- Providence (CA)
- …organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance program, management of projects and continual ... Analyst assists the Claims leaders in managing a quality assurance program to ensure compliance with laws and regulations pertaining to self-insured… more
- Cognizant (Sacramento, CA)
- …coverage guidelines and regulations. * Experience in the analysis and processing of claims , utilization review/ quality assurance procedures. * Must be able ... - 4:30pm ET **Experience:** A minimum of 1 years claims processing is required. **Travel:** None required **About the...is required. **Travel:** None required **About the role:** As Claims Processor, you will be responsible for timely and… more
- Elevance Health (Walnut Creek, CA)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance , or clinical documentation improvement, and a ... and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims … more
- Sharp HealthCare (San Diego, CA)
- …reasonableness checks). Providing efficient and cost-effective solutions as required.Oversees all claims testing and quality assurance activities and ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- Sharp HealthCare (San Diego, CA)
- …checks) provide efficient, cost-effective solutions as directed.Serve as the lead on claims testing and quality assurance activities and assisting ... investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or… more
- LA Care Health Plan (Los Angeles, CA)
- …Services/Population Health department. Advanced knowledge of and experience in health plan quality assurance (especially related to claims , health ... and analytical work related to the testing, validation, and quality assurance of business requirements for and...root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key… more
- Adecco US, Inc. (Los Angeles, CA)
- **Job Summary** We are seeking a ** Quality Assurance Specialist** to ensure our products and operations comply with all applicable US federal, state, and local ... quality and regulatory standards **Qualifications** + 5-10 years of experience in quality assurance , preferably in a US-based beauty or personal care platform… more
- Emanate Health (Covina, CA)
- …sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews ... Minimum of three years of utilization management experience. Experience in quality - related job preferred. Computer proficiency is required. Excellent customer… more
- Envista Holdings Corporation (Pomona, CA)
- …The **Sr. Quality Engineer** plans and conducts activities concerned with the quality assurance of industrial processes, materials, and products. The Sr. ... working closely with cross-functional teams to develop, implement, and maintain quality assurance protocols that comply with regulatory requirements and… more
- Banner Health (CA)
- …documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. ... different focuses (Facility vs Profee)._ In this **Inpatient Facility-based HIMS Coding Quality Associate** position, you bring your **5 years of acute care… more
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