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
...Description Real Estate Agent Spokane, WA (High Support & Abundant Leads) Haven Real... ...DOUBLE/TRIPLE average industry sales 30%+ of our team NET over $100,000 annually... ...Revenue sharing & stock options 85/15 commission split with $15k cap, zero franchise fees...
Job Description Job Description Assistant to the general manager. Candidates Need An Outgoing & Vibrant Personality. Must be ready to work in a fast paced environment and be able to take initiative and direction. In addition, Strong Work Ethic & Industry Experience...
...safety. If this sounds like you, Apply now ! We want to meet you. Requirements: This position is Entry-Level so no prior experience is required Must have proficient Math and Language skills Schedule: ~ Monday - Friday 6:30 am - 5:00 pm Benefits:...
...Overview Stryten Energy is looking for great additions to the Salina team! Distribution Center Workers fill Order Processors, Rotates, Warehouse, Plaque Room, and Dock Coordinator positions in our distribution center departments. Distribution center workers must work...
...Quarry Plant Operator Luck Stone Mount Airy Plant is seeking an experienced Plant Operator to join their team. Production is the core of our business. Our Plant Operators monitor our crushers, conveyors, screens, feeders and bins to maximize production and provide...