Astiva Health Careers
We are pleased to offer the opportunity to sell quality products in San Diego and Orange County.
Starting your career at Astiva Health gives you the opportunity to complete fulfilling work while helping others
live their life to the fullest. We are proud to serve a wide-ranging and diverse community through healing and hope
you can join us on our path to better healthcare for all.
- Responsible for manual input and adjudication of MSO claims.
- Interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts.
- Data enter paper claims into EZCAP.
- Strong working knowledge of Medicare and Medi-Cal, OPPS APC, Ambulatory Surgery pricing, and RBRVS payment guideline.
Utilization Management Coordinator
- Under the direction of UM Director and CMO processes Prior Authorization-Referral requests that are received from PCPs and-or Specialty Providers.
- Understand and follows UM policies and procedure pertaining to referral process.
- Works with Membership Management and Claims and Contract Departments on an as needed basis
- Verifies that the patient address in EZCAP corresponds with prior authorization/referral process.
Director of Utilization Management
- Analyzes UM data to identify trends and recommend interventions to the Medical Director.
- Assesses clinical and operational policies and procedures annually; revises and implements as appropriate.
- Prepares and manages regulatory audits and responds to departmental inquiries from the DMHC and CMS.
- Works with the finance and claims department to improve processes in the UM department such as turnaround times for authorizations, denial letters and member notification of services.
Director of Member Services
- Leads the Member Call Center and Appeals & Grievance teams
- Provides guidance and leadership to the Member Experience department by directly supervising employees.
- Develop and implement policies & procedures to ensure all compliance requirements are met.
- Use customer insight and root cause analytics to identify organization wide improvements and present these plans to leadership and peers.
Interested, apply by email resume to: Christopher.email@example.com