Medical Claims Resolution Specialist Kinetic Personnel Group, Inc.Medical Claims Resolution SpecialistOrange, CA$25–$31 / hourA full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one! Job duties: Addresses provider inquiries, questions, and concerns in all areas including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.
NewUtilization Management Policy Initiatives Registered Nurse Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered NurseLos Angeles, CARemote$102,183–$132,838 / yearThis role ensures that the day to day functions of Utilization Management initiatives comply with regulatory and accreditation requirements such as those stated in contracts, CalAIM Population Health Management (PHM) Policy Guide, National Committee on Quality Assurance (NCQA) Department of Health Care Services (DHCS) All Plan Letters (APLs), and Centers for Medicare and Medicaid Services (CMS) Model of Care (MOC) through sound clinical policy maintenance. Non-negotiable requirements of this position: Direct past experience with Health Care / Medical Policy work specifically within a Managed Care Plans environment; experience with the ongoing development of the Medical Policy review process including clinical and utilization data analysis; Assisted in developing training documents and presentations for new and/or revised Medical Policies to internal stakeholders.
Data Scientist - Trust & Safety (Remote) RulaData Scientist - Trust & Safety (Remote)Los Angeles, CaliforniaRemoteWhat makes this role uniquely exciting is its direct connection to our organizational trust: your daily work will build the proactive models and protective guardrails that safeguard Rula’s legal standing, protect patient care, and ensure the business runs securely. Strong data storytelling abilities, specifically a proven track record of translating complex, technical data discoveries into clear risk assessments for non-technical leadership and legal partners.
NewPatient Account Rep Senior MemorialCare Health SystemPatient Account Rep SeniorFountain Valley, CA$25.22–$36.57 / hourThis position must be able to utilize and understand many complex and varying State and Federal statutes and regulations, guidelines, and systems, and perform the account follow-up function with all Medicare government agencies to obtain maximum and correct reimbursement of accounts receivables. Medicare Patient Account Representative, Senior is responsible for all Medicare insurance collections of accounts to ensure that PFS is capturing all revenues as timely and efficiently as possible.
NewClaims Auditor MedPOINT ManagementClaims AuditorSherman Oaks, CARemoteFull timeMedPOINT Management is a leading Independent Practice Association (IPA) management company serving the greater Los Angeles area, dedicated to delivering high-quality, coordinated healthcare to patients across Southern California. Our team enjoys a collaborative work culture, opportunities for professional growth, and the satisfaction of making a meaningful impact in the healthcare industry.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
Certified Medical Coder Feed My People Food BankCertified Medical CoderLos Angeles, CaliforniaRemoteAfter work, you will find things to do in every season, including beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment. Under general supervision, according to established policies, procedures and protocols, codes all disease and operations according to accepted classifications.
Senior Physician Assistant - Radiology UCSF Medical CenterSenior Physician Assistant - RadiologyCAKey responsibilities for this role include (but not limited to) the following: Billable inpatient evaluation and management (E&M) services including evaluation of new adult and pediatric inpatient consults, daily rounding on established IR patients, assistance with admission and discharge for primary IR patients and with care coordination for all IR patients across all UCSF campuses. UCSF APPs are expected to demonstrate accountability for their own clinical practice, participate in patient and staff education, serve as resources for APPs, APP students/fellows, physician residents/fellows, nurses and other staff, exhibit leadership skills, and engage in the mentoring of newly hired APPs.
Sr. Physician Coder - Interventional Radiology - Remote 26-00157 Alura Workforce SolutionsSr. Physician Coder - Interventional Radiology - Remote 26-00157Fountain Valley, CARemoteDESCRIPTION Under the direction of the Coding Compliance Manager, the Senior Specialty Physician Coder is responsible for reviewing and accurately coding physician services to ensure compliant reimbursement and complete charge capture. This role is highly specialized in Interventional Radiology (IR) and requires a coder who can independently perform complex IR coding from day one.