- Elevance Health (Costa Mesa, CA)
- …outside of the client health plan network. + Notifies ordering physician or rendering service provider office of the preauthorization determination decision. ... and Experiences** : + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding , and managed health care, including HMO, PO and POS plans strongly… more
- Sedgwick (Long Beach, CA)
- …claimant and client. + Ensures claim files are properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical ... claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. + Maintains professional client… more
- Dignity Health (Stockton, CA)
- …medical findings, diagnoses, and treatment plans. + Ensure compliance with coding and billing regulations. **Diagnostic Procedures:** + Order and interpret ... Medical Group - Stockton is looking for a **Gastroenterology Nurse Practitioner or Physician Assistant** to join our group in Stockton, CA. **Highlights:** + Join… more
- Prime Healthcare (Ontario, CA)
- …Provides training to new staff on system and referral processes. Assists physician offices and vendors with problem resolution. Knowledgeable in policies, procedures ... Extensive knowledge of professional and hospital claims. + Extensive knowledge of coding , billing. + High School Diploma or GED Preferred qualifications: +… more
- Stanford Health Care (Redwood City, CA)
- …assisting program(2) Completion of medical assistant training by a licensed physician or podiatrist(3) Certification as medical assistant through a Medical Board ... to use and apply medical terminology in performing his/her duties.* Knowledge of coding and billing regulations.* Knowledge of computer systems and software used in… more
- Humana (Sacramento, CA)
- …duties include, but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and ... The Medical Director may occasionally speak with contracted external physicians, physician groups, facilities, or community groups to support regional market… more
- Humana (Sacramento, CA)
- …require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient ... scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities,… more
- Sharp HealthCare (San Diego, CA)
- …time, QC, resource, technical modifiers, technologist/student/RN/Radiologist)Provide correct coding of exams, billing modifiers, suppliesDepart patient in ... to: What the procedure is, how long it is going to take, physician involved, contrast administration and mode of delivery, positioning, instructions related to… more
- Stanford University (Stanford, CA)
- …children and adults. Our interdisciplinary team of leading scientists, physician -scientists, and specialists from fields such as immunology, gastroenterology, ... with multiple data management systems and data capture systems + Proficient coding experience + 1-2 years of personnel management experience + Experience monitoring… more
- Sharp HealthCare (San Diego, CA)
- …includes rationale for denial, potential appropriate alternatives, proposed member physician denial letter language. Pharmacy technicians are not authorized to ... and policies.Committee changes such as new or revised guidelines, drafting Benefit coding requests, and communication of changes to PBM vendor.Performs training for… more