- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …federal laws, regulations and guidelines including PhRMA Code on Interactions with Healthcare Professionals as well as complying with all OAPI standards and policies ... offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Dignity Health (Bakersfield, CA)
- …and areas for improvement. - Conducts in-depth data analysis: Analyzing large healthcare datasets to identify patterns, trends, and insights related to contract ... structures for operational clarity. - Collaborate with market leadership, finance, claims , and network teams to align contracting strategy with growth objectives.… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …or government relations consulting firm. Strong understanding of US healthcare system and regulatory environment is preferred. Excellent interpersonal skills ... offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Elevance Health (Costa Mesa, CA)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new... and medical records prior to payment. Researches new healthcare -related questions as necessary to aid in investigations. +… more
- Walgreens (Gilroy, CA)
- …enhancements to pharmacy systems to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... usage of medications, awareness with drug interactions and offering preventive healthcare services such as immunizations. Responsible for ensuring the proper… more
- Evolent (Sacramento, CA)
- …customer accounts + Strong knowledge of health plan operations, care/utilization management, claims processing , value-based care, and the levers to optimize ... Experience we look for:** + Master's degree in business administration, healthcare administration, public health, analytics, or a related field, master's degree… more
- UCLA Health (Los Angeles, CA)
- …Excel + Knowledge of Tableau Reporting dashboards + Understanding of Medicare/Medi-Cal claims processing guidelines + Experience with EPIC EHR, Cirius Claim ... compliance with government regulations, reimbursement issues, etc. + Analyze hospital billing claims within the EHR and claim scrubber system + Resolve claim errors,… more
- Humana (Sacramento, CA)
- …to make an impact** **Required Qualifications** + 1 - 5 years or more of claims processing experience + Minimum of 1 year experience in conducting thorough root ... first** The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work assignments are varied… more
- Humana (Sacramento, CA)
- …of experience researching MS-DRG, APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience ... IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Elevance Health (Los Angeles, CA)
- …**Preferred Skills, Capabilities, and Experiences:** + 3-5 years GBD Facets processing and adjustment experience strongly preferred. + Prior experience working with ... Experience working post-pay reviews, validation, and recovery processes in the healthcare industry strong preferred. + Experience managing multiple projects in… more