, advantage, medical collections, medical insurance billing, medical billing and coding Top Skills Details collector, healthcare, medical, commercial, insurance, medicare, advantage Additional Skills & Qualifications 2+… more
- Stanford University (Stanford, CA)
- …volunteers and class resources as needed. + Assist with design and management of appeals (eg, direct mail, email, video, phone, and other channels) to target key ... populations to maximize fundraising potential. + Engaging as an active contributor to the culture and effectiveness of the Class Giving team and the broader External Relations group. * _Other duties may also be assigned._ **To be successful in this position,… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager, Nursing positions are required to ... apply an advanced, broad-based knowledge of nursing practice and theory as well as advanced knowledge of management, supervisory, and leadership techniques. Health Facilities Program Manager, Nursing is distinguished from Supervising Health Facilities… more
- Sumitomo Pharma (Sacramento, CA)
- …to support business objectives. + Manage caseload of patent litigations, appeals , and other adversarial proceedings, while advising on substantive legal strategy ... with foresight and appropriate risk tolerance. + Work with internal teams to manage legal holds and oversee the gathering and preservation of documents and other information for discovery. + Assist in identifying and preparing internal employees who may serve… more
- Cardinal Health (Sacramento, CA)
- …* Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... fully exhausted * Track any payer/plan issues and report any changes, updates, or trends to management * Search insurance options and explain various programs to the patient while helping them to select the best coverage option for their situation * Handle all… more
- Cardinal Health (Sacramento, CA)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more
- City and County of San Francisco (San Francisco, CA)
- …The terms of this announcement may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department of Human Resources, 1 S ... Van Ness Avenue, 4th Floor, San Francisco, CA 94103-5413 by close of business on the 5th business day following the issuance date of this examination announcement. Information concerning other Civil Service Commission Rules involving announcements,… more
- Dignity Health (Bakersfield, CA)
- …of DHPR and CMS rules for Claim. Submission, Claim Payment, Eligibility, Appeals for Commercial, MediCare and MediCal lines of business. + Bachelor's Degree ... - Bachelor's Degree or equivalent experience. **Overview** The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We… more