- Ventura County (Ventura, CA)
- …analyze (Accountant I) or calculates and analyzes (Accountant II) Incurred but not Reported medical claims based on system generated claim lag reports to provide ... flexible credit allowance of up to $23,530 annually to offset the purchase of medical , dental, and/or vision insurance for you and your dependents. + Employee only -… more
- Sedgwick (Sacramento, CA)
- …and assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug ... in drug selection and dosage, and monitor complex drug regimens; to provide medical necessity reviews to evaluate, implement, and monitor options and services to… more
- LA Care Health Plan (Los Angeles, CA)
- …feedback to the team lead on any issues identified during research or claims review . Applies subject expertise in evaluating business operations and processes. ... medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management… more
- Centene Corporation (Sacramento, CA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- Cedars-Sinai (CA)
- …Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We provide an amazing benefits package that includes ... Professional Fee billing and collections. Duties include reviewing and submitting claims to payors, performing account follow-up activities, updating information on… more
- Humana (Sacramento, CA)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- The County of Los Angeles (Los Angeles, CA)
- SENIOR NURSING INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3309230) Apply SENIOR NURSING ... INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Salary $122,010.72 - $182,634.24 Annually Location Los Angeles County, CA Job Type Full time Job Number Y5216P Department… more
- Sedgwick (Sacramento, CA)
- …you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your ... of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Humana (Sacramento, CA)
- …Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + ... Coding Educator is responsible for reviewing and analyzing internal data and medical records, as well as coordinating educational sessions with providers to enhance… more
- Sutter Health (Emeryville, CA)
- …for critical health plan functions-including utilization management, credentialing, authorizations, concurrent review , and elements of claims review -ensuring ... best practices. + Proficiency in utilization management processes: authorizations, concurrent review , and medical necessity criteria. + Thorough understanding of… more