- CommonSpirit Health (Rancho Cordova, CA)
- …Services, including but not limited to medical necessity reviews and denials management. Oversees Clinical Care Coordination functions within the facilities in ... aimed at improving patient Length of Stay (LOS), decreasing concurrent denials , streamlining patient authorizations, and enhancing care coordination quality of care.… more
- Alameda Health System (Oakland, CA)
- Pharmacy Services Coordinator -Specialty Pharmacy, Per Diem, Varied shift days, 8hoursFeatured Job + Oakland, CA + Highland General Hospital + HGH Pharmacy - Retail + ... of treatment; helps to support the appeal process to overturn insurance denials and/or benefit exclusions when needed. 8. Provides specialty medication inventory… more
- Cardinal Health (Fresno, CA)
- …identify root causes and improvement opportunities. + Research CPT code denials against LCD/NCD requirements and payer policies. + Collaborate with cross-functional ... teams to implement clean claim strategies and reduce rework. + Serve as a liaison between billing staff, providers, and center leadership to resolve escalated issues. Communicate payer updates and industry changes to staff and leadership. + Participate in… more
- Prime Healthcare (Garden Grove, CA)
- …utilization review teams with regards to admission criteria, medical necessity, payment denials , and documentation issues. Able to work independently and use sound ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/220803/medical-review- coordinator /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityGarden Grove… more
- Sutter Health (Santa Clara, CA)
- …third-party payers as necessary to gather additional information and convey approvals, denials or appeals. + Provides excellent customer service by listening to ... provider, staff and patient concerns and assisting them in resolving issues in a courteous manner while documenting appropriately. + Cross-trains others to assure consistent coverage; provide back up support as needed. **EDUCATION:** HS Diploma or GED… more
- Sharp HealthCare (San Diego, CA)
- …assesses and select the appropriate denial reason. Maintain mandated TAT for denials .Obtains and gathers clinical information from multiple sources including use of ... Sharp and/or Hospital applications to retrieve patient medical records for review by Hospitalist Case Managers, SNF's or outpatient service providers.Verifies and documents eligibility and benefit details.Obtains prior authorizations for specific medications,… more
- Dignity Health (Los Angeles, CA)
- … and Physician Advisor status recommendations to the appropriate Care Coordinator and documents any related authorizations, denials or status determinations ... **Responsibilities** The Care Coordinator Assistant provides clerical, secretarial and administrative support...forwarding of communications to the responsible party. The Care Coordinator Assistant may be assigned other duties within the… more
- Behavior Treatment & Analysis (Walnut Creek, CA)
- …the Billing Coordinator in Billing to Insurance companies and claim denials resolution. Key Responsibilities: + Prepare and submit claims to insurance companies, ... out the following spreadsheets: + "Billing projection Monthly" + Follow up with claim denials /unpaid claims- Via Emails or Phone calls + Submit Disputes in order to… more