Medical Billing Customer Representative UCLA Health SystemMedical Billing Customer RepresentativeLos Angeles, CA$30.79–$40.60 / hourAs 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. We're seeking detail-oriented, self-directed professional with: REQUIRED - Two years recent professional billing collection experience as well as two years of customer service experience.
Collections Representative Government Billing SGA Inc.Collections Representative Government BillingLos Angeles, CA$20–$27 / hourResponsibilities : The Collections Representative – Government Billing is responsible for the accurate and timely billing of inpatient, outpatient, and laboratory claims to government and third-party payers. Software Guidance & Assistance, Inc., (SGA), is searching for a Collections Representative – Government Billing for a Contract assignment with one of our premier Healthcare clients in Los Angeles, CA.
NewSIU Investigator Centene Corporation GroupSIU InvestigatorCA$56,200–$101,000 / yearLicenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.
NewMedi-Cal Billing Specialist Pyramid, IncMedi-Cal Billing SpecialistPomona, CA$21–$24 / hourFull timeBy applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Must have skills: 1-3 years of experience in hospital accounts receivable, medical billing, or healthcare collections .
Denial Specialist - Business Office - Full Time - Days - 8hr Emanate Health Medical CenterDenial Specialist - Business Office - Full Time - Days - 8hrGlendora, CA$25.53–$38.29 / hourThe Denial Specialist will possess and apply thorough knowledge of collections and the ability to apply the knowledge to all aspects of a patient account that is involved in the audit and appeals process to accurately complete accounts receivable reconciliation. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.
NewSr. Coordinator, Individualized Care (Case Manager) Cardinal Health IncSr. Coordinator, Individualized Care (Case Manager)CA$21.40–$30.60 / hourDelivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, and support organizations to facilitate coverage and delivery of product in a timely manner.
Medical Assistant, Care Connections - CA ONLY Molina Healthcare IncMedical Assistant, Care Connections - CA ONLYLong Beach, CACoordinates care between members and providers after appointment/service delivery to support member navigation of the health care system, needs related to follow-up care and highest quality care/desired member health outcomes. Responsible for contacting members following appointments/services rendered to ensure member understanding and navigation of the health care system, and coordination support for follow-up care.
Strategic Client Manager CPSIStrategic Client ManagerCAThis role owns client-specific success and recovery plans, drives measurable improvements across the revenue cycle and broader solution portfolio, coordinates cross-functional execution, manages escalations and risk, supports retention and growth, and ensures clients can demonstrate value from the TruBridge partnership. Maintain a disciplined client risk management process using service, financial, operational, relationship, and contractual indicators; identify emerging risks early; quantify retention and financial exposure; establish mitigation plans with accountable owners and deadlines; and escalate unresolved risks through measurable resolution.
OP Coder Auditor Trainee Prime Healthcare Management IncOP Coder Auditor TraineeOntario, California$26.04–$32.37 / hourFull timeThe Outpatient Coder Auditor Trainee finalizes the coding and abstracting of the medical record upon ensuring the assignment of International Classifications of Diseases, Ninth Revision (ICD-9-CM) or Tenth revision (ICD-10/PCS), Current Procedural Terminology (CPT), and Health Care Procedure Coding System (HCPCS), are accurate and supported by the clinical documentation of the respective medial record. Responsibilities: The Outpatient Coder Auditor Trainee reviews and analyzes documentation present in the medical record for outpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software.
Internal Medicine Physician - Optum - Torrance, CA UnitedHealth Group IncInternal Medicine Physician - Optum - Torrance, CATorrance, CAClinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S. Artificial intelligence Architecture Business systems analysis Data analytics Data engineering Data science Network infrastructure Product management & development Security and risk Software engineering.
Primary Care Physician - South Bay/Torrance - Optum UnitedHealth Group IncPrimary Care Physician - South Bay/Torrance - OptumTorrance, CA$237,361–$331,688 / yearOur Value Based Care model allows our clinicians the time needed to provide quality care to patients while supporting a healthy worklife balance Our model is designed to provide the most efficient comprehensive and proven care techniques to treat the whole patient - physically mentally and socially - at each visit. Clinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S.
Supervisor, Benefit Distribution And Installation (50544) Western Growers AssociationSupervisor, Benefit Distribution And Installation (50544)Irvine, CAInterface with personnel in all field offices, TPA employers and brokers, and management staff as necessary to communicate any problems or issues with paperwork submission or installation issues for new business, plan changes, rate renewals and rate changes. Oversee the implementation of each new client with the third party administratorion (TPA) client, with necessary communication between the broker, PCMI operational areas, the client and any external vendor as necessary, including the review, completion & sign-off on Client Set-up Sheetsforms/screens.
NewClinical Documentation Integrity Specialist II - Hybrid FT Days Torrance Memorial Medical CenterClinical Documentation Integrity Specialist II - Hybrid FT DaysTorrance, CaliforniaUses clinical/nursing/coding knowledge to concurrently review and assess the medical record within 24-48 hours of admission including but not limited to physician documentation, lab and radiology results, nursing, nutrition, physical therapy and other provider’s documentation to determine that the most accurate severity of illness and expected risk of morality is reflected in the patient’s health record. Obtains additional documentation from physician or other qualified healthcare provider for clarification when there is conflicting, incomplete or ambiguous information in the healthcare record regarding any reportable data elements dependent on health record documentation.
Senior Director, Strategic Analytics Tendo Systems IncSenior Director, Strategic AnalyticsCARemote$2,024–$2,025This person will combine deep clinical informatics expertise with hands-on Databricks engineering and AI/ML skill to build algorithms that do two things simultaneously: (1) close documentation and coding gaps that affect risk adjustment, mortality index, and quality attribution, and (2) identify gaps and variation in the actual clinical processes of care that drive the metrics used by national hospital ranking and rating programs (e.g., CMS Star Ratings, U.S. News & World Report, Leapfrog, Vizient, Healthgrades, IBM Watson Health/Chartis 100 Top Hospitals). Maintain expert-level, current knowledge of major hospital ranking, rating, and benchmarking methodologies, including but not limited to: CMS Hospital Compare/Star Ratings, CMS Value-Based Purchasing and Hospital-Acquired Condition programs, U.S. News & World Report Best Hospitals methodology, Leapfrog Hospital Safety Grade, Vizient quality and safety benchmarking, Healthgrades, and payer-specific quality programs.
Salesforce Developer Brilliant CornersSalesforce DeveloperLos Angeles, CA$105,000–$115,000Reporting to the Salesforce Administrator Supervisor and working primarily with the Product Development team, the Salesforce Developer designs, builds, tests, and maintains custom solutions on the Salesforce platform with a strong emphasis on Apex programming, Lightning Web Components, and API-based integrations across the organization’s technology ecosystem. Design, develop, test, document, and deploy custom Salesforce solutions using Apex (classes, triggers, asynchronous Apex, batch Apex, queueable, and scheduled jobs), Lightning Web Components (LWC), Aura Components, Visualforce, SOQL, and SOSL, Omni-Channel flow, and flow orchestration.
Nurse Practitioner Family Medicine, Administrative Provider Solutions & DevelopmentNurse Practitioner Family Medicine, AdministrativeAnaheim, CA$183,822–$217,790 / yearIn addition, conducting telehealth visits once a week, a key success factor of this position is educating providers to improve the completeness, accuracy, and reliability of clinical documentation and HCC coding to accurately reflect the patient's true clinical picture. Famous for being the home of Disneyland Resort and the Los Angeles Angels baseball team, the city offers an escape from the bustle of city life, with multiple nature reserves, including Oak Canyon, Weir Canyon and the Anaheim Wetlands.
Coder City of HopeCoderCAThis role abstracts and codes relevant data elements for a certain type of professional fee service area (i.e., Evaluation & Management, major and minor surgical procedure, radiologic service, pathologic service, ancillary service, radiation oncology, and/or infusion charges) for multi-specialty physicians. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix.
Medical Director, Clinical Policy L.A. Care Health PlanMedical Director, Clinical PolicyLos Angeles, CAThis position ensures clinical policies and utilization management frameworks are evidence-based, operationally sound, compliant with regulatory and accreditation requirements, and aligned with organizational goals related to quality, safety, affordability, and member experience. The Medical Director oversees policy architecture, authorization strategy, and utilization oversight across all lines of business, ensuring clinical intent is accurately translated into authorization requirements, coding structures, and system configuration through partnership with internal teams.
Clinical Documentation Integrity Specialist University of CaliforniaClinical Documentation Integrity SpecialistLos Angeles, CARemote$100,161.36–$218,718 / yearThis role involves daily review of high-acuity patient records to identify potential and active payer denials, assess clinical validity, and to support denial prevention, analysis, and appeals across inpatient and outpatient settings; continuously communicating with department staff; educating physicians, residents, and mid-levels; and assisting with appropriate documentation strategies. You will prepare and submit high quality appeal letters supported by clinical evidence, regulatory guidelines, and payor-specific medical necessity criteria, while identifying denial trends and root causes and provide feedback to the CDI and Clinical teams.
Medical Director, Utilization Management L.A. Care Health PlanMedical Director, Utilization ManagementLos Angeles, CAThis position plays a critical role in the mitigation of Fraud, Waste and Abuse (FWA) and requires proactive analysis of service level utilization data to identify trends, outliers and emerging risk areas and recommend corrective action to minimize utilization variation, prevent improper payments and ensure financial stewardship. Job Summary The Medical Director, Utilization Management provides clinical oversight of authorization decision making and processing, pre and post payment claims review activities, payment integrity clinical validation and program integrity functions.