Must have High school diploma, GED or equivalent required, Two year degree preferred. Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization. Minimum of 2 years previous direct experience that included verifying and maintaining provider information and provider contract configuration in a managed care transaction system .

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Registered Nurse Case Manager will report to the FEP Department M

Providence caregivers are not simply valued they're invaluable. Join our team and thrive in our culture of patient focused, whole person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence is calling a Senior Claims Insurance Manager Medical Profe

Apply if looking for Flexibility and Financial Freedom

The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non contracted provide

Incumbent is responsible for obtaining all necessary authorizations in accordance with established guidelines. Verifies eligibility, obtains benefit information, and generates letters for authorizations. Responds to Member Services and Call Center inquiries and resolves any identified authorization issues which arise. The essential functions listed below are not intended

Incumbent is responsible for obtaining all necessary authorizations in accordance with established guidelines. Verifies eligibility, obtains benefit information, and generates letters for authorizations. Responds to Member Services and Call Center inquiries and resolves any identified authorization issues which arise. Total Compensation In addition to the salary range lis

Aya Healthcare has an immediate opening for the following position Claims Processor in Whittier, CA. This is a 13 week contract position that requires at least one year of Claims Processor experience. Make $1040.67/week $1266.01/week. Want a job close to home? We've got you! We'll work with you to build the career of your dreams. Aya delivers Front of the line access to e

Authorization Coordinator ENT Clinic Full Time 8 Hour Days (Non Exempt) (Non Union) Keck Medicine of USC Hospital Los Angeles, California The Authorization Coordinator coordinates communication with admitting, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. He/She will f

Take on an important role within an award winning health organization. Help ensure the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. You will receive urgent, routine, pre service, and retro authorization requests, as well as process prior authorization requests with accuracy and timeliness.

Coding Compliance Auditor (HIM Inpatient) HIM Financial Full Time 8 Hour Days (Non Exempt) (Non Union) Keck Medicine of USC Hospital Alhambra, California In accordance with current federal & state coding compliance regulations and guidelines, the 'IP Coding Compliance Auditor" performs 2nd level reviews of previously coded inpatient accounts for MS DRG validation purposes

Take on a key leadership role within an award winning health system. Help improve patient experiences and operational efficiency with a world class healthcare team. Take your career in an exciting new direction. You can do all this and more at UCLA Health. As an important member of our Medicare Advantage leadership team, you will provide tactical execution and leadership

Serves as administrative support for the Provider Relations team Resolves provider issues by interfacing with cross functional Optum teams Processes electronic communications via email, fax and text Coordinates mass mailing and outreach projects to providers and patients Helps the Operations team plan, prepare, and execute provider events and meetings Coordinates with int

When you join Verizon Verizon is one of the world's leading providers of technology and communications services, transforming the way we connect around the world. We're a human network that reaches across the globe and works behind the scenes. We anticipate, lead, and believe that listening is where learning begins. In crisis and in celebration, we come together lifting u