- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... verified through reconciliation of end to end on all regulatory functions. Duties Audit readiness: Performs ...Required: A minimum of 5 years of experience in regulatory auditing ( Appeals & Grievances ,… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... compliant with all Product Lines' contractual, state and federal regulatory , and accreditation requirements. The Compliance Advisor develops ...forth) and developing audit tools. Demonstrated experience developing and delivering training programs… more
- LA Care Health Plan (Los Angeles, CA)
- …is the liaison in external and or (CMS) claim audits Organization Determination, Appeals & Grievances (ODAG) of delegates and subsequently monitors delegates ... Plans Auditor III is responsible for planning audits and audit work programs that address appropriate claims and financial...reviewed and approved by management prior to submission for Regulatory Affairs & Compliance and Legal review. Monitors the… more
- Ventura County (Ventura, CA)
- … agencies as needed; + Serves as the compliance point of contact for grievances , appeals , and Notices of Adverse Benefit Determinations (NOABDs); + Supervises ... compliance policies and procedures, including those related to ethics, privacy, and regulatory requirements; + Collaborates with the HCA Compliance Officer to ensure… more