- ICW Group (San Diego, CA)
- …optimizing data models that support actuarial analysis, policy processing, claims processing, underwriting, compliance reporting, and overall business intelligence ... logical, and physical) tailored for Workers Compensation Insurance data such as claims , policies, premiums, exposures, and provider networks. + Builds and maintains… more
- Banc of California (Santa Ana, CA)
- …(ACH) transactions, Large on-us & Unusual items, Stop payment, ATM/Mobile/RDC Deposits, Check Claims , Fraud alerts for Wire, ACH & Debit Card, Wire Transfer. + ... + Follows established bank policies and procedures, meets and adheres to audit standards. Supports the company's goals and values accordingly. Supports general… more
- Walgreens (Citrus Heights, CA)
- …issues and prevent payment rejections. Follows-up with insurance companies as well as medical providers and participates in 3rd party audit . + Follows-up with ... privacy, generics, less expensive medicines, over-the-counter products, and refers to medical provider as needed to ensure medication is taken correctly, health… more
- Walgreens (Gilroy, CA)
- …issues and prevent payment rejections. Follows- up with insurance companies as well as medical providers and participates in 3rd party audit . + Follows-up with ... privacy, generics, less expensive medicines, over-the-counter products, and refers to medical provider as needed to ensure medication is taken correctly, health… more
- Cedars-Sinai (Torrance, CA)
- …Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's ... Duties include but are not limited to, reviewing and submitting claims to payors, performing account follow-up activities, updating information on patient… more
- Sharp HealthCare (San Diego, CA)
- …and group agreements; Operations Manual; benefit matrices; and other administrative and medical guidelines, policies, and procedures. Works closely with the Chief ... Medical Officer (CMO) who is responsible for all decisions...and grievances. **Required Qualifications** + 3 years' experience in claims , utilization review, appeals or member services in a… more
- Cedars-Sinai (Los Angeles, CA)
- …Duties include but are not limited to, reviewing and submitting claims to payors, performing account follow-up activities, updating information on patient ... for appropriate pseudo-code creation. Identifies possible coding deficiencies through charge/ medical record review and coordinates coding review to ensure accurate… more
- Ankura (Los Angeles, CA)
- …+ Review, analyze, and code diagnoses based on information in a patient's medical record according to specific guidelines for each project. + Evaluate compliance ... guidelines and reference materials + Drafts clear and concise analyses of medical record review and coding findings + Ensures successful completion of project… more
- Gilead Sciences, Inc. (Foster City, CA)
- …data like IQVIA, audit data like Ipsos, epidemiology data like NHANES, claims data, etc.) to glean insights and understand implications for our business, inform ... paid time off, and a benefits package. Benefits include company-sponsored medical , dental, vision, and life insurance plans*. For additional benefits information,… more
- Providence (Irvine, CA)
- …compliance with key healthcare regulations, including Stark Law, Anti-Kickback Statute, False Claims Act, Medicare and Medicaid billing rules, HIPAA and EMTALA. + ... Draft and review physician agreements, including medical director agreements, on-call agreements, and professional services agreements. + Prepare and review business… more