of Partnership’s computer systems, and technical and problem resolution support to the systems user community. Utilize knowledge... as a liaison for Claims to Configuration, Contracting, and Finance. Maintains in-depth knowledge of Partnership systems...
to the Director of Transportation. Assists staff and providers with the interpretation of Partnership policies, procedures... changes. Participates in all cost containment efforts of both the Health Services department and Partnership. Develops...
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...
Overview: To oversee the appropriateness and quality of care delivered through PartnershipHealthPlan of California..., in State Fair Hearings. * Engagement of the Partnership provider network to improve quality of care and member experience...
or equivalent. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy... ability to lift, carry, or move objects of varying size, weighing up to 35 lbs. All HealthPlan employees are expected...
as assigned. Qualifications: Education and Experience Minimum three (3) years claims examining experience;or Partnership... coding. Knowledge of Partnership Claim Policy and Procedures, EDS provider manual guidelines, Title 22 regulations...
. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy.... Manages work flow and process reengineering efforts as required. Develops strategies and schedules for meeting Partnership...
, 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...
Team and is responsible for leading a growing Quality Department at PartnershipHealthPlan of California (PHC) through...’s Partnership Improvement Academy, DCHS mandated improvement work, performance improvement and engagement activities done with the...