- Ventura County (Ventura, CA)
- …general direction, the incumbent is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, ... analyzes credits, payments, and over adjustments; + Analyzes and updates claims generated prior to transmitting to the appropriate intermediary/payor within billing… more
- BrightSpring Health Services (Union City, CA)
- …Prior supervisory experience. Skills/Knowledge: + Required: Knowledge of Medicaid claims regulations and processes. Basic understanding of drugs, medication ... centers nationwide. If your passion is service excellence and top- quality care come join our team and apply today!...Identifies and resolves issues of denials or follow-up of claims . + Maintains current knowledge of Medicaid claim regulations… more
- Sedgwick (West Hills, CA)
- …Establishes FMLA and other unpaid state, military, and/or company-specific leave claims ; tracks and codes documentation in accordance with internal workflow ... processes. + Analyzes FMLA and other unpaid claims to determine eligibility and certification in compliance with client plans, state and federal regulations. +… more
- Sharp HealthCare (San Diego, CA)
- …with medical management such as provider relations, member services, benefits and claims management, IT management, etc. + Plans, organizes, and directs the ... functions within the Medical Management Department (Utilization/Cost Management and Quality Management) + Develops and updates Physician management department work… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …information to catalog new data sources. + Work closely with the DE Data Quality & Standards capability to apply quality principals and best practices to ... of operational prioritization and planning. + Define indicators of performance and quality metrics and ensure compliance with data related policies and standards for… more
- Elevance Health (Los Angeles, CA)
- …HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of service, and quality of care issues to include executive and ... with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable… more
- Molina Healthcare (Long Beach, CA)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... accuracy in a timely manner to meet department standards of turnaround time and quality . + Audit loaded provider records for quality and financial accuracy and… more
- Highmark Health (Sacramento, CA)
- …supervisory direction and oversight for all enrollment, premium billing, claims and/or customer service telephone and written correspondence inquiries (routine, ... timeliness standards are met for each contract, provides oversight support for the quality control program and initial and ongoing training and mentor programs, and… more
- Travelers Insurance Company (Walnut Creek, CA)
- …Compensation Claim Professional Trainee, you will handle all aspects of a workers compensation claims . In this role, you will learn how to help our customers and ... injured at work. You will develop the technical skills needed for quality claim handling including investigating, evaluating, negotiating, and resolving claims … more
- Canon USA & Affiliates (Sacramento, CA)
- …and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business, ... of the business unit. + Support regulatory activities by managing image quality review with external medical experts, providing clinical expertise, and reviewing… more