- Sedgwick (Sacramento, CA)
- …+ Strong utilization practice knowledge + Knowledge of the insurance industry and claims processing + Knowledge of current pharmacy trends and alternative ... conduct a peer review of medications used on specific claims and provides insight for drug interactions, health and...cases. + Consults with pharmacy UR team for difficult claims requiring weaning schedule. + Assesses needs, gives appropriate… more
- LA Care Health Plan (Los Angeles, CA)
- …knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis. Strong project ... Nurse - Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- LA Care Health Plan (Los Angeles, CA)
- …execution, reporting and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. These ... vendors. Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for… more
- NTT DATA North America (San Francisco, CA)
- …including benefits, provider contracts, pricing, accumulators, authorization rules, and claims processing . -Collaborate with configuration analysts, business ... test scripts for functional, regression, and integration testing. -Create test data using Claims test Pro, testing tool created by Cognizant. -Identify test data and… more
- Molina Healthcare (San Diego, CA)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Sedgwick (Sacramento, CA)
- …to apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge of field case management + Excellent oral and ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- Prime Therapeutics (San Diego, CA)
- …skill and understanding of the point of sale and on-line pharmacy claims processing environment + Excellent oral, written and interpersonal communication ... and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance,...to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest risk for… more
- LA Care Health Plan (Los Angeles, CA)
- …Advanced understanding of managed care operations (including but not limited to, claims processing , population health, appeals and grievances, etc.) and the ... of major factors, root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key measures to facilitate improvement,… more
- Movn Health (CA)
- …experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a hands-on, senior-level ... of medical billing and payer systems is essential. Functional Responsibilities + Submit clean claims via EHR to all payers within 24 hours of service + Review and… more
- Kelly Services (Roseville, CA)
- …best practices and quality service standards **What's a typical day as a Claims Examiner? You'll be:** + Analyzing and processing complex workers' compensation ... style isn't always easy. That's where Kelly(R) comes in. We're seeking a ** Claims Examiner - Workers' Compensation** to work with a leading organization committed to… more