- Insight Global (Pleasanton, CA)
- …is hiring for a Part-Time Credentialing & HIPAA Coordinator to support a healthcare organization's compliance and provider onboarding efforts. This role ensures ... degree required; Bachelor's preferred. - 2-3 years of experience in healthcare credentialing or compliance . - Familiarity with CAQH, Medi-Cal/Medicare, and… more
- Humana (Sacramento, CA)
- …through collaboration with diverse stakeholders across the enterprise, including legal, compliance , education, and IT. In this role, you will contribute to ... the enterprise, including model risk assessments, fairness evaluations, and compliance with ethical and regulatory standards. Champion transparency, accountability,… more
- Ventura County (Ventura, CA)
- …or chronic conditions; and facilitating smooth care transitions across the healthcare continuum. The incumbent collaborates with medical directors, providers, and ... members to resolve service issues, ensure regulatory compliance (DMHC, NCQA, HEDIS), and support wellness, prevention, and...An educational Incentive of 2.5% for completion of an associate 's degree, 3.5% for completion of a bachelor's degree,… more
- Humana (Sacramento, CA)
- …efficiency. Ensure robust database security, backup, recovery, and regulatory compliance in alignment with Humana's standards. Monitor database performance, ... Terraform. Familiarity with cloud security, access management, and regulatory compliance best practices. Excellent communication and documentation skills. Is eager… more
- Humana (Sacramento, CA)
- …agents with pre-enrollment inquiries including the following: agent compliance (contracting, licensing, and certification), pre-enrollment inquiries, and agent ... call center. Assist agents with all pre-enrollment inquiries including compliance verification, enrollment, product, and processes. + Utilize documents, websites,… more
- Humana (Sacramento, CA)
- …for effective risk management and measurement. Join us in shaping the future of healthcare through AI excellence. We are seeking a Principal Data Scientist to guide ... Our goal is to create safe AI solutions that will revolutionize and improve healthcare experience and outcomes for our customers. Join our rapidly expanding team of… more
- Humana (Sacramento, CA)
- …interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and ... medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements,… more
- Humana (Sacramento, CA)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements,… more
- Dignity Health (Bakersfield, CA)
- …ICD-10, HCPCS coding, and medical terminology. + Associate 's Degree - Associate 's Degree in healthcare administration, business, or related field preference ... the detailed and accurate processing, review, and adjudication of complex healthcare claims. This position requires expert knowledge of claims processing, coding,… more
- Danaher Corporation (San Diego, CA)
- …+ Operations (supply chain, manufacturing, EH&S, real estate, etc.) + Compliance and Enablement (QRA/MAPSS, clinical affairs, etc.) + Strategy and Business ... person of influence at the company, serving as one of the legal and compliance team's primary contacts globally; directly partner with and advise leaders of your… more