- Zoological Society of San Diego (San Diego, CA)
- …collaborates with the Marketing team to coordinate comprehensive direct response appeals and membership programming. This position reports to the Chief Philanthropy ... Officer and closely collaborates with the Senior Director of Philanthropy as well as major gift, planned giving, and events staff. WHAT YOU WILL DO + Identify, cultivate, steward and solicit a dedicated portfolio of high potential donors. + Develop and oversee… more
- City and County of San Francisco (San Francisco, CA)
- …in person via court appearances and in written petitions, motions, appeals , and/or other court documents. Includes the preparation (word processing/database ... management) of such court documents. May require being placed in a high-stress environment and/or exposure to complex and challenging cases; + Dedicates role to the pursuit of justice by exercising fair and ethical prosecution practices and respecting the… more
- Sumitomo Pharma (Sacramento, CA)
- …portfolio, including hub services (benefits investigation, prior authorization, and appeals support), field reimbursement managers, Patient Assistance Program (PAP) ... and copay assistance programs + Drive **data-driven decision-making** , leveraging patient insights and real-world evidence to refine program effectiveness, + **Vendor Oversight** + Oversee **third-party service providers** , ensuring high-quality execution… more
- Providence (CA)
- …Policy Analyst will be responsible for replying to provider and member appeals and providing appropriate CPT, CMS, specialty society, Coding Policy, and/or other ... official documented rationale for Coding Policy edits. The analyst is responsible for monitoring changes to codes, coding guidelines and regulations, and coding edits from external agencies such as AMA, CMS, Medicaid, and specialty societies, and assists with… more
- Evolent (Sacramento, CA)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with… more
- Robert Half Accountemps (Palo Alto, CA)
- …payer websites or phone communication. + Investigate and resolve underpayments; file appeals when necessary. + Review and resolve claim denials and rejections. + ... Process bad debt transfers, adjustments, and contractual write-offs. + Review worklists in EPIC and resolve claim edits. + Rebill claims based on denial follow-ups. + Post payments and adjustments; manage undistributed payment worklists. + Process refunds and… more
- Southland Industries (San Diego, CA)
- …and potential career paths with one of the country's largest MEP building systems firms appeals to you and you're ready for the next big step in your career, then ... **JOIN** our team and become a part of an organization that values **PEOPLE** , **SAFETY, INNOVATION, COLLABORATION, INTEGRITY, ACCOUNTABILITY & SUSTAINABILITY.** **Build your experience with us!** Our internship program is designed to introduce students to a… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... direct contact with or refers patient/family to appropriate community resources. Maintains knowledge of currently available resources in the community. + Guides the patient in understanding the nature of his illness; confers with patients and their families to… more
- Prime Healthcare (Ontario, CA)
- …techniques and metrics. Someone with significantclaims experienceincluding PDR's, Disputes, Appeals and Recoveries. Sound intriguing, then you will be thrilled ... to know we offer verycompetitive compensationand amazing benefits. As you would expect, this role has many facets including Health Plan Operations, Health Performance Metrics, Cost Reduction, Market Forces, Quality and Delivery of Care, Regulatory Reforms,… more
- WelbeHealth (Modesto, CA)
- …but not limited to share of cost, spousal impoverishment protections, and appeals processes **Job Requirements** + Bachelor's Degree in relevant field preferred, an ... additional five (5) years of relevant Medi-Cal enrollment experience may be substituted + Bilingual (Spanish/English) strongly preferred + Minimum of three (3) years of experience working directly with the county DPSS submitting, managing, and appealing… more