- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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Medical Assistant Back Office
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Actalent Los Angeles, United States Full timeActalent is looking for a full time MA in the Mission Hills area in California. Bilingual in Spanish and making $20-$23/HR · Pay: $20-$23/hour · Typical day: Float between the front and the back depending on what they need for that day, it will be majority in the back. You will ...
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Staff Education RN
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Nursing Department Manager, Operating Room FT
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Certified Registered Nurse Anesthetist
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Certified Registered Nurse Anesthetist
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Certified Registered Nurse Anesthetist
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Clinical Nurse Specialist RN, NICU, FT, SIGN ON BONUS
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LVN I
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Emergency Room RN
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Sp Unit Staff RN
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Step Down Unit RN-L2
Found in: SonicJobs Direct Apply US - 2 days ago
Kaiser Los Angeles, United States Full timeJob Summary: · As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent with the Medical Center Vision, Mission, and St ...
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Sp Unit Staff RN
Found in: SonicJobs Direct Apply US - 4 days ago
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Level V Sr RN-Clinic Y1
Found in: SonicJobs Direct Apply US - 4 days ago
Kaiser Los Angeles, United States Full timeSign-On Bonus Eligible: $10,000.00 · Job Summary: · Functions as a Lead of the healthcare team, coordinates departmental operations that ensure quality patient care in a safe, healing environment that is patient and family centered. Demonstrates responsibility and accountability ...
Payment Integrity Recovery Services Processor II - Los Angeles, United States - L.A. Care Health Plan
Description
Salary Range: $50, Min.) - $62, Mid.) - $75, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Payment Integrity (PI) Recovery Services Processor II will work under the Payment Integrity recovery services framework. The PI Recovery Services Processor II will review, post, and reconcile incoming solicited and unsolicited refund checks to the appropriate claims processing platform while maintaining performance metrics. The PI Recovery Services Processor II will review and retract claims in appropriate claims processing platform to withhold recovery amounts against future provider payments while maintaining performance metrics. The PI Recovery Services Processor II will execute the activities of the recovery services unit to ensure that L.A. Care remains fully compliant with all Federal, State and regulatory requirements pertaining to claims payment and recovery functions.
The PI Recovery Services Processor II will identify incremental recovery opportunities by actively processing refunds and retractions to recognize trends resulting from provider billing issues or system misconfiguration. This position conduct in depth research to ensure recovery (retraction) functions are accurately applied according to reimbursement policies and contractual requirements. This position will consistently evaluate applicable policies and procedures and recommend changes, as appropriate, to ensure efficient and accurate processing of claims within L.A. Care's claims department. This position will maintain current and historical knowledge of national and state-wide standards pertaining to claims processes and recoveries and will ensure that these requirements are implemented throughout the recovery unit.
Duties
Review, post, and reconcile incoming solicited & unsolicited refund checks to the appropriate claims processing platform. Review and retract claims in the appropriate claims processing platform to withhold recovery amounts against future provider payments. (20%)
Assist Recovery Services Supervisor with in depth research of inquiries submitted from internal and external departments. Provide assistance/guidance with complex audits to Processor I staff members. (20%)
Recommend new pipeline opportunities based on active analysis of refunds received. Assist with Quality Assurance (QA) of new business processes with internal departments and vendors. Assist Recovery Services Supervisor in monitoring work queue inventory and prioritization based on departmental needs. (20%)
Prioritize work to achieve performance metrics while managing multiple competing priorities and tasks. Identify and document business processes for the recovery services team.(20%)
Handle and remediate escalated recovery communications (email, calls, etc.). Facilitate training sessions with Processor I staff on complex audits. Auditing of Refunds and Retractions in Centralized Overpayment Repository and Core Platform(s). (10%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Associate's Degree
Experience
Required:
At least 6months-1 years of experience in a claims role within a managed care environment processing Health Plan claims recoveries or demonstrated proficiency in current recovery role while exceeding performance metrics.
Preferred:
At least 3 years demonstrated experience in processing Health Plan claims recoveries or demonstrated proficiency in current recovery role while exceeding performance metrics.
Experienced in working with Hospital and Provider Billing Departments.
Experienced in interpreting complex contractual terms with Providers, Facilities, Plan Partners, delegated groups.
Skills
Required:
Solid understanding of standard claims processing systems and claims data analysis.
Working knowledge of claims coding and medical terminology.
Ability to effectively prioritize and meet deadlines while managing multiple competing tasks.
Must have excellent communication skills, strong analytical, team building skills.
Ability to work effectively with diverse team members.
Preferred:
A deep knowledge of claims code sets including but not limited to HCPCS, DRG, APC and other inpatient and outpatient coding systems. Knowledge of ICD 10 is desirable.
Good knowledge of contractual pricing mechanisms for inpatient, outpatient, LTC and ancillary services.
Must have a solid understanding of the application of Division of Financial Responsibility (DoFR) to claims processing.
Must be familiar with coordinating benefits between health plan payers.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including