Data Integration Analyst AI & Risk Adjustment ReveleerData Integration Analyst AI & Risk AdjustmentCARemoteWe especially welcome candidates transitioning from academic or research careers, for example, graduate study or research experience in fields such as molecular biology, genetics, physics, chemistry, or other quantitative sciences, who want to apply their talents in a fast-moving, high-impact commercial environment. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence.
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.
Cardiologist, Outpatient Welcome HealthCardiologist, OutpatientLos Angeles, California$400,000–$600,000 / yearThe role will be primarily based at our Bell clinic, with the opportunity to support additional clinic locations across Los Angeles, Orange, and Riverside Counties as the practice grows. Built on the principles of geriatric medicine and backed by SCAN Group, Welcome Health delivers care that meets patients where they are, including in home, in clinic, and virtual visits.
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.
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.
Business Analyst - REMOTE Molina Healthcare IncBusiness Analyst - REMOTECARemoteCommunicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
Clinical Documentation Improvement Specialist (CDI) II - Full Time, Days (CBO Culver City) NOR Healthcare SystemsClinical Documentation Improvement Specialist (CDI) II - Full Time, Days (CBO Culver City)Culver City, CAFull timeRequired QualificationsCDIP or CCDS Medical Graduate, Physician Assistant or Registered Nurse (Current CA License) Minimum 1 year of previous practical floor CDI experience in an acute care setting Ability to multitask and maintain a work pace appropriate to workload Must demonstrate customer service skills appropriate to the job Excellent written and verbal communication skills in English Ability to effectively communicate with physicians in a clear and concise manner Computer literacy and proficiency Hospital Fire and Life Safety Card (Los Angeles City Employees only) Preferred QualificationsCCS Physical RequirementsIndicate physical requirements for performing the essential functions of the job by double clicking and selecting ‘checked’ on the boxes below. Standing - Frequently Walking - Frequently Sitting - Frequently Reaching with Hands and Arms - Occasionally Climb or Balance - Occasionally Stooping, Kneeling, Crouching, or Crawling - Occasionally Talking - Frequently Hearing - Constantly Seeing - Constantly Performing repetitive motions with arms or hands - Frequently Lifting, carrying, pushing or pulling up to 10 lbs - Constantly Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally Lifting, carrying, pushing or pulling up to 50 lbs - None Lifting, carrying, pushing, or pulling greater than 50 lbs - None Driving - None Essential Job Functions / Major Areas of ResponsibilityThe essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position.
Hospitalist Physician - Remote YO AI LabsHospitalist Physician - RemoteLos Angeles, CARemoteWe are seeking experienced Hospitalist Physicians to contribute their medical expertise to a project focused on inpatient care, clinical documentation, and medical record quality . In this role, you will review clinical records, evaluate documentation for accuracy and completeness, and apply your clinical expertise to support high-quality medical data and AI training.
Sr Hospitalist Clinical Reviewer - Remote YO AI LabsSr Hospitalist Clinical Reviewer - RemoteLos Angeles, CARemoteWe are seeking experienced Senior Hospitalist Clinical Reviewers to support a high-impact project focused on inpatient clinical quality, documentation accuracy, and medical review . In this role, you will apply your hospitalist expertise and clinical judgment to evaluate inpatient cases, identify complex or ambiguous clinical scenarios, and provide clear, well-reasoned feedback.
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.
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.
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.
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.
Revenue Assurance Specialist IV - CDM and Epic experience needed Kaiser PermanenteRevenue Assurance Specialist IV - CDM and Epic experience neededPasadena, CAPerforms routine review and maintenance of system codes by: performing a regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; conducting pre- and post-implementation assessments of automated and manual charge capture for quality and accuracy; analyzing moderately complex billing issues related to charges/codes and proposing and implementing action plans to resolve charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications. Executes monitoring activities and process improvements by: independently performing tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; recording findings in accordance with relevant policies/procedures to ensure complete and consistent data integrity, partnering with other departments to resolve moderately complex deficiencies and/or compliance issues identified through monitoring activities; communicating results of monitoring activities to senior team members and/or department leaders; and implementing corrective action plans resulting from monitoring activities.
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.
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.
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.