Job Title Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. Essential Job Duties Supports
Your Role The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting
Claims Support Specialist Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for
About POS360 We are a rapidly growing technology company specializing in point-of-sale payment processing and delivery integrations for locally owned brick-and-mortar stores. Our mission is to accelerate the transition from traditional electronic cash registers to powerful new point
Audit Support For Enterprise Risk Adjustment Provides audit support for Molina enterprise risk adjustment activities. Responsible for developing, recommending and implementing controls and cost-effective approaches to minimize the organizations risks effects. Identifies and analyzes potential sources
Job Title Claims Recovery Specialist Job Description Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Collaborates with health