- LA Care Health Plan (Los Angeles, CA)
- … Claims is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans ... contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans… more
- Guidehouse (El Segundo, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... any and all related job duties as assigned. **_The medical biller will be working a Hybrid schedule based...Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Specialty Plans Auditor III is responsible for planning audits and audit work programs that address appropriate claims and financial compliance ... Senior Health Care Audit Analyst Job Category: Accounting/Finance Department: Financial Compliance...also LA Care contractual agreements. The position handles DMHC claims data submissions for LA Care and its Plan… more
- Robert Half Accountemps (Los Angeles, CA)
- …payments meet the standards dictated by the Department Policies and Procedures. Requirements Medical Claims , IPA, Claims Adjudications Robert Half is the ... Description The Claims Auditor reports functionally to the Administrative Manager...accuracy of the payment release. Provide back-up support to audit Member Service Representatives, fielding incoming telephone calls from… more
- Providence (CA)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and...Insurance terminology + Legal concepts + Liens + Electronic claims databases + Medical terminology **Skills required… more
- Conduent (Los Angeles, CA)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Sedgwick (Long Beach, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Supervisor | Long Beach, CA (Hybrid) | SIP Required Are you looking… more
- Sedgwick (Ontario, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Workers Compensation **PRIMARY PURPOSE:** To supervise the operation… more
- Prime Healthcare (Ontario, CA)
- … Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the VP will identify financial ... relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for the development and execution of Claim Operations… more
- UCLA Health (Los Angeles, CA)
- …with: + High school diploma, GED or equivalent + Four or more years of medical claims payment experience in an HMO environment + Experience with CPT-4, ICD-9CM, ... Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You...medical terminology + Experience in benefit determination and claims adjudication + Ability to accurately key 6,000-8,000 keystrokes… more