Current jobs related to Compliance Audit Specialist - Long Beach, California - Blue Shield of CA

  • Certification Payroll Compliance Specialist

    3 weeks ago

    Long Beach, California, United States Booth Management Consulting Full time

    Job Title: Certification Payroll Compliance SpecialistAbout Us: Booth Management Consulting, LLC is a diverse CPA firm that provides accounting, auditing, and management consulting services to public and private clients nationwide. Our employee-friendly company environment emphasizes quality of life, initiative, creativity, strong work ethics, and...

  • Claims Audit Professional

    3 days ago

    Long Beach, California, United States Advanced Medical Manage Full time

    We are seeking a highly skilled Claims Audit Manager to join our team at Advanced Medical Manage. As a Claims Audit Manager, you will be responsible for ensuring that incoming claims are processed in accordance with policies, procedures, and guidelines.Key Responsibilities:Prepares and coordinates the completion of complex regulatory and compliance reports...

  • Recertification and Compliance Specialist

    2 days ago

    Long Beach, California, United States Avanath Full time

    Key ResponsibilitiesAs a Recertification and Compliance Specialist at Avanath, you will be responsible for conducting annual recertifications, completing income calculations, maintaining accurate tenant files, and ensuring compliance with all regulatory requirements. You will also be responsible for providing excellent customer service, responding to queries...

  • Medical Claims Audit Expert

    3 weeks ago

    Long Beach, California, United States Advanced Medical Manage Full time

    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...

  • Audit Services Director Job

    5 days ago

    Long Beach, California, United States Jobot Full time

    As a Senior Assurance Manager, you will play a key role in our organization's success. You will be responsible for managing multiple engagements, leading diverse teams, and building strong client relationships.BenefitsWe offer a competitive compensation package, comprehensive benefits, and opportunities for professional growth and development. Our...

  • Compliance and Risk Manager

    4 weeks ago

    Long Beach, California, United States Beach Front Property Management Inc Full time

    Job DescriptionAbout Us:Beach Front Property Management Inc. is a leading provider of property management services, specializing in enhancing the value and performance of both residential and commercial properties. We are known for our professionalism, integrity, and commitment to excellence. Currently, we are looking for a detail-oriented and motivated...

  • Specialist, Quality Assurance and Compliance

    5 days ago

    Long Beach, California, United States Molina Healthcare Full time

    Molina Healthcare is committed to delivering high-quality healthcare services to our members. We are seeking a talented Quality Assurance and Compliance Specialist to join our team and contribute to our quality improvement functions. In this role, you will work closely with our quality improvement team to develop and implement quality improvement...

  • Compliance and Safety Technician

    3 weeks ago

    Long Beach, California, United States Curtin Maritime Full time

    Company OverviewCurtin Maritime has been an industry leader in quality maritime solutions for 25 years. We offer a dynamic work environment and opportunities for professional growth. Estimated Salary: $78,000 - $88,000 per year based on experience and qualifications.About the RoleWe are seeking a highly skilled Operations Compliance Technician to join our...

  • EHS Compliance Specialist

    3 weeks ago

    Newport Beach, California, United States AMVAC CHEMICAL CORP Full time

    Job OverviewThe EHS Audit Manager role at AMVAC Chemical Corp is an exciting opportunity for a seasoned professional to oversee the development, maintenance, and auditing of the company's EHS standards and policies.With 4 sites operating 24/7, the successful candidate will have experience auditing EHS/PSM facilities, with international experience being a...

  • Grant Compliance Accountant

    3 weeks ago

    Long Beach, California, United States Transformational Living Homes Inc Full time

    **Job Overview:**Transformational Living Homes, Inc. is seeking a skilled Grant Compliance Accountant to join our team. In this role, you will be responsible for overseeing the complete grant lifecycle, from acquisition to reporting.Key Responsibilities:Enter, verify, and reconcile all financial data and transactions related to grants.Analyze grant-related...

  • Compensation Specialist

    17 hours ago

    Long Beach, California, United States Fetch Full time

    Job SummaryFetch is seeking a skilled Compensation Specialist to manage and process payroll for U.S. and Mexico-based employees. This role involves overseeing semi-monthly payroll processing, ensuring compliance with regulations, and collaborating with HR and Benefits teams to maintain accurate employee data.Key Responsibilities:Process semi-monthly payroll...

  • Compliance and AP/AR Manager

    3 weeks ago

    Long Beach, California, United States Transformational Living Homes Inc Full time

    **Job Title:** Compliance and AP/AR ManagerWe are seeking a highly skilled Compliance and AP/AR Manager to join our team at Transformational Living Homes, Inc. This role involves overseeing the complete grant lifecycle, from acquisition to reporting, and managing essential financial processes related to accounts payable and receivable.Key...

  • Lawyer and Compliance Specialist

    2 days ago

    Long Beach, California, United States Cover Genius Full time

    Cover Genius is seeking an experienced Legal Counsel to join our team and provide critical legal expertise. In this role, you will support our business operations and ensure compliance with relevant laws and regulations.Responsibilities:Develop and implement policies and procedures to ensure regulatory complianceNegotiate and draft commercial agreements,...

  • Compliance and Risk Management Specialist

    6 days ago

    Newport Beach, California, United States Insight Global Full time

    Job Overview:Insight Global is a dynamic company that seeks an experienced ServiceNow Administrator to join its team. This key role plays a vital part in implementing and maintaining audit management within ServiceNow, with a strong focus on policy and compliance. The successful candidate will have a deep understanding of compliance and risk management...

  • ServiceNow Compliance Specialist

    6 days ago

    Newport Beach, California, United States Insight Global Full time

    Compliance and Risk Management RoleInsight Global is seeking a highly experienced ServiceNow Administrator to support the Infrastructure Request Management team. This role is crucial for implementing and maintaining audit management within ServiceNow, with a strong focus on policy and compliance, including SOC2, ICO, HIPAA, and PCI standards.Key...

  • Real Estate Compliance Specialist

    3 weeks ago

    Long Beach, California, United States Beach Front Property Management Inc Full time

    About UsBeach Front Property Management Inc. is a leading provider of property management services, specializing in enhancing the value and performance of both residential and commercial properties.We are known for our professionalism, integrity, and commitment to excellence. Currently, we are looking for a detail-oriented and motivated Legal Assistant to...

  • Onboarding and Compliance Officer

    3 weeks ago

    Pismo Beach, California, United States Allied Universal® Full time

    Job DescriptionWe are seeking a highly skilled and motivated individual to fill the role of Onboarding and Branch Support Specialist at Allied Universal. In this position, you will be responsible for administering various aspects of branch operations, including but not limited to:Maintaining accurate records and files for employees, benefits, and...

  • Medical Claims Compliance Specialist

    3 weeks ago

    Long Beach, California, United States Advanced Medical Manage Full time

    Job Title: Medical Claims Compliance SpecialistAbout Advanced Medical ManageAt Advanced Medical Manage, we are dedicated to delivering high-quality healthcare services. Our team is passionate about ensuring that our processes and programs are compliant with all applicable state and federal regulations.

  • Nonprofit Financial Specialist

    3 weeks ago

    Long Beach, California, United States Transformational Living Homes Inc Full time

    **Job Summary:**We are seeking a highly skilled Nonprofit Financial Specialist to join our team at Transformational Living Homes, Inc. This role involves overseeing the complete grant lifecycle, from acquisition to reporting, and managing essential financial processes related to accounts payable and receivable.Key Responsibilities:Enter, verify, and...

  • Provider Contract Development and Maintenance Professional

    2 days ago

    Long Beach, California, United States Dental Health Services Full time

    Dental Health Services Provider Network SpecialistIn this role, you will develop and maintain a strong network of dental providers to ensure access to care for our members. You will be responsible for:Recruiting general dentists and specialists to participate in our network.Performing evaluations and audits of dental provider offices to ensure compliance...

Compliance Audit Specialist

3 weeks ago

Long Beach, California, United States Blue Shield of CA Full time
About the Role

We 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 hospital itemized bills and process claims manually for exceptions related to medical necessity, DRG validation, and other factors. This is a challenging and rewarding role that requires strong analytical and problem-solving skills, as well as excellent communication and collaboration abilities.

Key Responsibilities
  • Review medical documents and apply clinical criteria to determine the most appropriate level of care
  • Conduct comprehensive line-by-line audits of hospital itemized bills
  • Process claims manually for exceptions related to medical necessity, DRG validation, and other factors
Requirements
  • Bachelor's degree in Nursing or advanced degree preferred
  • Current California RN License required
  • Minimum 5 years of relevant experience in utilization management or a related field
  • Strong written and oral communication skills
  • Strong analytical and problem-solving skills
  • Active AAPC or ADHIMA coding certification (e.g., CPC-CIC or COC) with procedure coding experience (HCPCS/CPT) preferred
  • Experience with claim data analytics and arbitration preferred
What We Offer

We offer a competitive salary range of $87,230 - $130,900 per year, depending on location and experience. Additionally, we provide opportunities for professional growth and development, a collaborative work environment, and a comprehensive benefits package.