Managed Care Coordinator jobs in Temecula, CA

Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)

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Sr. Managed Care Biller Collector
  • Prime Healthcare Management Inc
  • Ontario, CA FULL_TIME
  • Overview

    Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

    We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

    Responsibilities

    The Senior Managed Care Biller/Collector is responsible for both billing and collections, gathering and securing all information needed for billing, follow up, and payment of accounts in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for managed care. This includes maintaining the deficiency lists used to obtain missing documents from internal or external entities, resolving claim rejections, packaging claims, including global billing with attachments of professional fee claims, performing proactive follow up with payers and other entities and securing payment of accounts. The senior biller/collector is accountable and responsible for billing through account closure.

    #LI-BF3

    Qualifications

    Education and Work Experience

  • Minimum of three years hospital managed care/commercial collector experience.
  • 2 years of recent hospital managed care billing experience in an automated environment.
  • Associates degree or equivalent work experience required.
  • Knowledge of contract interpretation.
  • Familiar with hospital billing requirements.
  • Knowledge of out of state Medicaid billing guidelines.
  • Knowledge of basic managed care, Medicaid/Medicare billing rules, regulations, and deadline.
  • Working experience with all payer types including: commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross-over into different payers.
  • Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $20.00 to $38.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

  • 2 Months Ago

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Associate Counsel (Managed Care/Health Care)
  • Inland Empire Health Plan
  • Rancho Cucamonga, CA FULL_TIME
  • What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Provi...
  • 1 Month Ago

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CCT/CCA Care Coordinator
  • Access TLC Health Care
  • Riverside, CA FULL_TIME
  • Access TLC is seeking dedicated and compassionate Care Coordinators to join our team. The Care Coordinator has direct responsibility for an assigned caseload of patients and provides case management a...
  • 12 Days Ago

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Non Medical Home Care Coordinator
  • Nu Grace Family Care
  • Ontario, CA PART_TIME,TEMPORARY
  • Coordinate and oversee non-medical home care services for clients. Conduct client assessments to determine care needs and develop individualized care plans. Match clients with appropriate caregivers b...
  • 1 Month Ago

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LVN Care Coordinator
  • SUPERIOR HOME HEALTH CARE SERVICES, INC
  • Upland, CA FULL_TIME,PART_TIME
  • DUTIES Direct the coordination of patient care, under the supervision of the Clinical Manager. RESPONSIBILITIES Coordinate patient care, among disciplines. Confer, with Clinical Manager on problems an...
  • 21 Days Ago

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Scheduling Coordinator
  • Care At Home
  • Corona, CA FULL_TIME
  • The Staffing Coordinator & Recruiting Coordinator primarily responsible for recruiting & scheduling caregivers to fulfill client needs. The Staffing Coordinator & Recruiting Coordinator is expected to...
  • Just Posted

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0 Managed Care Coordinator jobs found in Temecula, CA area

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Care Coordinator
  • Interim Healthcare of Irvine
  • Irvine, CA
  • Job Description Job Description We are seeking an in-office Care Coordinator plus Recruiter to join our Interim HealthCa...
  • 3/28/2024 12:00:00 AM

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RN Care Manager, Outpatient Care Coordination, Hematology (Full Time)
  • Children's Hospital of Orange County
  • Orange, CA
  • Work Location Orange, California Work Shift Day - 08hrs (United States of America) Why CHOC? At CHOC, we strive to be th...
  • 3/28/2024 12:00:00 AM

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Patient Care Coordinator
  • Smile Brands
  • Moreno Valley, CA
  • Overview At Bright Now Dental we pride ourselves on being a people-first organization, led by passionate and experienced...
  • 3/27/2024 12:00:00 AM

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Patient Care Coordinator
  • Optum
  • Mission Viejo, CA
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 3/25/2024 12:00:00 AM

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Patient Care Coordinator
  • Optum
  • Dana Point, CA
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 3/25/2024 12:00:00 AM

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Patient Care Coordinator
  • Optum
  • Laguna Beach, CA
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 3/25/2024 12:00:00 AM

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Patient Care Coordinator
  • Optum
  • Trabuco Canyon, CA
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 3/25/2024 12:00:00 AM

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Patient Care Coordinator
  • Optum
  • San Clemente, CA
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 3/25/2024 12:00:00 AM

Temecula /təˈmɛkjʊlə/ is a city in southwestern Riverside County, California, United States. The city is a tourist destination, with the Temecula Valley Wine Country, Old Town Temecula, the Temecula Valley Polo Club, the Temecula Valley Balloon & Wine Festival, the Temecula Valley International Film Festival, championship golf courses, and resort accommodations for tourists which contribute to the city's economic profile. The City of Temecula, forming the southwestern anchor of the Inland Empire region, is approximately 58 miles (93 km) north of downtown San Diego and 85 miles (137 km) southea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$53,363 to $91,582
Temecula, California area prices
were up 3.0% from a year ago

Managed Care Coordinator in San Francisco, CA
Care managers also sometimes provide case management--for example, information about transportation assistance, food programs, and other social services.
December 12, 2019
Managed Care Coordinator in Santa Barbara, CA
Nursing home administrators manage staff, admissions, finances, and care of the building, as well as care of the residents in nursing homes.
February 02, 2020
Managed Care Coordinator in Orange, CA
Assist with on-boarding and training of new Managed Care Coordinators.
January 20, 2020