Medical Case Manager, BHI Utilization Management - Covered California CalOptima Join Us in this Amazing Opportunity.... You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health...
Claims Resolution Specialist CalOptima Join Us in this Amazing Opportunity The Team You'll... line of contact for CalOptima Health providers. You will assist providers with questions related to the payment of claims...
Regulatory Affairs & Compliance Analyst, Policies & Procedures CalOptima Join Us in this Amazing Opportunity The..., and implementation of CalOptima Health policies and procedures. You'll aim to strengthen CalOptima Health's policy framework and ensure...
of insurance payors: PPO, HMO, POS, EPO, Medicare, Medi-Cal, & CalOptima Bi-lingual (English/Spanish, or English/Vietnamese...
and acts a liaison within or outside CalOptima Health. Facilitates communication on specialized topics. Prepares reports...
. Ensure timely and accurate documentation of case notes, service records, and updates in AICA, HMIS, and CalOptima Connect...
as needed. Qualifications At least two years medical back office experience. Knowledge of insurance groups e.g. Medi-Cal, CalOptima, Medicare...
EAP, Carelon/Anthem, IEHP, CalOptima, and any additional contracted payers. Submission must be completed before the client... EAP, Carelon/Anthem, and Medi-Cal managed care plans (including CalOptima and IEHP). Strong working knowledge of the...
, CalOPTIMA, MediCal, etc. Qualifications: Bilingual in Spanish Previous Medical Front Office experience Knowledge...
General knowledge of insurance payors: PPO, HMO, POS, EPO, Medicare, Medi-Cal, & CalOptima Bi-lingual (English/Spanish...