- LA Care Health Plan (Los Angeles, CA)
- …Collaborates with internal departments (Member Services, Provider Network Operations, Claims , Utilization Management, Pharmacy, and Quality Management) to ensure the ... member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review grievance and State Fair Hearing files for compliance with Policies… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …and Risks will be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy and strategy and gain a ... develops systems for Clinical vendor management and vendor oversight. + **Management Review :** Establish and maintain a system to ensure R&D Management Reviews are… more
- Cedars-Sinai (Torrance, CA)
- …new services for appropriate pseudo-code creation. Identifies possible coding deficiencies through charge/ medical record review and coordinates coding review ... experience highly preferred. + Experience in Pathology preferred. + Ability to review and interpret medical documentation, including progress notes, lab results,… more
- Elevance Health (Los Angeles, CA)
- …law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- The County of Los Angeles (Los Angeles, CA)
- …of proctoring. Prepares summary report of each application for evaluation and review by the Credentials and Medical Executive Committees; identifies any ... (CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In… more
- The County of Los Angeles (Los Angeles, CA)
- …Los Angeles County, CA Job Type Full time Job Number P4886A-R Department MEDICAL EXAMINER Opening Date 10/09/2024 Closing Date Continuous + Description + Benefits + ... is subject to closure without prior notice. About the Medical Examiner: The Department of Medical Examiner...as spam/junk/clutter mail. Los Angeles County will not consider claims of not viewing or receiving notification to be… more
- Elevance Health (Rancho Cordova, CA)
- …, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for identifying ... to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim...bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits,… more
- Cardinal Health (Fresno, CA)
- …Collector is responsible for the timely follow-up and resolution of insurance claims . This role ensures accurate and efficient collection of outstanding balances ... receivable and increase cash flow for the organization. **_Responsibilities:_** + Review aging reports and work insurance accounts to ensure timely resolution… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …warning flags to ensure clean claim submission. This position is responsible for pulling medical records to submit with claims and appeals as required by payors. ... the Billing & Collections Rep I is responsible to review and process charges via our EMR system. They...incumbent completes daily processing of claim edits or rejected claims processed through the billing system and from electronic… more
- Cedars-Sinai (Beverly Hills, CA)
- …Description** The Case Management Coordinator provides support to the utilization review process. The coordinator works collaboratively with all team members of ... Utilization Management, Patient and Provider Services, Claims Department and other Care Coordination Department staff. In...and communication skills and the ability to interact with Medical Directors, Providers, CSMNS members, Medical Group… more