Program Manager, Health Plan Payment Integrity - Long Beach

Description · ***Remote and preferred to live in Iowa*** · JOB DESCRIPTION  · Job Summary · Provides subject matter expertise for oversight, production, and resolution of health plan payment integrity (PI) recovery concepts.  Executes and monitors health plan scoreable action ite ...

The Director Payment Integrity defines payment integrity operating model responsible for prevention governance analytics risk reduction sustained accuracy prepay post pay activity. · ...

The Director Payment Integrity defines the payment integrity operating model As owner accountable for prevention governance analytics risk reduction sustained accuracy across all prepay post pay activity This position ensures accurate provider payments minimized inappropriate spe ...

The Director, Payment Integrity defines the payment integrity operating model. As owner, · dies accountable for prevention,governance.analytics,risk reduction,and sustained accuracy across all prepay · & post pay activity. · This position ensures the accuracy of provider payments ...

The Senior Manager leads critical components of L.A. Care's enterprise Payment Integrity program, · Manages multi-functional teams responsible for prospective edit development, · clinical and non-clinical pre-payment reviews,<br(retrospective audits, ...

The Senior Manager manages critical components of L.A. Care's enterprise Payment Integrity program. This position integrates operational management with analytic development to prevent inappropriate payments. · ...

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best ...

The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment I ...

The job involves reviewing and evaluating inpatient, outpatient, and provider billing for medical treatment appropriateness. · ...

We are a high-performing Managed Services Organization (MSO) supporting a Primary Care Independent Practice Association (IPA) operating under Full-Risk Medicare Advantage Value-Based Care contracts. Our organization partners with primary care providers to deliver high-quality, pa ...

SR Director - Claims Operations and Provider Configuration · We are a high-performing Managed Services Organization (MSO) supporting a Primary Care IPA operating under full‑risk Medicare Advantage value‑based care. We manage delegated claims, provider configuration, payment integ ...

The Senior Director of Claims Operations & Provider Configuration is a senior operational leader responsible for end-to-end claims execution provider setup/configuration and claims system integrity across a fully delegated full-risk Medicare Advantage environment. · <liOwn end-to ...

JOB DESCRIPTION Job Summary · Provides lead level support developing diagnosis-related group (DRG) validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and in accordance with quality reviews of appropriate ICD-10 and/or C ...

We're hiring a Shopify-focused engineer to help scale and evolve high-traffic e-commerce experience. · This role partners closely with design and engineering to build polished conversion-driven storefronts and support global expansion initiatives. · What you'll do · Build and ex ...

SR Director - Claims Operations and Provider Configuration · We are a high-performing Managed Services Organization (MSO) supporting a Primary Care IPA operating under full‑risk Medicare Advantage value‑based care. We manage delegated claims, provider configuration, payment integ ...

This position in Long Beach, CA is designed for a candidate that is looking to begin a career. · ...

+We're hiring a Shopify-focused engineer to help scale and evolve a high-traffic e-commerce experience. · +Build and extend custom Shopify Plus themes · , Develop responsive front-end experiences using modern web technologies · , Collaborate with designers and developers to trans ...

Provides member service by acknowledging the member identifying their needs assisting with purchasing decisions locating merchandise resolving issues and concerns and promoting the company's products and services. · Maintains merchandise presentation by stocking merchandise setti ...

This position in Long Beach, CA is designed for a candidate that is looking to begin · a career. The goal is to learn about steel trading on the inside and develop into an outside sales person. · ...

The Job Manages the capitation and claims accounting responsibilities to ensure accurate and timely reporting of capitation and claims expenses to support financial reporting and analysis. · Oversight includes contract interpretation/analysis, capitation and claims expenses, prov ...