Medical Claims Compliance Specialist

Job OverviewThe Medical Claims Review Specialist will be responsible for reviewing facility claims to ensure compliance with medical necessity and billing standards. This role involves conducting retrospective utilization reviews, preparing cases for medical director oversight, and ensuring adherence to regulatory and accreditation requirements.Key...

Job Title: Medical Claims Audit ExpertAbout the RoleAt Advanced Medical Manage, we are seeking a highly skilled Medical Claims Audit Expert to join our team. As a key member of our audit team, you will play a critical role in ensuring compliance with regulatory requirements and optimizing our claims processing operations.ResponsibilitiesPrepare and...

Job SummaryWe are seeking a Claims Resolution Specialist to join our team at TAJ Technologies Inc. This role is responsible for analyzing and resolving workers' compensation claims, ensuring compliance with company standards and industry best practices.About the RoleThis position involves managing workers' compensation claims from start to finish,...

At Blue Shield of California, we're seeking a highly skilled Healthcare Compliance Specialist to join our Facility Compliance Review team. As a key member of this team, you will play a vital role in reviewing post-service prepayment facility claims for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never...

Job Title: Claims Resolution SpecialistEstimated Salary: $85,000 - $110,000 per yearWe are seeking a highly skilled Claims Resolution Specialist to join our team at United Pacific. This role is responsible for overseeing the incident reporting and claims process to achieve early claim resolution and avoid litigation in a cost-effective and time-efficient...

Senior Healthcare Compliance Specialist Job DescriptionIn this challenging role, you will be responsible for conducting retrospective utilization reviews to ensure compliance with medical necessity and billing standards.The ideal candidate will possess strong analytical skills and effective communication to manage claims and improve quality of care. You will...

Job Summary: We are seeking a highly skilled Claims Resolution Specialist to join our team at Rocket, a part of United Pacific. The ideal candidate will have a strong background in risk management and claims administration, with excellent communication and analytical skills.The Claims Resolution Specialist will be responsible for overseeing the Incident...

Clinical Dispute Resolution SpecialistWe are seeking an experienced Clinical Dispute Resolution Specialist to join our team at Advanced Medical Manage. As a key member of our organization, you will be responsible for managing and resolving disputes between our company and healthcare providers regarding reimbursement, claims processing, and contractual...

Job SummaryWe are seeking a highly skilled and detail-oriented Medical Billing & Back Office Specialist to join our team at Vensure Employer Services. This individual will be responsible for processing medical claims, collecting patient or provider payments, resolving questions and problems with customer accounts, and performing various administrative...

About UsThe Children's Clinic dba TCC Family Health is a unique leader in the greater Long Beach community, addressing disparities in health by providing quality care for the under-served of all ages. We offer a comprehensive range of healthcare services, including well-child visits, acute and chronic care, adult clinic, community outreach and education,...

About the RoleWe are seeking a highly skilled Utilization Management Nurse, Senior to join our Facility Compliance Review team at Blue Shield of CA. In this role, you will be responsible for reviewing medical documents and applying clinical criteria to determine the most appropriate level of care.You will also conduct comprehensive line-by-line audits of...

Job Description:The Clinical Coding Analyst RN, Consultant role is a vital part of our team at Blue Shield of California. We are committed to ensuring the highest level of care and compliance in our services.Company Overview:We pride ourselves on delivering exceptional healthcare services that prioritize patient well-being. Our team works tirelessly to...

Job DescriptionCompany OverviewAdvanced Medical Manage is a leading healthcare management company seeking an experienced Healthcare Claims Processing Lead to join our team.Estimated Salary:$80,000 - $110,000 per yearJob SummaryWe are looking for a skilled and detail-oriented Healthcare Claims Processing Lead to oversee the claims processing workflow and...

Job SummaryWe are seeking a skilled Medical Biller to work in our Long Beach office. As a Medical Biller, you will be responsible for assisting clients with processing insurance claims, noting and processing necessary forms from insurance companies, and accurately recording patient information.Responsibilities:Process and manage insurance claims through...

About the RoleUnited Pacific, a leading gasoline and convenience store retailer, is seeking an experienced Insurance Claims Coordinator to oversee the Incident Reporting and Claims process. As a key member of our team, you will be responsible for achieving early claim resolution and avoiding litigation in a cost-effective and time-efficient manner.In this...

Job OverviewAt Advanced Medical Manage, we are seeking an EDI Process Specialist to join our team. This is a unique opportunity to work in a fast-paced environment and make a significant impact on the organization's operations.Salary: $80,000 - $110,000 per yearAbout the RoleThe EDI Process Specialist will be responsible for managing and overseeing...

Clinical Utilization Specialist, SeniorThe Clinical Utilization Specialist, Senior plays a critical role in the Facility Compliance Review team at Blue Shield of California.Responsibilities include reviewing post-service prepayment facility claims for compliance with contract requirements, industry standards, medical necessity, and hospital-acquired...

ResponsibilitiesPerform retrospective utilization reviews and first-level determination approvals for members using evidence-based guidelines, policies, and nationally recognized clinical criteria.Conduct clinical review of claims for medical necessity, coding accuracy, medical policy compliance, and contract compliance.Prepare and present cases to Medical...

We are seeking a skilled Medical Billing Specialist to join our team at JOSEPH VARDAYO MD INC in Long Beach. This role requires strong attention to detail, excellent customer service skills, and the ability to work closely with clients and medical professionals.Job DescriptionThis position involves processing insurance claims through private insurance and...

About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our purpose is to take care of people, and we strive to make a positive impact on the world through the people and organizations we serve.Job DescriptionWe are seeking a skilled Compensation Claims Adjudicator to join our team. As a...