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Comprehensive understanding and ability to interpret federal and state government (DHCS and CMS) guidelines, and eligibility and enrollment process in order to setup core systems for claims, case management, and grievance and appeals.
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Identify the managed care operations you have managed in a Knox Keene licensed health plan and the associated regulatory requirements, as applicable (i.e., Contracting, (Ancillary, Facility, Fee-for-service, Professional, Risk Based), Contract and Benefits Configuration, Compliance, Disputes and Grievances, Credentialing, Claims, Provider Data Management, Provider Relations, Service Operations, or Provider Services.
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The primary use of Dash Cams is to assist in the protection and safety of employees and property, prevention, and detection of criminal offenses such as vehicle vandalism and break-ins and staged-accident fraud, defense of legal claims, driver exoneration, and driver training and improvement.
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Specific responsibilities include writing patent specifications and claims, producing drawings for patent applications, organizing, and analyzing submissions of new ideas, prosecuting patent applications with the USPTO, and providing technical support for patent prosecution when working with outside counsel.
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On call technical support via phone, email or teleconference to Client, or Customers Operations, Risk Management or Claims Administration personnel. Overview: Gallagher Bassett Technical Services (GBTS) division is seeking a "Construction Safety Loss Control Consultant" needed on a per assignment/quarterly basis in the San Jose - San Francisco - Sacramento, CA region to perform safety/loss control risk inspection on multi-year construction project located in the educational/university business sector.
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ADARs are expected to have deep expertise in communicating requirements and addressing barriers associated with local payer policy coverage, multi-channel acquisition pathways, billing and coding (as needed), claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows.
$174,400 - $261,600 a yearFull-timeRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Establishes and manages the project controls staff assigned to the project, including budget/cost estimating, scheduling, document control and information systems, risk management and claims analysis functions.
$183,576.84 - $333,234.25 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Key responsibilities will include claims payment and remittance, network management, provider credentialing, data exchange and reporting and quality oversight. Job Description :A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
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Maintaining familiarity with laws that affect client areas to issue spot and provide basic counseling, including those relevant to sales and marketing of products to health care professionals and reimbursement by government programs, for example, fraud and abuse (Anti-Kickback Statute, False Claims Act), FDA regulation (Food, Drug & Cosmetic Act), privacy (HIPAA), and anti-corruption (Foreign Corrupt Practices Act.
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Under the supervision of a fiscal manager, the Accounting Technician performs full-charge bookkeeping or paraprofessional level accounting work in reviewing, entering, and maintaining program information, claims, reports, budget, and expenditure review and analysis for program contracts, and provides financial reports on contract and program performance.
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The Manager Data Management position will also be responsible for loading and maintaining other system control files to support claims processing, membership, provider and authorization processing, and to oversee and manage the Electronic Claims System, ACO/PPO Eligibility, & Excelicare staff, and Provider Database staff.
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Juris Doctor degree from an accredited law school, demonstrate a strong academic background, and be admitted to a US state bar in good standing. Resolving legal issues using negotiation skills and legal expertise, including pre-litigation dispute resolution and settlements.
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8+ years of experience as a commercial attorney at a top law firm and/or in-house. Anticipation: Holistic, big picture thinker, who anticipates changes in law, enforcement, and/or business objectives and adapts approach as necessary to manage risks effectively and mitigate issues before they arise.
$164,900 - $329,700 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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The attorney will be responsible for acting as the day-to-day legal advisor for Abbott’s Vascular team, and for the drafting and negotiation of various commercial agreements. Tuition reimbursement, the student debt program and education benefit - an affordable and convenient path to getting a bachelor’s degree.
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Monitor equipment and tool warranty programs to insure warranty claims are forwarded to Asset Manager for processing. Assist Maintenance Manager in the repair and fabrication of equipment by performing basic to advanced welding techniques (MIG, TIG, ARC.
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claims job Company: Remote Career Jobs Recruit in San Jose, CA
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