- Rady Children's Hospital San Diego (San Diego, CA)
- …Under the supervision of the Utilization Management (UM) Operations Supervisor, the UM Coordinator I's primary job function is to support UM operations by performing ... the phone (including all provider calls regarding authorization processing, claims related phone calls, and any other calls received...codes, CPT Codes, HCPC Codes, Health Plan benefits, or claims **The current salary range for this position is… more
- CVS Health (Sacramento, CA)
- …with heart, each and every day. **Position Summary** The **Quality Appeal Coordinator ** coordinates reviews and evaluations for complaints and appeals received by ... the organization. This includes denied claims , coverage issues, medical necessity, service quality, or other concerns expressed by patients, providers, or other… more
- Actalent (Sacramento, CA)
- …providing healthcare to underserved communities? Apply today. The Employee Relations Coordinator serves as a key liaison between the Human Resources department ... with workers' compensation insurance providers to ensure timely follow-up on all claims . + Review all terminations to ensure the actions comply with policies… more
- Prime Healthcare (Ontario, CA)
- …members to join our corporate team! Responsibilities The Corporate Compliance Coordinator at Prime will participate and assist in compliance-related functions across ... of laws relating to Medicare, Medicaid, EMTALA, HIPAA, the Stark Law, the False Claims Act, and the Anti-kickback Statute + Experience in conducting or responding to… more
- Bowman (Sacramento, CA)
- **Short Description** Bowman has an opportunity for a Project Accounting Coordinator to join our team remotely (Pacific, Mountain or Central time zones only). At ... and resolve any issues that may arise as it relates to disputes, or claims + Act as liaison between operations and many corporate accounting functions including but… more
- Sharp HealthCare (San Diego, CA)
- …non-clinical appeals and grievances. **Required Qualifications** + 3 years' experience in claims , utilization review, appeals or member services in a managed care ... requests for assistance.Provides feedback to Customer Service, Enrollment, Provider Relations, Claims Research, and Health Services on issues and trends identified… more
- Centene Corporation (Sacramento, CA)
- …customers and shipping vendors when necessary + Coordinate and/or complete delivery claims when necessary to delivery vendors + Coordinate, monitor and record ... reimbursements from claim submissions + Maintain shipping records including delivery claims , refunds, or other vendor related correspondence + Complete all… more
- Sharp HealthCare (San Diego, CA)
- …HCPC coding using appropriate tools.Make determination on the more complex claims that are designated CC authorization level within SCMG TAT guidelines.Coordinates, ... reviews and processes more complex retrospective claims for medical care and services, including, SNF inpatient admission, medical transportation, durable medical… more
- Southland Industries (Garden Grove, CA)
- …record of industrial equipment training. + Report and manage all company vehicle claims . + Assist in reporting workers compensation claims . + Update Material ... Safety Data Sheets (MSDS) manual. + Assemble various safety manuals for distribution. + Assist in implementing and distributing safety tailgate meetings. + Maintain record of signed safety tailgate meeting forms. **What you bring to the table:** + You love… more
- UCLA Health (Los Angeles, CA)
- …perform analysis, obtain information, and enter prior authorization data necessary for claims adjudication. You will use your critical thinking skills to identify ... missing information and make prior authorization processing determinations based on clinical protocols and other guidelines. You will also interact with internal and external customers to provide and obtain information and ensure the delivery of outstanding… more