- CRC Insurance Services, Inc. (Napa, CA)
- …requests and certificates. 3. Underwrite CRC products and services to clients. 4. Audit , correct, and verify all necessary information prior to policy issuance. 5. ... and follow-up for receipt of policies, endorsement information, inspections, correspondence, claims , etc. from outside sources. 15. Conduct ratings as necessary to… more
- Elevance Health (Costa Mesa, CA)
- …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 ... coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of… 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 ... or vendor's management for LA Care vendors. + Performance claims audits for Specialty Health Plans and...for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care delegates. + Annually reviews… more
- Highmark Health (Sacramento, CA)
- …This job is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Sharp HealthCare (San Diego, CA)
- …and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit ... of the Director. **Required Qualifications** + 5 Years in HMO or Health Insurance Management. + 2 Years leadership experience working collaboratively across multiple… more
- Sharp HealthCare (San Diego, CA)
- …investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or ... Health Insurance Management. + Experience working collaboratively across multiple functional areas (eg, operations, configuration, clinical, IT, plan design) and… more
- Highmark Health (Sacramento, CA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding ... audit activities. Reviews medical records to determine data quality...of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines.… more
- Walmart (Chino, CA)
- …related field AND 3 years' experience in the field of Asset Protection, Audit , Investigations, or Environmental, Health and Safety within Supply Chain, Retail, ... field. Option 2: 5 years' experience in the field of Asset Protection, Audit , Investigations, or Environmental, Health and Safety within Supply Chain, Retail,… more
- The County of Los Angeles (Los Angeles, CA)
- …our patients and our communities by providing extraordinary care. DEFINITION: Prepares reimbursement claims for health and/or mental health care provided ... HEALTH CARE FINANCIAL ANALYST/COMMUNITY PROGRAMS Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4827547) Apply HEALTH CARE FINANCIAL… more
- The County of Los Angeles (Los Angeles, CA)
- HEALTH CARE FINANCIAL ANALYST / EMERGENCY APPOINTMENTS HOMELESSNESS Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4659553) Apply HEALTH ... Los Angeles County, CA Job Type Temporary Job Number b0672B-EA Department MENTAL HEALTH Opening Date 09/16/2024 Closing Date Continuous + Description + Benefits +… more