Medical Claims Audit Expert

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 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...

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 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...

At Sedgwick, we believe in the value of caring for our colleagues and clients alike. Our mission is to provide exceptional service and support to those who need it most.What We Offer:We offer a comprehensive benefits package that includes medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or...

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...

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...

ResponsibilitiesIn this pivotal role as Risk Adjustment Coder- Admin, you will be responsible for several critical tasks:Reviewing medical record information to identify, collect, assess, monitor, and document claims and encounter coding information related to Hierarchical Condition Categories (HCC)Auditing provider documentation of CPT, ICD-9, and ICD-10...

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,...

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...

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...

Job Title: Clinical Audit Specialist**Salary:** $70,000 - $90,000 per yearWe are seeking a skilled Clinical Audit Specialist to join our team at Molina Healthcare. In this role, you will be responsible for supporting the prevention, detection, investigation, and reporting of healthcare fraud, waste, and abuse.Key Responsibilities:Perform accurate and...

Job Summary: Claims Processing SpecialistWe are seeking a highly organized and detail-oriented Claims Processing Specialist to join our team at Jobot. This individual will be responsible for processing claims, data entry, and policy processing. The ideal candidate will have proficiency in Word and Excel and excellent analytical skills.Estimated Salary:...

Job SummaryWe are seeking a highly organized and detail-oriented Medical Benefits Administrator to join our team at Advanced Medical Manage.The ideal candidate will have experience with benefits configuration and interpretation, as well as excellent analytical and problem-solving skills. The selected individual will be responsible for supporting all aspects...

About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to help our clients protect their brand, minimize business interruptions, and provide exceptional customer experiences. Job Description: Claims Team Lead - Workers CompensationPrimary Responsibilities:Supervise multiple...

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...

JOSEPH VARDAYO MD INC is looking for a highly organized and detail-oriented Healthcare Claims Processor to join our team in Long Beach.The successful candidate will have previous experience with medical coding and billing, excellent communication skills, and the ability to work accurately and efficiently.The estimated salary for this position is $50,000 -...

ResponsibilitiesBenefit Configuration: Program, review, and audit benefit configurations for Authorizations and Claims to ensure accuracy and reliability.Eligibility Verification: Verify members' benefits through Health Plan websites and phone calls while checking eligibility simultaneously.Communication: Document findings internally with the Benefits team...

Job Title: Insurance Claims AdministratorThe company Jobot is seeking a highly organized and detail-oriented Insurance Claims Administrator to join their team. This individual will be responsible for processing renewal certificates of insurance, data entry in the agency management system, and policy processing. The ideal candidate will have proficiency in...

Job Title: Benefits AdministratorJob DescriptionAs a key member of the Advanced Medical Manage team, the Benefits Administrator will play a crucial role in supporting all aspects of benefit configuration. This includes programming, reviewing, and auditing benefit configuration to ensure accurate authorizations and claims processing.The ideal candidate will...