- LA Care Health Plan (Los Angeles, CA)
- …Medicare & Medicaid Services, as well as requirements from the National Committee on Quality Assurance (NCQA) and LA Care policies and procedures. This position ... etc. Collaborates with internal departments (Member Services, Provider Network Operations, Claims , Utilization Management, Pharmacy, and Quality Management) to… more
- Jacobs (Albuquerque, NM)
- …* Monitoring the contractor's quality for compliance with the contractor's approved quality control / quality assurance (QA/QC) plan. * Monitoring ... needed. * Receiving and reviewing progress reports from the contractor and Conducting quality assurance audits. * Assisting the Project Scheduler in reviewing… more
- CGI Technologies and Solutions, Inc. (Knoxville, TN)
- …provides support, feedback, and guidance to the Auditor. Audit performance review and quality assurance are provided through a well-defined review and quality ... management program. **Your future duties and responsibilities:** 1. Reviews medical records to identify recovery opportunities on claims for outpatient… more
- New York eHealth Collaborative (New York, NY)
- …external stakeholders. + Design, implement, maintain, and enhance data workflows, quality assurance protocols, analytical processes, and reporting products (eg, ... (eg, R, SAS, SQL, Python, Salient) as well as quality assurance processes. + Hands-on experience with...both technical and non-technical audiences. + Familiarity with Clinical Quality reporting, Medicare and Medicaid claims data,… more
- Mass Markets (Las Cruces, NM)
- …originating from a call center + Proven ability to meet performance, efficiency, and quality assurance targets + Monitoring of individual and team results to ... Work with other departments in the organization, such as quality assurance , training, IT, and recruiting. +...cars! + Health Benefits:Full-time employees are eligible for comprehensive medical , dental, and vision coverage after 60 days of… more
- Covenant Health Inc. (Knoxville, TN)
- …tell the truth. + Maintains established departmental policies and procedures, objectives, quality assurance program and safety standards. + Demonstrates an ... care is required. Computer experienceand basic math skills required. Knowledge of medical terminology, claims submission, customer service is preferred. Expected… more
- AECOM (Philadelphia, PA)
- …+ Monitoring the contractor's quality for compliance with the contractor's approved quality control / quality assurance (QA/QC) plan + Monitoring ... orders, requests for clarification (RFI's), submittals, and other as needed + Conducting quality assurance audits + Receiving and reviewing progress reports from… more
- Actalent (Des Moines, IA)
- …metrics, completing a minimum of 40 reviews per day post-training, and maintain quality assurance standards at 97%. + Document reviews accurately and ... of our healthcare services. Responsibilities + Conduct utilization management reviews and claims assessments using InterQual criteria and medical policy. +… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …fax, mail, and upload correspondence and documentation as needed. + Follow established quality assurance standards and all policies and procedures. + Report and ... About The Role MagnaCare provides Utilization Review/ Case Management/ Medical Management/ Claims Review services to its clients. Care Coordinators facilitate… more
- Travelers Insurance Company (Las Vegas, NV)
- …Travelers' Claim Organization is at the heart of our business. By providing assurance to our customers during life's rainy days, the Travelers Workers Compensation ... you will handle all aspects of a workers compensation claims . In this role, you will learn how to...work. You will develop the technical skills needed for quality claim handling including investigating, evaluating, negotiating, and resolving… more
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