- Elevance Health (Cerritos, CA)
- …to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to ... analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or...Minimum of 3 years experience working in grievances and appeals , claims , or customer service; or any… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ... position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations,… more
- CVS Health (Sacramento, CA)
- …meetings when required. + Understands and can respond to Executive complaints and appeals , Department of Insurance , Department of Health or Attorney General ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- Insight Global (Los Angeles, CA)
- …the Health Plan staff, Plan participants, business managers, health care providers, medical insurance companies and related governmental agencies, and medical ... next steps need to be taken. * Assist with research to advise management on medical claims issues and assist with developing guidelines for use by the examiners… more
- Humana (Sacramento, CA)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... caring community and help us put health first** The Medical Director actively uses their medical background,...of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of… more
- Stanford Health Care (Palo Alto, CA)
- …to effectively facilitate work groups to successful outcomes. + Knowledge of medical and insurance terminology, MS-DRG, APR-DRG, CPT, ICD coding structures, ... the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong… more
- Robert Half Accountemps (Los Angeles, CA)
- …Collections. The Medical Biller must be able excel at denials management, appeals , and insurance follow-up, Key Responsibilities: + Submit and track hospital ... claims to Medi-Cal and other insurance payers,...+ Review, analyze, and resolve denied or rejected Medi-Cal claims + Prepare and submit timely appeals … more
- University of Southern California (Alhambra, CA)
- …which might prevent or delay payment of a particular claim or group of claims . Prepares appeals and rebuttals letters/packages in responses to payer's reason for ... Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related ' claims denials' and ' claims rejections,' specific to ICD-10-CM,… more
- Sacramento County (Sacramento, CA)
- …Or: Two years of full-time paid experience providing technical support for claims administration, developing and/or administering insurance programs for a public ... Two (2) years of full-time paid experience providing technical support for claims administration, developing and/or administering insurance programs for a public… more
- CenterWell (Sacramento, CA)
- …help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims . The Medical Director, Primary Care ... an in-depth evaluation of variable factors. The Medical Director relies on medical background and reviews health claims . The Medical Director work… more