- TEKsystems (San Bernardino, CA)
- The Collector 1 performs telephone calls and website checks for claim status from insurance companies, government payers, third party payers, worker's compensation ... with the terms and conditions of each contract and/or insurance company policies. Determines if payer needs additional information, identifies barriers, and… more
- Conduent (Los Angeles, CA)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a...claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- Prime Therapeutics (San Diego, CA)
- …passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in California) **Job Description** The Onsite Pharmacy Auditor ... pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting… more
- Elevance Health (Walnut Creek, CA)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time, ... required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Highmark Health (Sacramento, CA)
- ** Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
- Lineage Logistics (Riverside, CA)
- …and virtual product inventories via daily activities of cycle counting, claims management and accounts administration within the facility. Manage data concerned ... handling equipment to move product while following all regulatory and company safety standards, policies, and procedures. **MINIMUM REQUIREMENTS (KNOWLEDGE, SKILLS,… more
- Humana (Sacramento, CA)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its… more
- Insight Global (Irvine, CA)
- …terminology. Previous experience as a medical claims examiner or auditor preferred. Experience with claim investigation, quality assurance process, ad-hoc ... An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working...will assist management with implementation of measures to ensure claim processing and payment accuracy. They will also help… more
- LA Care Health Plan (Los Angeles, CA)
- …data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements. Manages complex ... including recommendations and corrective action plans requirements. Maintains related company 's policies and procedures ensuring they are current. Proactively… more
- DoorDash (San Francisco, CA)
- …team at DoorDash is responsible for all things corporate insurance at the company . We are a rapidly growing and exciting function that helps DoorDash manage ... risk and safety with a close lens on the company 's bottom line. We are looking for forward thinkers that are excited to help build out this team and match our… more