NewPatient Service Rep, Sea View - Irvine Children's Hospital of Orange CountyPatient Service Rep, Sea View - IrvineIrvine, CaliforniaBending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation Physical Activity Lifting . Lifting (Floor to waist level) - Constant 67 or more%, Lifting (Floor to waist level)- Frequent 36-66%, Lifting (Floor to waist level) - Occasional 0-35%, Lifting (Waist level and above) - Constant 67 or more%, Lifting (Waist level and above)- Frequent 36-66%, Lifting (Waist level and above) - Occasional 0-35% Sensory Requirements:
Special Investigation Unit Investigative Analyst III L.A. Care Health PlanSpecial Investigation Unit Investigative Analyst IIILos Angeles, CAUses knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability, reimbursement methodologies, and relevant laws to find suspicious patterns in claims data, provider enrollment data, and other sources. Care's mission is to provide access to quality health care for Los Angeles Countys vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Decision 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.
Clinical Documentation Integrity Specialist UCLA Health SystemClinical 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.
BioMed Tech I PHS Bio-Medical ServicesBioMed Tech IInglewood, California$25–$34.91 / hourFull timeOverview: Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more. 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.
Nurse Itemized Bill Reviewer IBR Analyst MachinifyNurse Itemized Bill Reviewer IBR AnalystCA$80,000–$90,000 / yearAt Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will, as a Nurse Itemized Bill Reviewer (IBR Analyst), be responsible for reviewing facility insurance claims to determine true and accurate charges.
NewSupervisor Grievance and Appeals CalOptimaSupervisor Grievance and AppealsOrange, CA$84,092–$134,548 / yearBachelor's degree PLUS 1 year of experience of health care management experience, preferably in a managed care environment in related areas of responsibility of utilization management, quality management, customer service or grievances and appeals required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. We are hoping you will join us as a Supervisor Grievance and Appeals and help shape the future of healthcare where you'll be an integral part of our GA - Provider Disputes 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.
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. 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.
Medical Assistant/ Insurance verifier , authorization specialist Apex Practice Management GroupMedical Assistant/ Insurance verifier , authorization specialistNorthridge, CAFull timeThe ideal candidate will be responsible for obtaining insurance authorizations and check eligibility for medical procedures and services, ensuring timely approvals to facilitate patient care. - Communicate with healthcare providers, insurance companies, and patients to gather necessary information.
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.
Pharmacovigilance Specialist Grifols SAPharmacovigilance SpecialistLos Angeles, CA$95,000–$105,000 / yearExample: If a job level requires a Bachelor's degree plus 4 years of experience, an equivalency could include 8 years of experience, an Associate's degree with 6 years of experience, or a Master's degree with 2 years of experience. Serves in an advisory capacity including activities such as product monographs review; draft responses to pharmacovigilance requests from regulatory agencies; participates in the drafting and implementation of pharmacovigilance contracts and agreements.
NewHealthcare Contract Definition Analyst - Medical Group Experian Information Solutions IncHealthcare Contract Definition Analyst - Medical GroupCARemoteExperian''s people first, inclusive and purpose driven culture is multi award-winning; World''s Best Workplaces 2025 (Fortune Global Top 25), Great Place To Work in 26 countries to name a few. You''ll have opportunity to: Analyze as well as, define, medical group contracts for Medicare, Medicaid, Workers'' Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payers.
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.
Senior Actuary Health Plan Analytics ReveleerSenior Actuary Health Plan AnalyticsCARemote$150,000–$185,000 / yearThis role builds member-level actuarial models that quantify risk adjustment performance, HCC (Hierarchical Condition Category) capture, medical economics, utilization, and population health trends, and translates those models into customer-facing dashboards that inform pricing, forecasting, and program strategy. Reveleer is hiring a senior actuary to lead health plan and risk adjustment analytics for each line of business for Reveleer customers across Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), Affordable Care Act (ACA), Medicaid, and provider value-based contracts.
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.
Commercial Managed Care Collections and Denials Manager - HB Patient Financial Services - FT Days University of California, IrvineCommercial Managed Care Collections and Denials Manager - HB Patient Financial Services - FT DaysAnaheim, 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. Responsibilities: Position Summary: The Commercial/Managed Care Collections/Denials Manager reports to the Assistant Director-Patient Financial Services and is responsible for managing hospital accounts receivables (A/R) and the collections, denial, and workflow activities for Commercial/Managed Care payers – Commercial, Managed Care, Workers Compensation, TriWest/VA and all other third-party payers.
Field Reimbursement Manager - Central ImmunityBio IncField Reimbursement Manager - CentralEl Segundo, CAThe Field Reimbursement Manager proactively provides education and support to appropriate providers and their office staff on reimbursement programs for designated therapeutic products in their defined geographically aligned accounts. Designated an FDA Breakthrough Therapy, ANKTIVA is the first FDA-approved immunotherapy for non-muscle invasive bladder cancer CIS that activates NK cells, T cells, and memory T cells for a long-duration response.
Manager, Payment Integrity Program Development & Innovation HGS Healthcare LLCManager, Payment Integrity Program Development & InnovationCAJob Description: Manager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. Manager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments.
Pharmacy Biller/Office Manager Oncare PharmacyPharmacy Biller/Office ManagerDowney, CaliforniaCompletion of classes in medical terminology, anatomy and physiology, ICD-9 and Current Procedural Terminology (CPT) coding conventions, and disease process from an accredited program. At least two (2) year billing experience in private or health care organization (preferred but required); Experience with physician or ambulatory setting coding preferred.
Certified Risk Coder Astrana Health IncCertified Risk CoderMonterey Park, CAThe Certified Risk Coder plays a critical role in supporting Astrana Health"s value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.