Manager II Grievance/Appeals
2 weeks ago
**Manager II Grievance/Appeals – Claims Support** **Location: *CA Residential Requirement** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations. The **Manager II Grievance/Appeals** is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements. **How you will make an impact:** •Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance. •Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines. •Addresses both internal/external customer/provider needs and concerns related to team activities. •Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards. •Hires, trains, coaches, counsels, and evaluates performance of direct reports. **Minimum Requirements:** •Requires a minimum of 5+ years grievance & appeals experience and a minimum of 3 years of management experience in the healthcare industry; or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences** : • BA/BS preferred. •Medicaid experience •RN _For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills_ . For candidates working in person or remotely in the below locations, the salary* range for this specific position is $79,360 to $142,848. **Locations:** California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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Collector II
1 week ago
Costa Mesa, United States DB HEALTHCARE INC Full timeJob DescriptionJob DescriptionTitle: Collector II - CALocation: Costa Mesa, CA 92626Type: ContractDuration: 3 MonthsStart Date: 05/27/2024Positions: 1Role Type: Local candidates onlyJob Summary:The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments...
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Collector II
2 weeks ago
Costa Mesa, United States APN Software Services Inc Full timeJob DescriptionJob DescriptionThe Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. -Completes assigned accounts within assigned work queues. -Obtains the maximum amount of reimbursement by evaluating claims at the contract rate...
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Collector II
1 week ago
Costa Mesa, United States PRIDE Healthcare Full timeJob DescriptionJob DescriptionCollector IIPride Health is seeking a Collector for one of the large health systems based out of Costa Mesa, California.Location – Costa Mesa, California– 92626Pay range - $24 - $28 per hour.Length of assignment – 3 months (With Possible extension)Shift – Monday-Friday 1st shift.Job SummaryThe Collector serves as the...
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Collector II
2 weeks ago
Costa Mesa, United States ICONMA Full timeDescription: The Collector serves as the account representative for Client in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples:...
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Collector II
1 day ago
Costa Mesa, United States ICONMA Full timeDescription: The Collector serves as the account representative for Client in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples:...
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CarelonRx Account Manager II
1 week ago
Costa Mesa, United States Elevance Health Full timeCarelonRx Account Manager II - Pharmacy Account Management Location: This position will work a hybrid model (remote and office). The ideal candidate must live within 50 miles of one of our Elevance Health PulsePoint locations listed on the requisition. The CarelonRx Account Manager II is responsible for retention and operational excellence that...
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Revenue Analyst II
2 days ago
Costa Mesa, United States DB Healthcare Full timeJob Description Job Description Title: Revenue Analyst II - CA Location: Costa Mesa, CA 92626 Type: Temp to Perm or Direct Hire Duration: Role can be 3 months TTH OR Direct Hire Start Date: 05/06/2024 Positions: 1 Schedule: Monday-Friday 8-5 PM Job Summary: The Revenue Analyst II is a technical expert with strong analytical experience in a healthcare...
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Back Office Assistant Ii
4 weeks ago
Costa Mesa, United States MemorialCare Medical Foundation Full time**Back Office Assistant II** - (MEM007925) **Description** **Title**: Back Office Assistant II **Location**: Costa Mesa, CA **Department**: Pediatric and Adult Medicine **Status**: Part time **Shift**: Days (8hr shift) M, W, F 8:30am - 5:00pm **Pay Range: $22.41/hr - $32.50/hr** At MemorialCare Health System, we believe in providing extraordinary...
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Accounting Specialist II
11 hours ago
Costa Mesa, United States Automobile Club of Southern California Full timeAccounting Specialist IIAs an Accounting Specialist II you will performs a variety of general accounting support tasks in an accounting department.What You’ll Do Daily you will be doing the following.Performs standard accounting duties in the areas of Accounts Payable, Accounts Receivable, Cost Accounting, Transaction Processing, Payroll or Credit and...
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Physician (MD/DO) - CCHP Clinical Operations
2 weeks ago
Contra Costa County, United States Contra Costa County (CA) Full timeContra Costa Health Plan (CCHP) has been serving the health needs for people in Contra Costa County for almost 50 years. CCHP was the first federally qualified, state-licensed, county-sponsored HMO in the United States. In 1973, CCHP became the first county-sponsored health plan in California to offer Medi-Cal Managed Care coverage. In 2024, Contra Costa...
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Relationship Manager
6 days ago
Costa Mesa, United States Comerica Full timeRelationship Manager, Middle MarketThe Relationship Manager is responsible for new business development, portfolio management and underwriting to support the needs of the group. This role will focus on clients that typically have an annual revenue between $30MM and $500MM.Position Competencies:Successful incumbents are customer focused, have strong decision...
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Relationship Manager
6 days ago
Costa Mesa, United States Comerica Bank Full timeRelationship Manager, Middle MarketThe Relationship Manager is responsible for new business development, portfolio management and underwriting to support the needs of the group. This role will focus on clients that typically have an annual revenue between $30MM and $500MM.Position Competencies:Successful incumbents are customer focused, have strong decision...
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Relationship Manager
3 weeks ago
Costa Mesa, United States Comerica Full timeRelationship Manager, Middle MarketThe Relationship Manager is responsible for new business development, portfolio management and underwriting to support the needs of the group. This role will focus on clients that typically have an annual revenue between $30MM and $500MM.Position Competencies:Successful incumbents are customer focused, have strong decision...
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Relationship Manager
3 weeks ago
Costa Mesa, United States Comerica Bank Full timeRelationship Manager, Middle MarketThe Relationship Manager is responsible for new business development, portfolio management and underwriting to support the needs of the group. This role will focus on clients that typically have an annual revenue between $30MM and $500MM.Position Competencies:Successful incumbents are customer focused, have strong decision...
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Relationship Manager
1 week ago
Costa Mesa, United States Comerica Full timeRelationship Manager, Middle MarketThe Relationship Manager is responsible for new business development, portfolio management and underwriting to support the needs of the group. This role will focus on clients that typically have an annual revenue between $30MM and $500MM.Position Competencies:Successful incumbents are customer focused, have strong decision...
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Case Manager II
3 weeks ago
Mesa, United States Encompass Health Full timeJob DescriptionJob DescriptionCase Manager Career OpportunityRecognized for your abilities as a Case ManagerAre you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact...
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Medical Collector
6 days ago
Costa Mesa, United States Peregrine Team Full timePeregrine Team is hiring for a Collector in Costa Mesa, CA. This position is a full-time, contract to hire role with full benefits and competitive pay. $26 - $32/hourJob Duties: The Collector serves as the account representative for the hospital in working with insurance companies, government payors, and/or patients for resolution of payments and...
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Collector
5 days ago
Costa Mesa, United States Peregrine Team Full timePeregrine Team is hiring for a Collector in Costa Mesa, CA. This position is a full-time, contract role with competitive pay. $26 - $32/hourJob Duties: The Collector serves as the account representative for the hospital in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution.Completes...
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Medical Collector
6 days ago
Costa Mesa, United States Peregrine Team Full timeJob DescriptionJob DescriptionPeregrine Team is hiring for a Collector in Costa Mesa, CA. This position is a full-time, contract to hire role with full benefits and competitive pay. $26 - $32/hourJob Duties: The Collector serves as the account representative for the hospital in working with insurance companies, government payors, and/or patients for...
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Medical Collections Specialist
7 days ago
Costa Mesa, United States Peregrine Team Full timeJob DescriptionJob DescriptionPeregrine Team is hiring for a Collector in Costa Mesa, CA. This position is a full-time, contract role with competitive pay. $26 - $32/hourJob Duties: The Collector serves as the account representative for the hospital in working with insurance companies, government payors, and/or patients for resolution of payments and...
