Senior Special Investigations Unit Medical Reviewer

1 month ago

Rancho Cucamonga, United States IEHP Full time

What you can expect

Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience

Under minimal supervision, the Senior Special Investigations Unit Medical Reviewer (Senior SIU Medical Reviewer) performs clinical and complex reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP's Compliance Special Investigations Unit (SIU). The Senior SIU Medical Reviewer will provide guidance and mentorship to SIU Medical Reviewers.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

* CalPERS retirement
* 457(b) option with a contribution match
* Generous paid time off- vacation, holidays, sick
* State of the art fitness center on-site
* Medical Insurance with Dental and Vision
* Paid life insurance for employees with additional options
* Short-term, and long-term disability options
* Pet care insurance
* Flexible Spending Account - Health Care/Childcare
* Wellness programs that promote a healthy work-life balance
* Career advancement opportunities and professional development
* Competitive salary with annual merit increase
* Team bonus opportunities

Education & Experience

* A minimum of five (5) years of experience performing medical reviews in support of a healthcare SIU
* Bachelor's degree in medical billing or medical coding, nursing, healthcare administration, or related field from an accredited institution required


* Certified Professional Coder (CPC) required


* One of the following licenses required:

1.Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians

2. Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BR

Key Qualifications

* Excellent verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail
* Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary

Start your journey towards a thriving future with IEHP and apply TODAY

  • Senior Special Investigations Unit Medical Reviewer

    1 month ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!  Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under minimal supervision, the Senior Special Investigations Unit Medical Reviewer (Senior SIU Medical Reviewer) performs clinical and complex reviews...

  • Senior Special Investigations Unit Medical Reviewer

    2 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!  Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under minimal supervision, the Senior Special Investigations Unit Medical Reviewer (Senior SIU Medical Reviewer) performs clinical and complex reviews...

  • Special Investigations Unit Medical Reviewer

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to...

  • Special Investigations Unit Medical Reviewer

    2 weeks ago

    Rancho Cucamonga, United States IEHP Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to...

  • Special Investigations Unit Medical Reviewer

    1 month ago

    Rancho Cucamonga, United States IEHP Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to...

  • Special Investigations Unit Medical Reviewer

    2 months ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    **What you can expect!** Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience!** Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and...

  • Special Investigations Unit Medical Reviewer

    1 month ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!  Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare...

  • Special Investigations Unit Medical Reviewer

    2 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!  Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare...

  • Special Investigations Unit Medical Reviewer

    7 days ago

    Rancho Cucamonga, CA, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to...

  • Special Investigations Unit Investigator

    3 weeks ago

    Rancho Cordova, United States Federated Mutual Insurance Company Full time

    Who is Federated Insurance?: At Federated Insurance, we do life-changing work, focused on our clients’ success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we’re looking for employees who want to make a difference in others’ lives, all while...

  • Quality Review Nurse, RN

    1 month ago

    Rancho Cucamonga, United States Alura Workforce Solutions Full time

    Position Quality Review Nurse, RN Description MUST live in California and be able to wrok a hybrid position. Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for: - Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case...

  • Medical Biller

    3 days ago

    Rancho Cucamonga, United States California Medical Billing Full time

    **About us** California Medical Billing is a medical billing business in Rancho Cucamonga, CA 91730. We are challenging, fast-paced and engaging. Our work environment includes: - Growth opportunities - Casual work attire - Flexible working hours Full-time 40 hrs/week Physician Medical Billing and Collections Specialist. **MUST HAVE MINIMUM of 3 yrs....

  • Senior Accountant

    3 weeks ago

    Rancho Cucamonga, United States New World Medical Full time

    JOB SUMMARY: The Senior Accountant is responsible for providing overall support to the Finance & Accounting department. Responsibilities include maintaining the general ledger, reviewing and analyzing budgets and ensuring integrity of the financial data. They will also assist in preparing financial reports and working on special projects as needed. ESSENTIAL...

  • LVN Medication Nurse

    1 week ago

    Rancho Cucamonga, United States Oakmont Senior Living Full time

    Medication Nurse, LVN / LPN On-Call Pay Range: $25.00 - $28.25 IVY PARK AT ALTA LOMA is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Residents enjoy a rewarding lifestyle with individualized...

  • Special Loan Workout Officer

    3 days ago

    Rancho Cucamonga, United States U.S. Bank National Association Full time

    At U.S. Bank, we’re on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide,...

  • Senior Liability Claims Specialist

    4 weeks ago

    Rancho Cucamonga, United States CorVel Corporation Full time

    CorVel in is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Auto and General Liability claims. Additionally, the Specialist will work within delegated authority to best possible outcomes for CorVel and our clients. The position is premise liability and auto...

  • Senior Liability Claims Specialist

    2 weeks ago

    Rancho Cucamonga, United States CorVel Corporation Full time

    CorVel in is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Liability claims. Additionally, the Specialist will work within delegated authority to best possible outcomes for CorVel and our clients. The position is premise liability focused, with premise...

  • Senior Case Manager

    3 weeks ago

    Rancho Cucamonga, United States Kaiser Permanente Full time

    Job Summary: Position located within the Correspondence center, reporting to the Correspondence Center Team Lead or Correspondence Center Assistant Director. Responsible for handling grievances and appeals review process through investigation, preparation, effectuation, and presentation of appropriate materials for review. Partner with internal and external...

  • Senior Case Manager

    3 weeks ago

    Rancho Cucamonga, United States Kaiser Permanente Full time

    Job Summary: Position located within the Correspondence center, reporting to the Correspondence Center Team Lead or Correspondence Center Assistant Director. Responsible for handling grievances and appeals review process through investigation, preparation, effectuation, and presentation of appropriate materials for review. Partner with internal and external...

  • Senior Claims Specialist

    6 days ago

    Rancho Cucamonga, United States CorVel Corporation Full time

    The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to...