Partnership departments and internal staff for additional review. Follows up and completes claims once response to request... has been received. Follows established Partnership policies and procedures, Partnership Claims Operating Instruction...
interpersonal skills. Valid California driver’s license and proof of current automobile insurance compliant with Partnership... elements. * Serves as a primary contact for internal and external stakeholders related to Partnership performance data...
for all Partnership lines of business. Responsibilities: Perform concurrent and retro claims audits on new Claims examining staff.... Document audits and report all audit outcomes following the Partnership Claims Operating Instruction Memorandums on claims...
in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements and Partnership policies and procedures.... Works with other Partnership departments to resolve issues relating to authorization of medical services. Audits medical...
: Develops and maintains working knowledge (technical and user interfaces) of Partnership data management and analytics... of all data elements. * Serves as a primary contact for internal and external stakeholders related to Partnership performance...
desirable. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy... setting, program planning, budget/account management, and supervision of teams. Responsibilities: Direct Partnership...
Overview: The Manager of Quality Incentive Programs is responsible for managing Partnership HealthPlan’s Primary Care.... As part of this work, the position oversees Partnership’s Provider Data Portal which allows providers to evaluate...
health services. ▪ Maintains accurate and timely documentation, records, and case files in the Partnership HealthPlan... of California (Partnership) Case Management System for members in behavioral health access line management system. ▪ Develops...
, Microsoft Word, Excel, Outlook, Visio, and PowerPoint. Valid California driver’s license and proof of current automobile... insurance compliant with Partnership’s policy are required to operate a vehicle and travel for company business. Performance...
as assigned. Qualifications: Education and Experience Minimum three (3) years claims examining experience; or Partnership... claims examining experience and completion of Partnership claims training; or equivalent combination of education...
effective and high quality projects to meet the needs of associated Partnership departments. Identifies and manages project... requirements and project budget. Valid California driver’s license and proof of current automobile insurance compliant...
-specific records in the Partnership computer system, in databases and files as applicable. Participates in committees..., workgroups and/or multidisciplinary teams to support Partnership’s strategic plan, organizational goals, and/or business needs...
Overview: To plan, manage and evaluate clinical department and/or Partnership delegate(s) performance and compliance... and monitoring activities for applicable providers and entities, and on-going stewardship of NCQA activities to support Partnership...
a review of all relevant medical records. * Obtain responses from provider(s) and appropriate Partnership departments. When... Conditions (PPCs) and ensures that appropriate notification is sent to appropriate Partnership departments and DHCS Audits...
, Visio, and PowerPoint. Valid California driver’s license and proof of current automobile insurance compliant... with Partnership policy are required to operate a vehicle and travel for company business. . Performance Based Competencies...
management and staff, external clients, and vendors. Valid California driver’s license and proof of current automobile insurance... compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based...
effective and high quality projects to meet the needs of associated Partnership departments. Identifies and manages project... requirements and project budget. Valid California driver’s license and proof of current automobile insurance compliant...
relationships with Partnership HealthPlan of California partners and providers via open and timely communication. - Participates... training manuals, agendas, materials, and evaluation criteria based upon department and Partnership policies...
are preferred, however not required. Valid California driver’s license and proof of current automobile insurance compliant... with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies...
Overview: Train examiner and customer service level I staff on all related claim types for all Partnership lines...: Education and Experience Minimum two (2) years of claims examining experience and completion of Partnership Claims training...