Average salary: $104,556 /yearly
More stats ...turnaround times and quality standards meeting regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.
Ensure all...
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...and monitoring activities of internal health plan departments and external Plan delegates to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements.
Key Responsibilities
1. Conducts routine compliance...
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...capable of accomplishing program goals.
Maintain Member confidentiality.
Strong knowledge and familiarity with:
Medi-Cal and Medicare required.
Resources available in both Riverside and San Bernardino Counties such as housing assistance, food programs, county...
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...Job Description
Job Description Pharmacy Technician Responsibilities:
1. Input, review and decision Medicare Part B and Medi-Cal requests for J codes, S code, Q codes, B codes and other medical benefits drugs/supplies.
2. Review Requests based on UM logic and...
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...increase
~ Team bonus opportunities
Qualifications:
Education & Experience
Minimum of five (5) years in Medi-Cal and/or Medicare managed care with regulatory marketing, enrollment, and member communications guidelines. Five (5) years of experience in a...
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Flexible hours
...Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
* Excellent oral and written communication, including presentation...
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Local area
..., processes, procedures, policies, etc. are in compliance with regulatory agencies, including but not limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health...
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...care environment including contract and financial DOFR interpretation.
Two years (2) claims processing including Medi-Cal and Medicare.
High school diploma or GED required.
Key Qualifications
Yes, must have a valid California Driver's License.
Knowledge...
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...Health Equity Operations: Complete and/or respond to regulatory agency reports (Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), etc.), surveys, audits, and evaluations.
22. Any...
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...possibility to convert to FTE
Pay Rate: $38.49/hr or $80,059/yr
Company Overview:
We are the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire, renowned as a "Great Place to Work." With a commitment to serving over 1.5 million members, we...
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...accreditation interpretation. Specifically, develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures. Manages multiple complex...
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Local area
Flexible hours
..., processes, procedures, policies, etc. are in compliance with regulatory agencies, including but not limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health...
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Monday to Friday
...merit increase
~ Team bonus opportunities
Education & Experience
Four (4) years claims processing experience including Medicare and Medi-Cal
Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation...
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...that support IEHP’s strategic initiatives. The Network Development Manager must have experience in cross-functional business units, Medicare, Medi-Cal, and Covered California lines of business requirements, organizational design, and business process improvement methods....
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...opportunity to an authentic experience!
This Director is responsible for pricing, performance management, and forecasting for IEHP’s Medicare and Commercial (i.e., Covered CA) line of business. This includes, but not limited to, the development of product analytics to...
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...774.40, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With...
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...Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
Communicates...
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...patients, maintaining accurate records, following recommendations from physicians and clinical supervisors. The ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations.
..., based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,0...
Work experience placement
...benefit and financial matrix interpretation.
Preferred Experience
Experience preferably in an HMO or Managed Care setting. Medicare and/or Medi-Cal experience preferred. Prior experience in a lead role or customer service environment is a plus.
Education...
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...and monitoring activities of internal health plan departments and external Plan delegates to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements.
Key Responsibilities
1. Conducts routine compliance...
Holiday work
Full time
Temporary work
Flexible hours
...and monitoring activities of internal health plan departments and external Plan delegates to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements.
2. Leads and reviews audits of the Plan’s delegates...
Full time
Temporary work
Flexible hours
...Director, Product Development will be responsible for developing product portfolios for all IEHP lines of business: Covered California, Medicare Advantage, Dual-eligible Special Needs Plans (D-SNP), and Group products. This role will manage the product development lifecycle,...
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...Care
Health Diagnostics
Hospital
Specialties
HMO Healthcare Insurance
managed care
Medicaid
Medi-Cal
and Medicare
About the Role
The Vice President, Contracting will be responsible for managing and overseeing the organization's contracting...
Full time
Temporary work
...022.40, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With...
Work experience placement
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...CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence.
Nationally recognized criteria such as Medicare Local Coverage Determination, Medicare National Coverage Determination, Milliman Care Guidelines, InterQual, and Apollo Managed...
Full time
Temporary work
Work experience placement
Local area
Flexible hours
...Health Policy, or related field from an accredited institution required.
Key Qualifications
Thorough knowledge of Medi-Cal and Medicare managed care. Must possess strong knowledge of project management and cross-organizational coordination.
High proficiency in...
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Full time
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Flexible hours
..., processes, procedures, policies, etc. are in compliance with regulatory agencies, including but not limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health...
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Full time
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...60 , based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,0...
...779.20, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With...
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