- Sharp HealthCare (San Diego, CA)
- …all decisions. Maintains set turnaround times for program completion (subject to audit ).Observes and follows through on Pharmacist or Medical Director directions ... Pharmacy -REQUIRED **Preferred Qualifications** + experience in HMO or delegated risk medical group/IPA setting. + experience with Electronic Health Records (EHR). +… more
- Sharp HealthCare (San Diego, CA)
- …of the requested service. This position is responsible for conducting retrospective claims review for services to determine the medical appropriateness of ... plan coverage criteria, etc. + Retrospective Review Coordinate, review, and process retrospective claims for medical care and services including, but not limited… more
- Ventura County (Ventura, CA)
- …analyze (Accountant I) or calculates and analyzes (Accountant II) Incurred but not Reported medical claims based on system generated claim lag reports to provide ... flexible credit allowance of up to $23,530 annually to offset the purchase of medical , dental, and/or vision insurance for you and your dependents. + Employee only -… more
- Highmark Health (Sacramento, CA)
- …or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated funds paid ... for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into… more
- The County of Los Angeles (Los Angeles, CA)
- …(CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In ... addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the County's 911 emergency response system, as well as… more
- LA Care Health Plan (Los Angeles, CA)
- …reporting and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. These audits ... of business. The position is responsible for the DMHC claims data submissions for LA Care and its Plan...for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care delegates. + Annually reviews… more
- The County of Los Angeles (Los Angeles, CA)
- …permanent appointment to Health Care Financial Analyst. DEFINITION: Prepares reimbursement claims for health and/or mental health care provided under Federal, State ... and Special medical aid programs or prepares yearly budget requests, annual...for Federal, State, and/or Special Programs to determine if claims for reimbursement conform to applicable rules and regulations… more
- The County of Los Angeles (Los Angeles, CA)
- …requirements for Federal, State, and/or Special Programs to determine if claims for reimbursement conform to applicable rules and regulations and result ... policy and procedure manuals pertinent to accounting control, fiscal record keeping and audit trails. Reviews, analyzes and drafts replies to audit findings of… more
- Clay Lacy Aviation (Van Nuys, CA)
- …robust internal controls to prevent errors, fraud, and non-compliance, with audit -ready processes and documentation aligned with applicable regulatory standards. + ... escalation point for sensitive payroll issues, wage disputes, and labor claims , providing strategic counsel and documentation to mitigate legal and financial… more
- Walmart (Red Bluff, CA)
- …environmental impacts and assessments + Supports regulatory visits and prepares audit reports for management review + Assists in integrating environmental ... Assists with third party audits + Develops and presents audit findings to facility management + Responds to inquiries...to inquiries by regulatory authorities + Consults on complex claims and settlements + Designs preventative claims … more