- UCLA Health (Los Angeles, CA)
- …career to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners ... assigned to the auditor . You will review claims (paid, pending,...maintain statistical data consistent + Maintain departmental production and quality standards Salary Range: $31.51 - $62.64 HourlyQualifications We're… more
- Centene Corporation (Sacramento, CA)
- …PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims ... a monthly, quarterly and annual basis to ensure regulatory compliance. + Perform claims compliance audits for either federal or state programs. + Evaluate processes… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III, $5,000 SIGN ON BONUS Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Specialty Health Plans Auditor III is offering a $5,000 Sign On Bonus.… more
- Prime Therapeutics (San Diego, CA)
- …passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in California) **Job Description** The Onsite Pharmacy Auditor ... and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance,...+ 2 years of work experience in audit or quality assurance + 1 year of work experience in… more
- Elevance Health (Walnut Creek, CA)
- …applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Highmark Health (Sacramento, CA)
- …and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, ... processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management, designs and… more
- Humana (Sacramento, CA)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel,… more
- Insight Global (Irvine, CA)
- …terminology. Previous experience as a medical claims examiner or auditor preferred. Experience with claim investigation, quality assurance process, ad-hoc ... An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working...be responsible for the investigation, determination, and reporting of claims processing through auditing billing processes, including pre and… more
- The County of Los Angeles (Los Angeles, CA)
- …management, all in compliance with applicable laws (eg, California Environmental Quality Act), rules and regulations and policies and procedures. + Supervises ... final approval. + Reviews and approves all requests to auditor controller for payments to confirm the requests are...Ideas + Using Time Efficiently + Working to High Quality Standards + Adapting to Change + Deductive Reasoning… more
- DoorDash (Sunnyvale, CA)
- …pillar, which focuses on three key principles: ensuring Dashers understand quality through clear feedback, motivating improvements with a suite of rewards, ... and safety alerts, provide instant support when incidents occur, and streamline claims through automated processes-all while gathering invaluable data that makes our… more