- LA Care Health Plan (Los Angeles, CA)
- Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ... coding elements. Audits can include inpatient, outpatient, and professional claims . Serves cross functionally with Utilization Management, Medical Directors, and… more
- VetsEZ (CA)
- …care teams, payers, and providers to improve how patients experience care, how claims are processed, and how care coordination is managed across the continuum. By ... we enable smarter decisions, seamless patient engagement, and more efficient claims management. Together, we are shaping a healthcare ecosystem that delivers… more
- CDM Smith (Walnut Creek, CA)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...documentation to determine the validity and value of disaster-related claims . This may involve reviewing income statements, balance sheets,… more
- Towne Park (San Francisco, CA)
- …the ability to positively move the metrics for forecasting, productivity, claims , customer service, and turnover. Manages payroll and ensures that controls ... have been adequately trained in safety and loss prevention procedures. Ensures claims are reported timely and accurately and cooperates with the Risk Management… more
- Towne Park (San Diego, CA)
- …the ability to positively move the metrics for forecasting, productivity, claims , customer service, and turnover + Manages scheduling, overtime for associates ... have been adequately trained in safety and loss prevention procedures + Ensures claims are reported timely and accurately and cooperates with the Risk Management… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- …SUMMARY: The Adjudication Specialist manages a portfolio of rejected pharmacy claims , ensuring timely billing and maximum payer reimbursement. They prioritize ... and enhance our services. DUTIES/RESPONSIBILITIES: + Manage and Identify Claims Portfolio: + Review and evaluate insurance claims... Claims Portfolio: + Review and evaluate insurance claims to determine the extent of the insurer's liability,… more
- ProTrain (Rancho Santa Margarita, CA)
- …the responsibilities assigned to insurance billing and coding specialists and electronic claims processors. + Describe the health care delivery system. + Explain the ... of body systems and related medical terminology in order to properly process clean claims . + Utilize the ICD‐10-CM manual, including V codes, E codes, and the… more
- Oracle (Sacramento, CA)
- …grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for ... clinical validation) to lead the appeals initiative to review denied claims , create write-ups for appeals packets, identify trends/improvement opportunities to… more
- Jacobs (Los Angeles, CA)
- …Oversee the Owner Controlled Insurance program (OCIP)Timely administer claims , including investigation, evaluation, and negotiation/recommendation of claim ... settlements * Claims reporting to include data collection, analysis, documentation filings,...for services when required for prosecution or defense of claims , compliance issues, contract review and insurance coverage *… more
- The County of Los Angeles (Los Angeles, CA)
- …the County of Los Angeles in the defense of workers' compensation claims before the California Workers' Compensation Board, the California Court of Appeals ... firms that represent County of Los Angeles in defense of workers' compensation claims . Approves contract law firms request for payment of attorney fees. Drafts… more