- Sharp HealthCare (San Diego, CA)
- …and no pay reasons, and successfully collect additional monies due.Structure audit by payor timeframes, denial/underpay categories, and contract rates with a ... preventing and mitigating future denials/underpayments. Document and report out audit findings along with process improvement opportunities and recommendations.Identify… more
- Aveanna Healthcare (Los Angeles, CA)
- …Tickets to correct and update client's invoices. * Works with Respite Biller to ensure claims are refiled and/or billed to the Regional Centers in a timely manner. * ... Understands Regional Center specific requirements for submitting claims (ie, includes Respite biller's notes, invoices, etc.). *...Computer literate and ability to type, file and maintain audit records. * Strong Excel skills * Excellent research… 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
- 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
- Highmark Health (Sacramento, CA)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Highmark Health (Sacramento, CA)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Robert Half Accountemps (Los Angeles, CA)
- …and tracking actionable follow-ups. Requirements EMR (Electronic Medical Records), Healthcare regulations, Audit Management, Medi-Cal, Excel Formulas, Health ... Description A National Healthcare Organization is seeking a knowledgeable and detail-oriented...the effectiveness of insurance and risk management programs. + Claims Management: Collaborate with the Risk Management team to… more
- Humana (Sacramento, CA)
- …for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must be able to work core business hours on EST time between ... Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This… more
- The County of Los Angeles (Los Angeles, CA)
- …developing and implementing the Quality Improvement program for these sections. + Reviews audit and monitoring tools on an on-going basis to ensure applicability and ... revises these tools and/or develops new audit tools. + Performs administrative work related to role...work related to role as Emerging Infectious Disease and Healthcare Recovery and Business Continuity Program Manager. + Participates… more
- Aston Carter (San Bernardino, CA)
- …resolve patient credit balance report Audit and resolve outstanding collections Audit and resolve insurance pending claims Conduct random financial audits ... experience AP and AR experience keying and matching invoices to POs experience healthcare industry Experience Level Entry Level Pay and Benefits The pay range for… more