Description. The Position. The Regulatory & Compliance Manager will assist the Compliance Officer with implementation and ongoing development of the Company’s Compliance Program to ensure adherence to regulatory requirements. The Regulatory & Compliance Manager will serve as a subject-matter expert on compliance and privacy related topics and will be responsible for working collaboratively with business units, external regulators, and clients to ...
Description. We are looking for a Quickbook experienced individual that has experience in specifically Quickbook Desktop Enterprise to assist with bookkeeping services for our clients. This individual must have a proactive and entrepreneurial mindset to assist in Managed Service Organization (MSO) operations by bookkeeping our clients' finances. Knowledge of interpreting and analyzing financial statements, running reports, and understanding the A...
Description. The UM Customer Support will play a role in ensuring the satisfaction of the company's clients and members by delivering outstanding customer service and resolving any inquiries or issues related to UM submissions or processes. This position will also actively support the UM Department and provide any comprehensive support, including but not limited to administrative and clerical tasks such as mailing, data entry, and other assigned ...
Description. The Claims Customer Support will play a role in ensuring the satisfaction of the company's clients and members by delivering outstanding customer service and resolving any inquiries or issues related to claim submissions or processes. This position will also actively support the Claims Department and provide any comprehensive support, including but not limited to administrative and clerical tasks such as mailing, data entry, and othe...
Description. Position: Credentialing Specialist. Hybrid: Remote & In-office (as needed). This position reports to the Director of Provider Services and is responsible for full cycle credentialing of Providers and Facilities. Position must have experience with facility credentialing of Hospitals, SNF, Home Health, Radiology etc. The role will work closely with new client implementation and will assist regularly with transitioning Credentialing fil...
Description. Position: UM Case Manager. UM Case Manager implements the effective and best practices of Utilization Management. The UM Case Manager will provide high quality medical care review and service by appropriately applying the Milliman Care Guidelines, Health Plan and CMS/DMHC clinical guidelines to determine medical necessity for all authorizations. Position Specs. Full Time, Benefits Eligible. Non-Exempt. Hybrid: Remote & In-office (as ...
Description. THE SPECS. Non-Exempt. Full-Time. Benefit-Eligible: PTO, PSL, Holidays, Medical, Dental, Vision, Life Insurance, etc. Hybrid: Remote & In-office. Wage Range: $20 - $26 per our, or depending on experience. THE POSITION. The Claims EDI Coordinator has a vital role within the healthcare administration industry. It is responsible for managing the electronic data interchange (EDI) process for claims submissions and ensuring accurate and t...
Description. Position: UM Case Manager. UM Case Manager implements the effective and best practices of Utilization Management. The UM Case Manager will provide high quality medical care review and service by appropriately applying the Milliman Care Guidelines, Health Plan and CMS/DMHC clinical guidelines to determine medical necessity for all authorizations. Position Specs. Full Time, Benefits Eligible. Non-Exempt. Hybrid: Remote & In-office (as ...
Description. THE POSITION. This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for management and monitoring of claims compliance with all products and lines of business for managed care claims payments. This person is the liaison with internal...
Description. Position: Contract Coordinator. . This position will assist in the development and management of the contracting process workflow, and other duties as needed by the Contracting Department. The Contract Coordinator will need to be able to multi-task, be articulate and detail-oriented, with excellent reading comprehension and analysis to assist the Director of Contracting and Contract Specialist. The Contract Coordinator will need to u...
Description. Position: Credentialing Specialist. Hybrid: Remote & In-office (as needed). This position reports to the Director of Provider Services and is responsible for full cycle credentialing of Providers and Facilities. Position must have experience with facility credentialing of Hospitals, SNF, Home Health, Radiology etc. The role will work closely with new client implementation and will assist regularly with transitioning Credentialing fil...
Description. The Position. We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Commercial, Medicare Advantage, and Medi-Cal claims will make you a great candidate, along with experience or familiarity with Healthcare Service industry, Indepen...
