Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer Processes all types of medical claims and adjusts medical disputed claims (Professional and Facility) according to department, contract, and regulatory requirements

Monitors and document all totals related to claims payment errors and examiner productivity for reporting purposes as established in the Compliance Department and Claims Policies and Procedures Develops materials, Trains claims examiners regarding the system and claim procedures and documents results Identifies and resolves various claims issues, documents, and reports re

Apply if looking for Flexibility and Financial Freedom

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 Sr. Medical Malpractice Claims Manager Profes

Apply if looking for Flexibility and Financial Freedom

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

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

The Claims Auditor performs various audits of claims payments and denials to ensure accuracy based on the DOFR, internal policies and procedures and regulatory requirements. Providence caregivers are not simply valued they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient focused, whole person care built on understanding, c

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

Coding Compliance Auditor (HIM Inpatient) HIM Financial Full Time 8 Hour Days (Non Exempt) (Non Union) Apply 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 pu

Authorization Coordinator ENT Clinic Full Time 8 Hour Days (Non Exempt) (Non Union) Apply 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

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.

Working under the direction of the Director, Business Applications & Analytics, this position is responsible for performing alpha and numerical data entry and data verification functions according to established procedures using Teleform, member research in IDX, and mailing of correspondence. The Claims Verifier will perform duties in accordance with guidelines set forth