- Elevance Health (Walnut Creek, CA)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance , or clinical documentation improvement, and a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Guidehouse (El Segundo, CA)
- …This role ensures the efficient handling of patient accounts while maintaining quality assurance standards. The individual is to provide support in ... You Will Do** **:** The **Team Lead - Hospital Claims ** is responsible for supervising and coordinating the daily...and a point of contact for team questions + Quality assurance reviews, feedback, and other trainings… more
- LA Care Health Plan (Los Angeles, CA)
- …continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases, which ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...additional service needs according to specific program guidelines. Uses claims processing and care management software to look up… more
- Sharp HealthCare (San Diego, CA)
- …reasonableness checks). Providing efficient and cost-effective solutions as required.Oversees all claims testing and quality assurance activities and ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- LA Care Health Plan (Los Angeles, CA)
- …Medicare & Medicaid Services, as well as requirements from the National Committee on Quality Assurance (NCQA) and LA Care policies and procedures. This position ... etc. Collaborates with internal departments (Member Services, Provider Network Operations, Claims , Utilization Management, Pharmacy, and Quality Management) to… more
- Sharp HealthCare (San Diego, CA)
- …checks) provide efficient, cost-effective solutions as directed.Serve as the lead on claims testing and quality assurance activities and assisting ... investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or… more
- Travelers Insurance Company (Walnut Creek, CA)
- …Travelers' Claim Organization is at the heart of our business. By providing assurance to our customers during life's rainy days, the Travelers Workers Compensation ... you will handle all aspects of a workers compensation claims . In this role, you will learn how to...work. You will develop the technical skills needed for quality claim handling including investigating, evaluating, negotiating, and resolving… more
- Sedgwick (Sacramento, CA)
- …Performs monthly reconciliations and various balance sheet account controls to safeguard quality assurance . + Prepares deposits, posts receipts, and reconciles ... the Finance Manager or Director. + Process account collections/receivables. + Reconcile claims activity between general ledger and claims system and investigate… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …in regulatory affairs or related areas (eg, clinical development, project management, quality assurance , etc.) in pharmaceutical or healthcare related industry. ... of the global regulatory team (GRL, regional leads, CMC-RA, labeling, medical writing, regulatory operations, etc.) to develop global regulatory plans, address… more
- City and County of San Francisco (San Francisco, CA)
- …compliance with federal requirements. + Reviews targeted tasks, phone calls, and supervisor quality assurance forms to ensure quality of customer service. ... is sustained by our City's commitment to heighten the quality of life for the diverse population of San...general duties above: + Detects, investigates, and prevents fraudulent claims for public assistance to avoid welfare fraud and… more
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