Claims Examiner Career AdvocatesClaims ExaminerLos Angeles, CaliforniaThe Claims Examiner will be responsible for researching and resolving pending claims, reviewing claim denials requiring manual review, and ensuring timely processing in compliance with policies, procedures, and regulatory guidelines. Assist in claims processing and report billing/error trends identified during reviews.
Referral Coordinator (Bilingual English/Spanish) St. Jude Neighborhood Health CentersReferral Coordinator (Bilingual English/Spanish)Orange, CA$23–$25.49 / hourOur health centers use a team-based model of care that includes family medicine, obstetrics, women's health, oral and vision care, preventative and educational health, mental health, patient advocacy, case management, and community health. Obtain authorization for referrals to specialty care and other services from CalOptima, IEHP, Medi-Cal insured patients and facilitate access to care for those without health insurance coverage.
Primary Care Advanced Practitioner (Cantonese Fluency Required) Florence HealthPrimary Care Advanced Practitioner (Cantonese Fluency Required)Monterey Park, CATitle: Primary Care Advanced Practitioner (Cantonese Fluency Required) Company Overview We are an independent primary care practice dedicated to providing exceptional care to our patients. Role Overview As a Primary Care Advanced Practitioner, you will work collaboratively within a small, close-knit care team.
Telehealth Nurse Practitioners UrrlyTelehealth Nurse PractitionersLos Angeles, CARemote$600–$720 / yearPreferred Availability: We are looking for providers who can consistently work weekday/daytime hours , with Thursday and Friday availability strongly preferred . Ability to consistently work weekday/daytime hours , with Thursday and Friday availability preferred .
Telehealth Nurse Practitioners (Remote) UrrlyTelehealth Nurse Practitioners (Remote)Los Angeles, CARemote$600–$720 / yearPreferred Availability: We are looking for providers who can consistently work weekday/daytime hours , with Thursday and Friday availability strongly preferred . Ability to consistently work weekday/daytime hours , with Thursday and Friday availability preferred .
HEDIS Abstractor Astrana Health, Inc.HEDIS AbstractorSan Francisco, CA$27–$33 / hourThe HEDIS Abstractor collaborates with internal quality teams, providers, and external audit vendors to improve measure performance, maintain compliance, and support successful HEDIS audits. The HEDIS Abstractor supports Quality Care Improvement initiatives by conducting comprehensive medical record reviews and abstraction activities to identify and close HEDIS measure care gaps.
CDS Trainee Prime Healthcare Management IncCDS TraineeOntario, California$26.04–$29.69 / hourFull timeResponsibilities: CDS Trainee is responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate the clinical documentation is reflective of quality-of-care outcomes and reimbursement compliance for acute care services provided. 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.
Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRID University of California, IrvineClinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRIDIrvine, CaliforniaFull timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
NewCLINICAL DOCUMENTATION SPECIALIST 4 HX - Clinical Doc Integrity - FT Days Remote University of California, IrvineCLINICAL DOCUMENTATION SPECIALIST 4 HX - Clinical Doc Integrity - FT Days RemoteIrvine, CaliforniaRemoteFull timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
NewCLINICAL DOCUMENTATION SPECIALIST 4 HX - Clinical Doc Integrity - FT Days REMOTE University of California, IrvineCLINICAL DOCUMENTATION SPECIALIST 4 HX - Clinical Doc Integrity - FT Days REMOTEIrvine, CaliforniaRemoteFull timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
Plan Coder (50456) Western Growers AssociationPlan Coder (50456)Irvine, CAThis position will ensure that all new and existing health (medical/dental/pharmacy) insurance plans underwritten by Western Growers Assurance Trust (WGAT) and those of Pinnacle Claims Management, Inc. (PCMI) are in compliance with the respective employers' summary plan descriptions. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively.
Implementation Auditor (50487) Western Growers AssociationImplementation Auditor (50487)Irvine, CAUsing close and comprehensive analyses, verify new and existing plans loaded on the Company's claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments. This position will ensure that all new and existing health (medical/dental) insurance plans underwritten by the Western Growers Assurance Trust (WGAT) and those of Pinnacle, Inc. (PCMI) are in compliance with the respective employers' summary plan descriptions.
NewDecision Scientist - Clinical Informatics (Clinical Data Standards) CVS Health CorpDecision Scientist - Clinical Informatics (Clinical Data Standards)CA$64,890–$158,620 / yearA&BC leverages advanced analytics, clinical informatics, and hypothesis-driven approaches to transform data into actionable, customer-centric insights that drive growth, improve health outcomes, and expand access to healthcare across all CVS Health businesses. Collaborate with data engineering teams to inform data pipeline development, ensuring clinical data is ingested, transformed, and stored in ways that support downstream analytics needs.
Field Reimbursement Manager - Neurology (Los Angeles, CA) Regeneron PharmaceuticalsField Reimbursement Manager - Neurology (Los Angeles, CA)Los Angeles, CaliforniaIn this role, you will support providers throughout all facets of the reimbursement cycle including coverage, coding, product acquisition, available patient support services and site-of-care decision making to enable sustained patient access in a competitive rare disease environment. A bachelor’s degree and at least 5 years of experience in the biopharma reimbursement, market access or field-based access roles working in a matrix environment – with at least 2 years direct Reimbursement experience supporting medical benefit therapies (buy & bill preferred).
NewBill Review Specialist Ethos Risk Services LLCBill Review SpecialistCAABOUT US: Ethos Risk Services is a leading provider of workers' compensation medical management, investigations, and claims solutions, dedicated to helping clients make better decisions through industry expertise, innovation, and exceptional service. Experience: Minimum of 3 to 5 years of workers' compensation bill review experience, reviewing and adjudicating medical bills using state fee schedules, PPO contracts, reimbursement methodologies, client guidelines, and applicable workers' compensation regulations.
Medical Biller Health Atlast West LaMedical BillerLos Angeles, CaliforniaAfter seeing many patients placed on multiple medications by numerous providers without much coordination, HEALTH ATLAST founders Stephanie and Wayne Higashi, both doctors of chiropractic, found a need to create a multi-disciplinary approach to healing where doctors work together as one to optimize a patient's health. Core Responsibilities Manage full-cycle billing: charge entry, claim submission, payment posting, and follow-up.
Medical Biller HEALTH ATLAST WEST LAMedical BillerLos Angeles, CAFull timeManage full-cycle billing: charge entry, claim submission, payment posting, and follow-up. This is an execution-heavy, accountability-driven role—not a passive billing position.
Xcelys Medical Claims Examiner (Remote) NTT DATAXcelys Medical Claims Examiner (Remote)Ontario, CARemoteAs part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.
RAC Manager Prime Healthcare Management IncRAC ManagerOntario, California$71,760–$94,619.20 / yearFull timeExtensive knowledge of nursing care, clinical measurement tools, and clinical outcomes; ability to establish cooperative working relationship with diverse groups and individuals, the medical staff, and other healthcare disciplines; program and database development a plus. Working with the Supervisor(s), a RAC manager functions as a subject matter expert (SME) for the appeals process and takes an active role in managing the process and coordinating with the RAC team, Corporate Utilization Review and Clinical appeals team.
Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - P/T Days Remote University of California, IrvineClinical Documentation Specialist 4 HX - Clinical Doc Integrity - P/T Days RemoteIrvine, CaliforniaRemotePart timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.