- Evolent (Sacramento, CA)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... Bachelor's degree, preferably with a quantitative major (eg actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health… more
- Elevance Health (Los Angeles, CA)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing… more
- Movn Health (CA)
- …Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a hands-on, senior-level role ... payer systems is essential. Functional Responsibilities + Submit clean claims via EHR to all payers within 24 hours...and metrics to leadership + Collaborate with clinical and operations teams to resolve coding or documentation issues +… more
- Evolent (Sacramento, CA)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more
- J&J Family of Companies (Irvine, CA)
- At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, ... we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …regulatory team (GRL, regional leads, CMC-RA, labeling, medical writing, regulatory operations , etc.) to develop global regulatory plans, address global regulatory ... **K** **nowledge** - Experience working in the pharmaceutical and/or healthcare industry. - Knowledge and experience with preparation of...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Humana (Sacramento, CA)
- …to assignments. The Senior Encounter Data Management professional ensures data integrity for claims errors that result from the data exchange between Humana and its ... to make an impact** **Required Qualifications** **5+ years of medical claims processing/auditing or encounter data management experience** **Demonstrated deep dive… more
- Walgreens (Woodland, CA)
- …until satisfied, etc.). + Develops strong relationships with most valuable customers. Operations + Under the supervision by the pharmacist, assist in the practice ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more
- Cardinal Health (Fresno, CA)
- **_What Revenue Cycle Management (RCM) contributes to Cardinal Health_** Practice Operations Management oversees the business and administrative operations of a ... on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient...and pursuing payment for all unpaid and delinquent denied claims . They also act as a liaison between the… more
- Highmark Health (Sacramento, CA)
- …MUST BE A US CITIZEN This position serves as a key liaison between Claims Operations , Customer Service, Regulatory Affairs, IT, Legal and other departments, ... industry regulatory changes and assess their potential impact on Claims Operations , Customer Service and other operational...Health Insurance Industry + 3 - 5 years the Healthcare Industry + 3 - 5 years in Lean/Six… more