- Evolent (Sacramento, CA)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Humana (Sacramento, CA)
- …caring community and help us put health first** The Grievances & Appeals Representative 4 Investigates and resolves member and practitioner issues. manages client ... if an a grievance, appeal or further request is warranted. The Grievances & Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** California. This role enables associates to work virtually full-time, with the exception of ... a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any… more
- Humana (Sacramento, CA)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... + Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.… more
- Highmark Health (Sacramento, CA)
- …could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides ... times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of… more
- Ventura County (Ventura, CA)
- …accuracy rate, compliance rate with quality standards and HCAI requirements; + Reviews insurance denials and submit appeals as necessary, provide education to ... coders based on denials; + Assists in organizing, coordinating, and directing of coding activities of the Health Information Management Department at VCMC; + Reviews and evaluates policies and procedures for the Medical Records Department in relation to the… more
- Cardinal Health (Sacramento, CA)
- …level customer service + Experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + ... the patient and/or program + Conducts benefits investigations to identify patients' insurance plan coverage for medications, procedures, and travel and lodging +… more
- Affordable Care (Sacramento, CA)
- …skills. Experience working with Dentrix, handling dental office finances, full insurance billing process (including claims submission, appeals , and denial ... job well. **Additional benefits include** , group medical and dental insurance , vision insurance , life insurance , flexible spending (health and dependent… more
- CVS Health (Sacramento, CA)
- …**Quality Appeal Coordinator** coordinates reviews and evaluations for complaints and appeals received by the organization. This includes denied claims, coverage ... and independently coaches others on matters regarding complaints and appeals . **In this role, you will:** + Handle quality...experience working with claims. + Prior experience in health insurance . + Prior experience in compliance or auditing. +… more