- UCLA Health (Los Angeles, CA)
- …knowledge of the health care model, capitation and other managed care IPA and provider reimbursement methodologies. + Strong knowledge of physician and facility ... billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding. + Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the… more
- Centene Corporation (Sacramento, CA)
- …quality improvement experience. Project management experience at a medical group, IPA , or health plan setting. Strong communication and presentation skills ... Proficient in HEDIS/Quality measures, cost (ie MLR analysis) and utilization metrics. Pay Range: $68,700.00 - $123,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans,… more
- Cognizant (CA)
- …Operations strategy + Conversant with business processes, models and automation solutions ( IPA /RPA) and ability to sell them across multiple business + Show P&L ... responsibility with a track record of building a high-growth business within Capital Markets, Operations, Asset Management and Automation. + Consistent record of growing business successfully over the years through strong client relationships and a deep… more
- Emanate Health (Covina, CA)
- …etc.). Knowledge of medical terminology and CTP/HCPS codes. Knowledge of networks, IPA 's, HMO's, PPO's and PCP's and contract affiliations. Strong analytical skills, ... proficient with spreadsheets. c. Minimum License Requirement : Delivering world-class health care one patient at a time. Pay Range: $24.31 - $36.47 We are more than just a health system. At Emanate Health, we are a catalyst for change and a beacon for… more
- HCA Healthcare (Campbell, CA)
- …experience negotiating and managing contracts either in a health plan or IPA /MSO model + Experience negotiating DOFRs, physician and ancillary agreements and Letters ... of Agreement + Working knowledge of claims operations, credentialing process and overall MSO operations + Minimum of three years of claims experience and/or one year of provider operations work required **CERTIFICATION/LICENSE:** + No license or certification… more
- Cedars-Sinai (Los Angeles, CA)
- …to ensure appropriate coverage for ongoing daily operations + Interfaces w/ IPA 's, Medical Groups and other Review Organizations in resolving authorization and ... eligibility issues. + Collaborates with managers and clinical/support services managers in cross-functional process improvement, collaborative teamwork, open communication and problem solving to ensure the effective coordination and integration of services… more
- Cedars-Sinai (Beverly Hills, CA)
- …ability to interact with Medical Directors, Providers, CSMNS members, Medical Group and IPA 's to ensure the delivery of high quality, cost effective healthcare and ... aligned with all state and federal regulations and guidelines. **Job duties and responsibilities:** + Enters data and processes referral authorization requests, to include appropriate coding and quantities. + Answers incoming calls from Providers, IPAs,… more
- US Tech Solutions (Whittier, CA)
- …guidelines **Experience:** 2+ years of experience in claims adjudication (HMO, IPA , or hospital environment) **Skills:** + Claims reimbursement knowledge + ... Experience working with DOFR (Division of Financial Responsibility) + Hands-on experience processing lab claims + Familiar with UB-92 and HCFA-1500 forms + Understanding of provider contracts, Medi-Cal, commercial, and senior plan claims + Strong knowledge of… more
- Emanate Health (Covina, CA)
- …Five (5) to seven (7) years of managed healthcare experience in an IPA or health plan setting. Previous physician on boarding experience. **Minimum License ... Requirement :** None. Delivering world-class health care one patient at a time. Pay Range: $39.23 - $57.66 We are more than just a health system. At Emanate Health, we are a catalyst for change and a beacon for healthier lives. When you come to any one of our… more
- Molina Healthcare (San Diego, CA)
- …Speaking, MCO, Medicare Advantage, Waiver, healthcare, Health Care, LTSS, IPA , Salesforce, Data, Analysis, Reporting, Enrollment, Enroll, Travel, MPC, Accountable ... Care Networks, Accountable Care Organizations, AIM, ACHs, DOH, DSHS, FQHC, FFS, HCA, Population Health Pay Range: $20.74 - $40.44 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. more