- LA Care Health Plan (Los Angeles, CA)
- …by fax, electronic medical records, or on-site visits if needed. (15%) Review medical records, claims , and encounter data to identify key information to help ... to members to close care gaps. The QPHC also outreaches to providers for medical record pursuit and retrieval. This position supports the LA Care medical … more
- CVS Health (Sacramento, CA)
- …R, Alteryx, Trifacta, Linux OS, GCP/ AWS/ Azure. + Experience working with medical and/or pharmacy claims data. + Experience in healthcare industry, including ... work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information… more
- J&J Family of Companies (Santa Clara, CA)
- …Description:** Johnson & Johnson is hiring for a **Principal** **R&D Technician - Shockwave Medical ** to join our team located in **Santa Clara, CA** . Fueled by ... of Intravascular Lithotripsy (IVL) to treat complex calcified cardiovascular disease. Our Shockwave Medical portfolio aims to establish a new standard of care for … more
- Deloitte (Monterey, CA)
- …and business terms) with PBMS + Experience performing analytical analysis of medical & pharmacy claims , including understanding financial impact of network ... emerging trends and cost drivers + Work directly with medical and PBM vendors to analyze the program offering...in rate negotiation, and analyzing financial terms for both medical and pharmacy + Prepare financial projections and rate… more
- Command Investigations (Santa Barbara, CA)
- …hire. Visit our website and find out why at www.GoCommand.com . The Claims Investigator should demonstrate proficiency in the following areas: + AOE/COE, Auto, or ... include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: + Medical , dental and vision insurance + 401K + Extensive performance bonus program… more
- Guidehouse (San Marcos, CA)
- …service. + Working knowledge can be of the following: insurance claims , billing, coding, follow-up, finance, accounting or customer service related responsibilities. ... reflects our commitment to creating a diverse and supportive workplace. Benefits include: + Medical , Rx, Dental & Vision Insurance + Personal and Family Sick Time &… more
- Sharp HealthCare (San Diego, CA)
- …level within SCMG TAT guidelines.Coordinates, reviews and processes more complex retrospective claims for medical care and services, including, SNF inpatient ... business practices. **What You Will Do** To review more complex requests for medical care and services, if part of the discharge plan, inpatient admission, skilled… more
- Gilead Sciences, Inc. (Foster City, CA)
- …of data from both primary as well as secondary sources (eg, from administrative claims , medical records, etc), expertise in the use and application of ... partners in Clinical Development, Global Patient Safety, Regulatory Affairs, Clinical Operations, Medical Affairs and Global Value and Access, to anticipate and meet… more
- LA Care Health Plan (Los Angeles, CA)
- …relevant coding elements. Audits can include inpatient, outpatient, and professional claims . Serves cross functionally with Utilization Management, Medical ... insurance business, industry terminology, and regulatory guidelines. Working knowledge of claims coding and medical terminology. Solid understanding of standard… more
- Elevance Health (Costa Mesa, CA)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible for… more