- The County of Los Angeles (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.**...steps to view correspondence, and we will not consider claims for missing notices to be a valid reason… more
- The County of Los Angeles (Los Angeles, CA)
- …direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of ... for and the effective conduct of the system to review patients' medical charts to ascertain the...to view correspondence. Los Angeles County will not consider claims of not viewing or receiving notifications to be… more
- Sedgwick (San Francisco, CA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Estimate Review Specialist **PRIMARY PURPOSE** **:** To review all estimates and ... services. + Monitors, assists, tracks, and provides approval for all claims that are re-inspected by the Carrier. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES**… more
- Sedgwick (Sacramento, CA)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- LA Care Health Plan (Los Angeles, CA)
- …reports by fax, electronic medical records, or on-site visits if needed. (15%) Review medical records, claims , and encounter data to identify key ... to members to close care gaps. The QPHC also outreaches to providers for medical record pursuit and retrieval. This position supports the LA Care medical … more
- Robert Half Accountemps (Los Angeles, CA)
- …Proactively reach out to insurance companies to resolve unpaid or denied medical claims , ensuring timely reimbursement while addressing discrepancies. + Patient ... any questions or concerns to enhance patient satisfaction. + Claims Review and Correction: Analyze claims...claims processing. + Technical Skills: Familiarity with electronic medical records (EMR) systems such as Cerner or Epic… more
- Sharp HealthCare (San Diego, CA)
- …and outcomes studies as directed by the Quality Management + Committee, Peer Review Committee and Chief Medical Officer and reports findings in conjunction ... Director. + Assists in POS/PPO Case Management and high-cost review with CMO and Claims management teams....+ Able to manage difficult peer situations arising from medical care review . + Appreciation of cultural… more
- Robert Half Accountemps (Los Angeles, CA)
- …Proactively reach out to insurance companies to resolve unpaid or denied medical claims , ensuring timely reimbursement while addressing discrepancies. *Patient ... copay inquiries, and addressing any questions or concerns to enhance patient satisfaction. * Claims Review and Correction: Analyze claims data, identify… more
- CVS Health (Sacramento, CA)
- …The ideal candidate will be able to work independently and with others to review claims tied to different overpayment projects in the Overpayment Tracking ... day. **Position Summary** This position will be responsible for utilizing previous ACAS claims experience along with provided guidance to review and validate … more
- Ventura County (Ventura, CA)
- …patients, and payers. + Process bills accurately and receive prompt reimbursements. + Review billing claims , analyze and correct errors, submit appeals and ... Medical Billing Specialist II - Patient Financial Services...direction, the incumbent is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance… more