Clinical Dispute Resolution Expert
4 days ago
Job Summary:
We are seeking a highly skilled Clinical Dispute Resolution Expert 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 agreements.
Key Responsibilities:
- Triage incoming appeals and properly distinguish between PDRs and appeals, analyze provider disputes regarding reimbursement, claims, or contractual agreements and transfer issues to the correct departments.
- Use internal tracking mechanisms to ensure proper processing timelines and the appropriate actions that need to be taken.
- Review and process PDRs according to CMS guidelines.
- Create proper acknowledgement letters and send to appropriate departments for additional information as needed.
- Reprocess claims as needed for overturned PDRs.
- Create proper resolution letters to close PDRs timely.
- Assist in preparing and reviewing PDRs for health plan audits.
- Assist in training of other members of the PDR team as needed.
Requirements:
- 3+ years experience processing and examining claims and PDRs.
- Experience with EZCAP software a plus.
- Understand different payment methodology and financial responsibility contracts/DOFRs.
- Problem solving skills and expert analytical skills.
- Ability to plan and organize things effectively.
- Excellent communication skills, both verbal as well as written.
Salary:$60,000 - $80,000 per year.
-
Dispute Resolution and Claims Examiner
4 days ago
Long Beach, California, United States Advanced Medical Manage Full timeClinical 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...
-
Phone-Based Case Resolution Expert
2 weeks ago
Newport Beach, California, United States Perun HR Full timeAbout the jobPerun HR is seeking a Phone-Based Case Resolution Expert to join our team.In this role, you will take high-volume inbound phone calls from various stakeholders and provide timely and effective solutions to their queries and concerns.You will work closely with our internal teams to ensure seamless communication and resolve client issues...
-
Business Process Improvement Expert
2 weeks ago
Long Beach, California, United States ShiftCode Analytics Full timeAbout ShiftCode AnalyticsShiftCode Analytics is a leading provider of business solutions. We are seeking a highly skilled Senior IT Systems Analyst to join our team.Estimated Salary: $130,000 - $160,000 per year.About the RoleWe are looking for a talented individual to fill the role of Business Process Improvement Expert and support our clients in Southern...
-
Paralegal Specialist
5 days ago
Long Beach, California, United States Peknic, Peknic & Schaefer, LLC. Full timeJob Title: ParalegalWe are seeking a highly skilled Paralegal to join our dynamic team at Peknic, Peknic & Schaefer, LLC. The ideal candidate will have between 1 and 10 years of experience in Personal Injury and/or Insurance Defense, with a strong presence on the South Shore of Long Island or Queens.The successful applicant will have a solid background in...
-
Part Time Psychiatric Nurse Practitioner
4 weeks ago
Long Beach, California, United States Roots Through Recovery Full timeOverviewRoots Through Recovery is a leading provider of trauma-focused outpatient treatment services for adults and adolescents in Long Beach, CA. As a clinical mental health expert, you will join our team to provide compassionate and evidence-based care to individuals struggling with mental health and substance use disorders.
-
Clinical Data Acquisition Director
4 weeks ago
Long Beach, California, United States Molina Healthcare Full timeJob OverviewMolina Healthcare is seeking an experienced Clinical Data Acquisition Director to lead our HEDIS operations team. This role is responsible for implementing, monitoring, and overseeing all chart collection activities for HEDIS projects, Risk Adjustment, and other state-specific audit initiatives.ResponsibilitiesDevelop and implement operational...
-
Civil Litigation Associate
7 days ago
Solana Beach, California, United States Jobot Full timeJob SummaryWe are seeking an experienced Civil Litigation Associate to join our team at Jobot. As a key member of our litigation department, you will be responsible for independently managing a full case load, handling all aspects of civil litigation from start to finish.About UsAt Jobot, we focus on defending public entity, insurance, and corporate clients...
-
Bodywork and Wellness Expert
5 days ago
Long Beach, California, United States Chiropractic Assistant Full timeAbout Our ClinicWe are a thriving Chiropractic clinic dedicated to delivering exceptional patient care and promoting overall wellness. We are seeking a skilled Massage Therapist to join our team and contribute to this mission.Main ResponsibilitiesPerform a variety of massage and body treatments to cater to client needsProvide expert advice on massage...
-
Construction Associate
4 weeks ago
Long Beach, California, United States Socotec Full timeJob DescriptionJob SummaryWe are seeking a highly motivated and detail-oriented Construction Associate - Financial Analyst to join our team at Socotec Advisory LLC.As a Construction Associate, you will be responsible for applying accounting, financial, and analytical skills to various client situations and practice disciplines. You will perform research,...
-
Children's Lung Health Expert
1 week ago
Long Beach, California, United States TPIRC Full timeJob Overview: The Pediatric Pulmonologist will provide comprehensive care to pediatric patients with respiratory conditions, working collaboratively with other healthcare professionals to ensure optimal patient care and outcomes. The ideal candidate will have a strong background in pediatric pulmonology and excellent clinical skills.Responsibilities:Provide...
-
Dynamic Real Estate Attorney
1 week ago
Newport Beach, California, United States Jobot Full timeJob OverviewSouthern California-based full-service law firm is seeking an experienced Permanent Transactional Real Estate Attorney to join their dynamic legal team.About the RoleNegotiate, draft, and review complex real estate agreements, including purchase and sale agreements, lease agreements, financing agreements, and development agreements.Advise on...
-
Physical Therapist Specialist
6 days ago
Long Beach, California, United States California Healthcare Clinical Employee Full timeRole SummaryWe are seeking a skilled Physical Therapist to join our team at California Rehabilitation & Sports Therapy in Lakewood. As a valued member of our outpatient ortho clinic, you will play a crucial role in providing exceptional patient care and contributing to the success of our organization.About the RoleThis is an exciting opportunity for a...
-
Visual Communications Expert
1 week ago
Long Beach, California, United States Parraway Recruitment Services Full timeParraway Recruitment Services is a creative and supportive team looking for talented Graphic Designers to join our crew.Graphic DesignersIn this role, you will create visually stunning designs for various projects, collaborating with teams to deliver engaging content. Your ability to work well in a team, as well as independently, in a fast-paced environment...
-
Respiratory Medicine Expert
1 week ago
Long Beach, California, United States TPIRC Full timeJoin Our TeamWe are seeking a highly skilled Pediatric Pulmonologist to join our dynamic team at TPIRC. As a key member of our healthcare team, you will provide comprehensive care to pediatric patients with respiratory conditions. This role involves working closely with other healthcare professionals to ensure optimal patient care and outcomes.About the...
-
Senior Litigation Attorney
4 weeks ago
Long Beach, California, United States Career Consulting Partners Full timeCareer Consulting Partners is a leading provider of legal services, partnering with top law firms to represent clients across various industries. We are seeking a highly motivated litigation attorney to join our team in Long Beach, California.Job SummaryThis role offers the opportunity to work on complex cases, from case management and motion practice to...
-
Clinical Operations Manager
5 days ago
Long Beach, California, United States Advanced Medical Manage Full timeJob DescriptionWe are seeking a highly motivated and experienced Case Management Manager to join our team at Advanced Medical Manage. The successful candidate will be responsible for implementing and managing case management programs, providing guidance to case managers, and leading the team to deliver high-quality care.Key ResponsibilitiesClinical...
-
Clinical Coding Expert RN, Senior Lead
4 weeks ago
Long Beach, California, United States Blue Shield of California Full timeJob OverviewWe are seeking a seasoned Clinical Coding Analyst RN, Senior to join our Facility Compliance Review team at Blue Shield of California.
-
Clinical Nurse Specialist
1 week ago
Long Beach, California, United States MemorialCare Health System Full timeJob Title: Clinical Nurse Specialist - Pediatric GIWe are seeking a skilled and compassionate Clinical Nurse Specialist to join our team at MemorialCare Health System. This is an exciting opportunity to make a meaningful difference in the lives of children and families.About the Role:As a Clinical Nurse Specialist, you will provide expert nursing care to...
-
Long Beach, California, United States Walgreens Full timeJob Title: Pharmacist (Full or Part Time)About the Role:We are seeking a skilled pharmacist to join our team at Walgreens. As a pharmacist, you will be responsible for providing high-quality patient care and medication expertise to our customers.Key Responsibilities:• Provides expert advice on medication usage and interactions to patients• Offers...
-
Senior Clinical Coder RN
4 weeks ago
Long Beach, California, United States Blue Shield of California Full timeAbout 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...