- Guidehouse (El Segundo, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... is a rewarding #jobs. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vp-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc… more
- LA Care Health Plan (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted ... regulatory and contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and… more
- Providence (CA)
- …we must empower them.** **Providence St Joseph Health operates a self-administered claims program for General and Healthcare Professional Liability, Directors ... organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending… more
- Conduent (Los Angeles, CA)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims ...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… 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 ... insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role. **Other Qualification Requirements** + Bachelor's degree in… 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 ... insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role. **Other Qualification Requirements** + Bachelor's degree in… more
- Sharp HealthCare (San Diego, CA)
- …of the requested service. This position is responsible for conducting retrospective claims review for services to determine the medical appropriateness of the ... completion of Medical Assistant Program or equivalent. + 2 Years experience in healthcare with experience in medical codes, medical terminology, and data entry .… 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 ... timely manner to meet department standards of turnaround time and quality. + Audit loaded provider records for quality and financial accuracy and provide documented… more
- Sharp HealthCare (San Diego, CA)
- …all decisions. Maintains set turnaround times for program completion (subject to audit ).Observes and follows through on Pharmacist or Medical Director directions in ... of the functions of Managed Care including HMO/PPO and ACO eligibility, claims , utilization management and the financial impact of decisions related to each.… more