Medical Coding Manager

Job OverviewAdvanced Medical Manage is seeking a skilled Risk Adjustment Coder-Admin to manage and train healthcare professionals on Hierarchical Condition Categories (HCC) coding. This is a full-time position with a salary range of $70,000 - $90,000 per year.Key ResponsibilitiesManage and analyze large datasets related to HCC coding.Develop and implement...

About the RoleAre you a detail-oriented healthcare professional with a passion for delivering high-quality care? Blue Shield of California is seeking a skilled Clinical Coding Analyst RN, Senior to join our team. As a member of our Facility Compliance Review team, you will play a critical role in ensuring the accuracy and integrity of medical coding for our...

Role Overview:The Clinical Coding Analyst RN Senior will be responsible for performing in-depth quality audits of hospital claims to support ICD-10-CM and ICD-10 PCS codes, as well as MS-DRG and APR-DRG reviews based on clinical determination. This role requires a strong understanding of medical necessity and reimbursement requirements, as well as the...

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 OverviewThe Contract Configuration Analyst I role at Advanced Medical Manage is a key position that requires strong analytical and problem-solving skills to support the configuration of our system. This role is responsible for ensuring accurate payments of claims and capitations to providers, vendors, and other stakeholders.Key Responsibilities:We are...

Job OverviewThis position is responsible for conducting prospective and retrospective reviews of requests for service authorizations to ensure continuity and coordination of care.Key Responsibilities:Determine compliance with established medical necessity criteria using Milliman and Healthcare Management Guidelines.Redirect members to alternative treatments...

About the RoleWe are seeking a highly skilled and experienced System Configuration Lead to join our Clinical Operations team at Advanced Medical Management.Job SummaryThe successful candidate will be responsible for managing and overseeing system configuration, benefits, and provider data to ensure accurate reflection of provider contracts and claims...

We are seeking a highly skilled Medical Facility Plumber to join our team at Delectus, LLC. As a key member of our design team, you'll be responsible for designing plumbing systems for healthcare facilities, ensuring compliance with relevant codes and standards.Key ResponsibilitiesDesign plumbing systems for healthcare facilities, ensuring compliance with...

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...

The Medical Management Specialist-LVN plays a crucial role in promoting and supporting the quality, medical necessity, and cost-effectiveness of care and services at SCAN Health Plan. This position is responsible for ensuring that necessary inpatient and outpatient care and services are rendered to SCAN members at the right time, at the right level of care,...

Job SummaryWe are seeking an experienced UM Nurse, LVN to join our team at Advanced Medical Management. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the highest level of care while also helping us optimize resource allocation.In this role, you will be responsible for conducting...

About TPIRCTPIRC is a leading non-profit research and clinical care center dedicated to transforming the treatment of rare and orphan diseases. Our innovative approach integrates cutting-edge diagnostic tools, artificial intelligence, and patient-centered research to push the boundaries of care and outcomes.As a Medical A/R Specialist at TPIRC, you will play...

OverviewAt Blue Shield of California, we are committed to delivering high-quality healthcare services. Our Utilization Management team plays a vital role in ensuring that our members receive the best possible care.In this exciting opportunity, you will work as a Clinical Review Nurse, Senior - Utilization Management, and be responsible for reviewing medical...

Position DetailsThis 13-week contract position offers a competitive hourly rate, meeting the city's minimum requirement. You will have the opportunity to work on a variety of cases, utilizing your skills and expertise to ensure the best possible outcomes for patients.To be considered for this position, you must have a minimum of 1 year of case management...

**Overview of Blue Shield of CaliforniaWe are a not-for-profit health plan that provides high-quality healthcare services to millions of Californians. Our mission is to make a meaningful difference in the lives of our members by delivering innovative, patient-centered care.About the RoleWe are seeking an experienced Clinical Review Specialist - Utilization...

Job DescriptionAdvanced Medical Manage is seeking a qualified Medical Services Coordination Expert to join our team. In this role, you will be responsible for coordinating medical services and ensuring the highest level of patient care.Main responsibilities include:Main Responsibilities:Coordinate with healthcare providers to ensure seamless careDevelop and...

About the PositionWe are seeking a highly skilled and experienced Senior Fire Protection Engineer to join our team. As a key member of our team, you will be responsible for leading the design of fire sprinklers, fire alarms, and special suppression systems for medium to large projects. Additionally, you will be responsible for project management, client...

Company Overview">This role is part of Blue Shield of California's medical management team, focused on coordinating care for members with complex needs.Estimated Salary Range: $23.15 to $32.51 per hour (California)Job Description:We are seeking a Clinical Services Coordinator to join our team. As a Clinical Services Coordinator, you will serve as an initial...

About SCANSCAN is a leading not-for-profit organization dedicated to improving the lives of older adults in the United States. With over 45 years of experience, SCAN has established itself as a trusted expert in senior healthcare.The OpportunityWe are seeking a highly skilled Senior Medical Policy Analyst to join our team. As a key member of our Medical...

Job SummaryThe Advanced Medical Manage organization seeks a Strategic Operations Manager to oversee the health plan gap analysis process and collaborate closely with the Administration and Quality teams.