- Insight Global (Irvine, CA)
- …medical terminology. Previous experience as a medical claims examiner or auditor preferred . Experience with claim investigation, quality assurance ... 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)
- Specialty Health Plans Auditor III Claims Job Category: Customer Service Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... achieve that purpose. Job Summary The Specialty Health Plans Auditor III Claims is responsible for all...liaison for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care delegates. Reviews and… more
- Centene Corporation (Sacramento, CA)
- …related field such as Business, Accounting, Finance, Healthcare or equivalent experience preferred . + 2+ years claims compliance experience, preferably with ... PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims… 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)
- …communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong education/training background ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… 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 ... and regulations governed by the Department of Insurance and CMS ** Preferred Qualifications** + Compliance regulations knowledge and compliance auditing experience +… more
- Warner Bros. Discovery (Burbank, CA)
- …production incentive claim from either 3rd party CPA or government auditor . + Retrieves all required support (from digital and physical filing systems) required ... to compile the claim /application and to defend the production incentive from audit/review....in production accounting. + Working knowledge of production incentives preferred . + Working knowledge of the production or postproduction… more
- Marriott (Santa Barbara, CA)
- **Additional Information** Pay: $16.50/hour, full time, experience preferred **Job Number** 25137682 **Job Category** Rooms & Guest Services Operations **Location** ... guests. Complete nightly audit of parked vehicles with vehicle claim tickets, resolve discrepancies, and submit list for charges...submit list for charges to be posted by Night Auditor . Maintain security of vehicles and vehicle keys. Follow… 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 ... lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree Experience Required: At least 6 years of experience in… more