Convergehealth - Forward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_Transformation DeloitteConvergehealth - Forward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_TransformationCosta Mesa, CA$105,400–$207,800 / yearWorking knowledge of the retrieval and knowledge layer behind agentic systems - RAG pipelines, embeddings and vector stores, and increasingly knowledge graphs - including how to ground use cases in large volumes of unstructured healthcare data (e.g., clinical notes, payer policies, contracts) alongside structured sources. Partner with Health Care consulting teams and Converge for Healthcare's account and product teams during the sales cycle - running technical discovery, demonstrations, and use-case fit assessments - such as denial prevention, prior authorization automation, or AR follow-up - that qualify client needs and shape a credible path to production value.
NewDRG Clinical Validation Lead Elevance HealthDRG Clinical Validation LeadCosta Mesa, CA$89,520–$161,136 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Revenue Cycle Specialist III (Gastroenterology) Cedars-Sinai Medical CenterRevenue Cycle Specialist III (Gastroenterology)Los Angeles, CAPrimary duties include: Develops and maintains excellent working relationships with Cedars-Sinai Clinical Departments, external clients, and patients, performing duties that include identifying, analyzing, resolving, and responding to our client's inquiries, concerns, and issues, and following up on accounts to ensure resolution. The Revenue Cycle Specialist III works under general supervision and following established practices, policies, and guidelines of Revenue Cycle Management supporting Hospital, Professional Fee billing and collections.
Insurance Collections Specialist Your Behavioral HealthInsurance Collections SpecialistTorrance, CAAt YBH, we pride ourselves on being a centralized hub teeming with resources designed to aid clients and their families in pinpointing the optimal support tailored to their distinct needs and aspirations for well-being. Answering questions from patients, clerical staff and insurance companies, Compiling and tracking outstanding balances owed to our providers.
NewDirector of Patient Safety & Clinical Risk Management Macpower Digital Assets Edge Private LimitedDirector of Patient Safety & Clinical Risk ManagementDowney, CA$168,400–$258,000 / yearOversees infection prevention and control programs to improve employee and patient safety by: directing and prioritizing epidemiological investigations and simulations of significant clusters of infection or serious communicable disease concerns as a part of prevention, surveillance, and outbreak management; coordinating, developing, and maintaining significant outbreak containment protocols and efforts; and consulting with Administration on infection control implications of architectural design, renovation, and construction. Oversees patient safety programs and initiatives by: directing significant event management and response to safety hazards, accidents, incidents, threats, and significant events; and collaborating with executive management and external personnel to develop patient care and satisfaction programs which aim to improve patient flow, clinical support, patient services, and seamless transition of care.
Manager, RCM Client Success Modernizing Medicine IncManager, RCM Client SuccessCAGenerous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. Job Description Summary: ModMed is hiring a Manager, RCM Client Success to oversee team members, including Enterprise Client Advisors, Client Advisors, and Leads, who support assigned RCM Specialties and ensure that exceptional service delivery, client satisfaction, and adherence to revenue cycle management objectives are met across assigned verticals.
Account Advisor I - Call Center Blue Cross and Blue Shield AssociationAccount Advisor I - Call CenterLos Angeles, CARemotePursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Reviews and researches billing and healthcare claim inquiries from members and providers, to ensure proper benefits and/or payments are applied correctly; researches multiple computer systems/applications to verify data/information accuracy.
Field Reimbursement Manager-South Central Harrow, Inc.Field Reimbursement Manager-South CentralLos Angeles, CAThis individual will provide non-promotional, compliant education on coverage, coding, billing, and claims processes - giving customers the confidence and technical know-how to appropriately access and be reimbursed for Harrow brands. The ideal candidate is a proactive problem-solver who thrives in the field, builds strong relationships with practice staff, and brings sharp analytical skills to identify and resolve access barriers at the account level.
NewRevenue Integrity QC Auditor UCLA Health SystemRevenue Integrity QC AuditorLos Angeles, CA$88,900–$190,300 / yearAs the Revenue Integrity QC Auditor, you will conduct pre-billing and retrospective claim audits, evaluate coding, charging, billing, denial, and reimbursement activity, and identify financial risks, root causes, and revenue recovery opportunities. As a condition of employment, the final candidate who accepts an 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; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
CHIEF, REVENUE MANAGEMENT, HEALTH SERVICES/CORRECTIONAL HEALTH Los Angeles CountyCHIEF, REVENUE MANAGEMENT, HEALTH SERVICES/CORRECTIONAL HEALTHLos Angeles, CA$141,907.20–$220,694.40 / yearVeteran's Credit: Pursuant to the County Charter and County policy, in all open competitive examinations (i.e., examinations open to everyone), the County of Los Angeles will add a credit of 10 percent of the total credits specified for such examination to the final passing score of an honorably discharged veteran, as well as the spouse of a deceased or disabled veteran, who served in the Armed Forces of the United States under specific conditions. Option 1: Three years of experience in directing one or more of the following complex health care fiscal operations: budgetary projections or reporting; revenue programs; patient, general, or cost accounting; cost reporting; revenue enhancement strategy development; revenue cycle operations; or other major finance-related areas.
Manager - Clinical Documentation Specialist DeloitteManager - Clinical Documentation SpecialistLos Angeles, CAFull timeExperience using clinical documentation, coding, and quality metrics, including Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined Diagnosis Related Groups (APR-DRG), patient safety indicators, hospital-acquired conditions, present on admission indicators, and risk adjustment measures. Case management or medical coding certification, including Certified Risk Adjustment Coder (CRC), Certified Coding Associate (CCA), Certified Coding Specialist-Physician-based (CCS-P), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Case Manager (CCM).
Claims Manager Medicare Advantage Plan Flexible-Hybrid UCLA Health SystemClaims Manager Medicare Advantage Plan Flexible-HybridLos Angeles, CA$95,400–$208,300 / yearThe Claims Manager of the Medicare Advantage Plan will: Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments. As a condition of employment, the final candidate who accepts an 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; or have filed an appeal of a finding of substantiated misconduct with a previous employer.n.
Sr Fraud, Waste and Abuse Investigator (Investigator Sr) CalOptimaSr Fraud, Waste and Abuse Investigator (Investigator Sr)Orange, CA$72,096–$115,353 / yearWe are hoping you will join us as a Sr Fraud, Waste and Abuse Investigator (Investigator Sr) and help shape the future of healthcare where you'll be an integral part of our OOC - Fraud & Waste team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Medical Review Nurse II - SNF/MDS Auditor MachinifyMedical Review Nurse II - SNF/MDS AuditorCA$85,000–$100,000 / yearMust be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
Account Representative - USC Care MSO CBO - Full Time 8 Hour Days (Non-Exempt)(Non-Union) University of Southern CaliforniaAccount Representative - USC Care MSO CBO - Full Time 8 Hour Days (Non-Exempt)(Non-Union)CA$26–$41.28 / hourWhen extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. The organization encompasses 17 clinical departments, with approximately 1,500 physicians and 2,000 staff delivering care across more than 80 locations from Kern County to Orange County and into Las Vegas.
SVP AI & Data ReveleerSVP AI & DataCARemote$305,000–$355,000 / yearDirect the engineering teams that extract medical codes and quality data from charts: retrospective risk extraction built on Textract OCR, Comprehend Medical, and Gemini; prospective risk extraction that runs PDF and CCDA charts through Gemini and a custom rules engine to surface candidate ICD codes; and quality and HEDIS extraction that applies large language models to chart content. The SVP, AI & Data sets technical direction and architecture, partners with engineering and product leadership on delivery, and stays close enough to the systems to make sound build decisions - while giving team leaders the autonomy to own their domains.
NewRevenue Integrity QC Auditor University of CaliforniaRevenue Integrity QC AuditorLos Angeles, CA$88,900–$190,300 / yearAs the Revenue Integrity QC Auditor, you will conduct pre-billing and retrospective claim audits, evaluate coding, charging, billing, denial, and reimbursement activity, and identify financial risks, root causes, and revenue recovery opportunities. As a condition of employment, the final candidate who accepts an 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; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Medical Billing / Frontdesk Kohan International FoundationMedical Billing / FrontdeskCULVER CITY, CAMedical Biller/Office Administrator (Full-Time, In-Person) We are a non-profit group therapy practice seeking a skilled and dedicated Medical Biller/Office Administrator to join our team immediately! Fluency in Tagalog/Filipino is A MUST to effectively serve our diverse clientele and team but not required.
Jr. Quality Improvement Coder Astiva HealthJr. Quality Improvement CoderOrange, CA$27–$30 / hourIn this role, the Junior QI Coder will partner with the Director to collaborate with network providers and IPA's to improve the quality of care through quality improvement activities that will include RAF, HEDIS, CMS Star Ratings and other health plan reporting. Apply official CPT/HCPCS and ICD10 coding guidelines, internal guidelines, and state specific Medicare/Medicaid coding instructions to review and analyze professionally coded services and coding queries.
Security Software Engineer - Top Secret Clearance SpaceXSecurity Software Engineer - Top Secret ClearanceHawthorne, CA$130,000–$155,000 / yearTo conform to U.S. Government export regulations, applicant must be a (i) U.S. citizen or national, (ii) U.S. lawful, permanent resident (aka green card holder), (iii) Refugee under 8 U.S.C. § 1157, or (iv) Asylee under 8 U.S.C. § 1158, or be eligible to obtain the required authorizations from the U.S. Department of State. You may also be eligible for long-term incentives, in the form of company stock, stock options, or long-term cash awards, as well as potential discretionary bonuses and the ability to purchase additional stock at a discount through an Employee Stock Purchase Plan.