- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Elevance Health (Los Angeles, CA)
- **Network Management Representative II** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... Monday to Friday, 10:00 AM to 6:00 PM, CST** The **Network Management Representative II** is responsible for providing comprehensive services to the dental provider… more
- Guidehouse (El Segundo, CA)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Patient Account ... Representative (PAR)** is expected to perform specific billing processes,...taking necessary actions to obtain account resolution + Submits appeals , as appropriate, for all non-clinical denials + Monitors… more
- CVS Health (Sacramento, CA)
- …heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service ... and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents expectations are met or… more
- UCLA Health (Los Angeles, CA)
- Description UCLA Health is seeking a Senior Cross-Functional Collections Representative to support Patient Business Services by managing a diverse portfolio of ... + Proven ability to resolve complex claims, process adjustments, and manage appeals effectively + Proficiency in Epic or similar billing systems, with strong… more
- Cardinal Health (Sacramento, CA)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …position is responsible for pulling medical records to submit with claims and appeals as required by payors. Responsible to validate and accurately complete the ... claims identified with potential new payor plan coverage added to the patient's account. Assists with other related duties as assigned. SKILLS REQUIRED: - Excellent verbal communication and active listening. Effective verbal communication is one of the most… more
- City and County of San Francisco (San Francisco, CA)
- …Duties According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are ... may appeal the administration of the examination components. All appeals must be filed in writing with the Department...not be counted as the fifth (5th) calendar day. Appeals shall be limited as defined in Rule 211.16.1.… more
- Wounded Warrior Project (San Diego, CA)
- …guides and manages the preparation and processing of all claims and subsequent appeals through the Department of Defense (DoD) and Department of Veterans Affairs ... the DoD and DVA. + Prepare briefs for pending appeals located at the local VA Regional Office level....effectively, facilitate discussion, and serve as a strong effective representative of WWP. + Professional presence & demeanor. Demonstrated… more
- City and County of San Francisco (San Francisco, CA)
- …Duties: According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are ... and in meetings with other departments. 7. Responds to appeals or protests of human resources decisions and/or procedures;...is subject to change after adoption (eg, because of appeals ), as directed by the Human Resources Director or… more