- Highmark Health (Sacramento, CA)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- NTT DATA North America (San Francisco, CA)
- …benefits, provider contracts, pricing, accumulators, authorization rules, and claims processing. -Collaborate with configuration analysts, business analysts, and ... test scripts for functional, regression, and integration testing. -Create test data using Claims test Pro, testing tool created by Cognizant. -Identify test data and… 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 ... responsible for the Department of Managed Health Care (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. Reviews and updates… 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
- Adecco US, Inc. (Fountain Valley, CA)
- …financial statements for Parts Accounting. . Establish procedures for processing warranty claims ; monitor such claims as received and coordinate dealer ... KPMG quarterly/year-end audits by providing PBC schedules, flux analysis and audit information requests in accordance with reporting timetables. . Establish and… 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
- Robert Half Finance & Accounting (San Ramon, CA)
- …uploads, match contributions, end of year reconciliation, annual 5500 reconciliation and audit administration. * Oversee 401(k), Worker's Comp and 3 Union annual ... employees in a timely fashion. * Oversee Worker's Compensation to include claims management; reporting, follow up with employees/claim rep/nurse case manager with… more