- Cedars-Sinai (CA)
- …and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements. + Maintains and tracks laws and ... on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated on all member and… more
- Tutor Perini (Fresno, CA)
- …accurate and submitted per established procedures. + Accompany all safety, health, and insurance inspectors on walk through tours. + Prepare written appeals for ... safety violation citations. + Additional assignments on supervisor's request. **REQUIREMENTS:** + Requires at least 10 years of heavy civil construction experience. + Certified Safety Professional (CSP). + Familiarity with occupational safety and health laws… more
- Highmark Health (Sacramento, CA)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. + ... 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
- Sharp HealthCare (La Mesa, CA)
- …management, and discharge planning, as specified by Sharp, federal, state, and private insurance guidelines. + Core principlesThe RN CM will make timely referrals to ... to Revenue Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission within 30 days;… more
- Elevance Health (Walnut Creek, CA)
- …to work with facilities and providers for care-coordination. + May also manage appeals for services denied. + Serves as mentor to lower leveled managers and ... and long term disability benefits, 401(k) +match, stock purchase plan, life insurance , wellness programs and financial education resources, to name a few. Elevance… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …of facts and issues in matters affecting disciplinary actions, grievances, appeals , and complaints, refers complex matters to HR Employee Relations Specialist ... California driver license and access to dependable transportation with adequate insurance EDUCATION: + Bachelor-s Degree or equivalent combination of education and… more
- Transdev (San Jose, CA)
- …benefits: 401(k) retirement plan, medical, dental and vision, life insurance , short-term disability, voluntary long-term disability. Benefits may vary depending ... staff and applicant while providing high quality customer service + Participate in appeals process, upon request + Maintain a positive attitude when interacting with… more
- Evolent (Sacramento, CA)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... regarding Advance Directives and POLST when requested. + Understands insurance , governmental, and accrediting agency standards to determine criteria concerning… more
- Stantec (Sacramento, CA)
- …on your talents through knowledge-sharing with some of the world's top talent appeals to you, join us! Your Responsibilities - Working with a multi-discipline group ... purchase program, life and accidental death & dismemberment (AD&D) insurance , short-term/long-term disability plans, emergency travel benefits, tuition reimbursement,… more