NewDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) Elevance Health IncDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)Costa Mesa, CA$86,560–$155,808 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
NewQuality Assurance Specialist NATIONAL COUNCIL ON ALCOHOLISMQuality Assurance SpecialistVan Nuys, CAThe Quality Assurance Specialist reviews clinical documentation and service data to verify that services submitted for reimbursement are supported by the patient record, appropriately documented, medically necessary, delivered by qualified staff, and compliant with applicable Los Angeles County Department of Public Health Substance Abuse Prevention and Control (SAPC), California Department of Health Care Services (DHCS), Medi-Cal, CalAIM, and organizational requirements. Director of Clinical Services and Program Innovation, the Quality Assurance Specialist is responsible for supporting the integrity, accuracy, compliance, and timely billing of Drug Medi-Cal (DMC) substance use disorder services provided by NCADD-SFV.
Paralegal ES Management GroupParalegalOntario, CaliforniaThis position manages workers' compensation claims from inception through resolution, coordinates with attorneys, insurance carriers, third-party administrators (TPAs), medical providers, and government agencies, and represents the company by attending workers' compensation hearings and related legal proceedings as authorized. The role also assists with employment-related investigations, legal documentation, risk management, and compliance initiatives.
Senior Manager, Regulatory Affairs RitualSenior Manager, Regulatory AffairsLos Angeles, CaliforniaRemoteProactively manage team capacity, anticipating bandwidth constraints, redistributing workload, and communicating trade-offs before they become obstacles for cross-functional partners. You'll report directly to the Director of Legal & Strategy, lead the regulatory team, and serve as a critical cross-functional partner to Legal, R&D, Innovation, Marketing, Quality, and Operations.
Assistant Vice President, U.S. Marine - Hull & Liabilities Ascot Group LtdAssistant Vice President, U.S. Marine - Hull & LiabilitiesLos Angeles, CAThe Company provides a competitive benefits package that includes the following (eligibility requirements apply): Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Life Insurance, AD&D, Work/Life Resources (including Employee Assistance Program), and more. All official communication comes from @ascotgroup.com email addresses, if you receive a job offer or recruitment communication from Ascot Group that you suspect might be fraudulent, do not hesitate to contact us directly to verify its legitimacy.
New["Producer Commercial Lines Insurance Los Angeles","Producer Commercial Lines Insurance Los Angeles"] Criterion Executive Search["Producer Commercial Lines Insurance Los Angeles","Producer Commercial Lines Insurance Los Angeles"]Los AngelesIf you're a successful producer frustrated with delayed payouts, low commission splits, lack of support, equity, or being stuck at a firm with no growth trajectory - this is your move. Those same strategic partnerships have allowed us to perfect our personalized, life-cycle approach to placing the ideal candidates with their ideal companies.
Audit Manager - Insurance and Banking Weaver And Tidwell LLPAudit Manager - Insurance and BankingManhattan Beach, CA$120,000–$160,000 / yearYou will be responsible for managing the day-to-day execution of complex financial services audits, mentoring and developing Associates, Senior Associates, and Supervisors, and collaborating closely with Partners on client service, project management, and business development. Working knowledge of U.S. GAAP and Statutory Accounting Principles (SAP) as they apply to property & casualty and/or life insurance companies, including familiarity with statutory financial reporting, the Model Audit Rule, and state insurance department regulatory requirements.
Life Insurance Position - State Farm Agent Team Member Nate Nguon - State Farm AgentLife Insurance Position - State Farm Agent Team MemberTustin, CAFull timeROLE DESCRIPTION: As an Account Manager Team Member for Nate Nguon Ins and Fin Svc Inc - State Farm Agency (Tustin, CA), you are vital to our daily business operations and customers’ success. Service can include responding to inquiries regarding insurance availability, eligibility, coverages, policy changes, transfers, claim submissions, and billing clarification.
Sr. Manager, Field Reimbursement (Hybrid Role in Valencia, CA) Setpoint Medical CorpSr. Manager, Field Reimbursement (Hybrid Role in Valencia, CA)Valencia, CARemote$125,000–$175,000 / yearAt least 4 years' experience working in medical device reimbursement, market access, healthcare consulting, accounts receivable or claims follow-up in a medical device company, healthcare provider, or third-party billing service provider. Understanding of hospital billing workflows, ancillary systems (OR systems, materials master files, charge routers, etc.) and ability to learn and use IT systems such as EPIC, Cerner, etc.
Liability Zone Leader - West Allianz SELiability Zone Leader - WestLos Angeles, CARemote$185,000–$250,000 / yearA minimum of 8 years of experience in underwriting profitable Liability business, including specialized expert understanding of sub-LoB products and portfolio; Recognized, well-established long term relationship building with brokers at peer group level and within the local market; Specialized understanding of regional/local Liability insurance markets and competitor landscape, including global elements; Understanding of legal and regulatory framework; Ability to assess risk inherent exposures and natural hazards relevant to Liability; Ability to analyze current performance against benchmarks applying how the market operates and functions, the business needs and customer needs; Experience designing, developing and implementing consistent, robust wordings; Robust understanding of policy administration life cycle, information collection, policy issuance, premium bookings, credit control, and cancellation; Ability to analyze highly complex data, from multiple sources, in detail, identifying and resolving issues before they transpire; Excellent written and verbal communications skills, with an ability to influence others; Experience with MS Office tools; Significant experience in leadership and development of direct teams, including coaching, mentoring and developing team members and performance assessment; Ability to persuade and motivate others to act, without executive authority; A deep knowledge of artificial intelligence (AI) and machine learning (ML), with the ability to leverage AI-driven insights to shape strategic decisions and drive innovation across the organization; and. The Impact You Will Have: Reporting to the Head of National Accounts, Liability, the Liability Zone Leader - West will: Lead a team of underwriters/team leads to underwrite profitable new and renewal business to meet Liability targets regionally and/or globally; Lead team in negotiating participation, pricing and terms and conditions for large/critical clients; Take ownership of large/critical accounts/clients and will have ultimate responsibility for accounts within the team; Lead and manage a team, including training and development and act as the referral point for other underwriters; and.
Senior Analyst, Medical Economics - REMOTE Molina Healthcare IncSenior Analyst, Medical Economics - REMOTELong Beach, CARemoteDemonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. Provides support and ownership for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities and improve financial performance.
Associate Principal Scientist, Innovation - Scientific Affairs Liquid I.V.Associate Principal Scientist, Innovation - Scientific AffairsEl Segundo, California$116,100–$174,100 / yearWe know that the happiest and highest performing teams include people with diverse perspectives that encourage new ways of solving problems, so we strive to attract and develop talent from all backgrounds and create workplaces where everyone feels seen, heard, and empowered to bring their full, authentic selves to work. Our team members enjoy a flexible and inclusive working environment, a highly collaborative and innovation-forward culture, generous benefits and perks that empower employees to champion their wellbeing every day, as well as an infinite supply of Liquid I.V. for extraordinary hydration.
NewExecutive VP of Finance - Laboratory Revenue Cycle Lighthouse Lab ServicesExecutive VP of Finance - Laboratory Revenue CycleLos Angeles, CALighthouse Lab Services is partnering with a growing healthcare organization in the Los Angeles, CA area to recruit an experienced Executive Vice President of Finance with deep expertise in laboratory revenue cycle management and reimbursement strategy. This is an outstanding opportunity to join the executive leadership team of a growing clinical laboratory organization where you'll have a direct impact on financial strategy, reimbursement optimization, operational performance, and long-term organizational success.
New["Utilization Review Tech","Utilization Review Tech"] KPC Health["Utilization Review Tech","Utilization Review Tech"]Santa AnaUnder direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus.
Claims Auditor Health Source MSOClaims AuditorAlhambra, CAFull timeResponsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates. Job Description : Claims Auditor will be responsible for auditing claims processed by Claims Examiners.
Claims Adjuster Kinetic Personnel GroupClaims AdjusterMonrovia, CA$55,000–$75,000 / yearTemporaryThe ideal candidate has a strong understanding of coverage analysis, liability evaluation, and California insurance regulations, and is able to resolve claims efficiently and fairly. This role is responsible for providing high-quality customer service while managing a volume of property damage claims.
Case Management Coordinator Health Source MSOCase Management CoordinatorAlhambra, CAFull timeJob Description: In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group.
Customer Service Representative Health Source MSOCustomer Service RepresentativeAlhambra, CAFull timeAbility to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time as needed. Review and research incoming healthcare claims from members and providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g.
FPI Level 2 - Aerospace/Manufacturing (2nd Shift 1:30pm - 10pm) Consolidated Precision ProductsFPI Level 2 - Aerospace/Manufacturing (2nd Shift 1:30pm - 10pm)Cudahy, CA$25–$28 / hourOther Required Knowledge, Skills & Abilities: Consolidated Precision Products (CPP) is an industry-leading manufacturer of highly engineered components and sub-assemblies, supplying the commercial aerospace, military and industrial markets with small-to-large “function critical” products. Recertification shall be accomplished by successful completion of practical and specific examinations equivalent to those required for initial certification.
FPI Level 2 - Aerospace/Manufacturing (2nd Shift 1:30pm - 10pm) (Cudahy, CA) Consolidated Precision ProductsFPI Level 2 - Aerospace/Manufacturing (2nd Shift 1:30pm - 10pm) (Cudahy, CA)Cudahy, CA$25–$28 / hourOther Required Knowledge, Skills & Abilities: Consolidated Precision Products (CPP) is an industry-leading manufacturer of highly engineered components and sub-assemblies, supplying the commercial aerospace, military and industrial markets with small-to-large “function critical” products. Recertification shall be accomplished by successful completion of practical and specific examinations equivalent to those required for initial certification.