Overview This is a hybrid role based in West Hills, CA. ACTIVE LVN or RN license required. Job Details Job Type: Contract Location: West Hills, CA / Canoga Park, CA 91304 (hybrid) Pay: $35.00 - $50.00/hr (eligibility requirements may apply) Responsibilities Audit denied provider and member claims for accuracy and compliance Review and process claims in accordance with UM guidelines and regulatory standards Analyze benefit structures and system configurations (EZCap or similar) Collaborate with cross-functional teams to resolve claim issues and process gaps Document findings, prepare reports, and present trends to leadership Support automated adjudication systems and identify strategies to reduce errors Ensure HIPAA and PHI compliance throughout all claim review activities Participate in special projects related to claim denials and appeals Qualifications Active LVN or RN license (California) 2+ years of experience in Utilization Management (UM) Hands-on experience with HMO/Medicare claims, audits, and denials Familiarity with claims processing systems (EZCap or similar) Strong analytical, documentation, and communication skills Ability to work independently and prioritize tasks Proficiency in MS Office Suite (Excel, Access, PowerPoint, Word) Preferred Skills: CPT, HCPCS, ICD-10 coding knowledge; Advanced Excel skills; experience with regulatory agencies and compliance audits #J-18808-Ljbffr
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