- LA Care Health Plan (Los Angeles, CA)
- …medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management ... Registered Nurse - Payment Integrity Nurse Coder RN III Job Category:...position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well… more
- Elevance Health (Costa Mesa, CA)
- …abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment . Researches new healthcare-related questions as ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Centene Corporation (Sacramento, CA)
- …involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment . + Develops alliances with the ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- UCLA Health (Los Angeles, CA)
- …with: + High school diploma, GED or equivalent + Four or more years of medical claims payment experience in an HMO environment + Experience with CPT-4, ICD-9CM, ... with policies and procedures. You will: + Research over and under- payment inquiries/appeals + Compile and maintain statistical data consistent + Maintain… more
- Sutter Health (Berkeley, CA)
- …dosing such as mediset system and/or electronic health record a plus. Experience with medical payment and reimbursement programs or willingness to learn is a ... the electronic health records** * Technicians receive training in the electronic medical records as required to perform their daily workflow. Refills are checked… more
- Amazon (CA)
- …and patients on health insurance benefits, answer complex billing inquiries, resolve payment processing issues, support One Medical 's efforts to empower patients ... handle inbound calls from One Medical patients (customers) regarding their medical bills, insurance claims, and payment inquiries. Daily activities include… more
- Tomo Credit (San Francisco, CA)
- …their financial future. Job Summary: We are seeking a highly motivated and detail-oriented Payment Risk Manager to join our growing team. This role is critical to ... managing TomoCredit's payment ecosystem-including card issuers, payment gateways and...our employees through ownership stakes. + Insurance : Comprehensive medical , dental, and vision benefits. + Flexible Vacation Policy… more
- Walmart (Sunnyvale, CA)
- …Payments and Financial Services team as a key member, leading innovative payment solutions and enabling the monetization of seller services and new Fintech ... Payments and Financial Services team is dedicated to developing and managing payment solutions that enhance the seller experience on our platform. By collaborating… more
- Prime Healthcare (Victorville, CA)
- …Hospital Clinical Excellence Award. Desert Valley Hospital, along with Desert Valley Medical Group, offers key services to the community including heart care, ... Paid Time Off + 401K retirement plan + Outstanding Medical + Dental + Vision Coverage + Tuition Reimbursement...Workers Responsibilities Under the supervision of the Director, the Payment Review Specialist position is responsible for accurate and… more
- UCLA Health (Los Angeles, CA)
- …role within a top-tier healthcare organization, supporting accurate and efficient payment posting processes that ensure smooth revenue operations. Elevate your ... of the Cash Posting Supervisor, you will: + Manage all aspects of payment postings within the accounts receivable (A/R) system + Interpret payer Explanation of… more