Assistant Director of Patient Business Services University of CaliforniaAssistant Director of Patient Business ServicesLos Angeles, CA$116,300–$264,600 / yearThe Assistant Director partners with clinical, operational, finance, contracting, IT, and revenue cycle leaders to remove barriers, improve workflows, and ensure high-quality billing performance aligned with organizational goals. Reporting to the PBS Director, this role is responsible for ensuring accurate and timely claims submission, regulatory compliance, and optimization of revenue cycle performance across the health system.
Risk Adjustment Compliance Specialist, Principal Blue Cross and Blue Shield AssociationRisk Adjustment Compliance Specialist, PrincipalOakland, CAThe Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medicaid and Medicare Advantage lines of business. The Principal collaborates with internal teams and external partners to maintain the integrity of risk adjustment data and supports the development and implementation of compliance programs.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) Elevance Health IncDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)Walnut Creek, CA$86,560–$155,808 / 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. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
DRG Clinical Validation Lead Elevance Health IncDRG Clinical Validation LeadWalnut Creek, 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.
Billing Specialist United Health Centers of San Joaquin ValleyBilling SpecialistFresno, CAMust be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn. As a Billing Specialist, one can look forward to ensuring that United Health Centers is able to obtain payment from appropriate parties.
Charge Integrity Specialist - PFS Revenue Integrity - Sharp Corporate - Day Shift - Full Time Sharp HealthCareCharge Integrity Specialist - PFS Revenue Integrity - Sharp Corporate - Day Shift - Full TimeSan Diego, California$49.70–$64.13 / hourWhat You Will Do To be the operational subject matter expert on all charge integrity solutions, support charge description master maintenance efforts, coordinate revenue enhancement opportunities for all entities supported by the System Revenue Integrity Department and in alignment with the overall mission of Sharp HealthCare. Works with revenue integrity, finance and clinical leadership to develop, implement charge capture entry, validation, reconciliation and correction processes; developing and implementing protocols, policies and procedures to support charge capture accuracy and timeliness.
Fqhc Experience In California Revenue Cycle Manager TrueCareFqhc Experience In California Revenue Cycle ManagerSan Marcos, CA$90,776–$136,165 / yearThe Back-End Revenue Cycle Manager is responsible for managing the day-to-day activities of the billing staff to ensure accurate and timely billing of claims, review of denials, adjustments, and write-offs and monitor accounts receivable balances to ensure compliance with TrueCare goals. Implement and maintain systems to audit billing submissions, payment posting, collections, denials, and adjustments including write-offs to ensure accuracy of accounts receivable, timely claims adjudication, and revenue maximization.
NewCharge Master Analyst Sutter HealthCharge Master AnalystSacramento, California$106,745.60–$160,118.40 / yearMaintains the CDM data elements (billing description, Current Procedural Terminology/Healthcare Procedure Coding System codes, revenue codes for Inpatient/Outpatient and appropriate modifiers) in the CDM software. Serves as a subject matter expert for Charge Description Master (CDM) regulatory requirements and guidelines and payer contractual obligations in order to ensure CDM line items are aligned with current billing, coding regulations, guidelines, and contractual obligations.
Senior Manager, Reimbursement Operations & Field Market Access - ION Intuitive Surgical IncSenior Manager, Reimbursement Operations & Field Market Access - IONSunnyvale, CAOn the provider side, this person generates billing guides, fields customer reimbursement questions, develops provider education materials, and supports all field logistics related to coding implementation. Certain information you provide as part of the application will be used for purposes of determining whether Intuitive Surgical will need to (i) obtain an export license from the U.S. Government on your behalf (note: the government's licensing process can take 3 to 6+ months) or (ii) implement a Technology Control Plan ("TCP") (note: typically adds 2 weeks to the hiring process).
Revenue Integrity Program Manager (Remote) Stanford Health CareRevenue Integrity Program Manager (Remote)CARemote$66.52–$88.14 / hourThrough a combination of data analytics, and process improvement techniques, this role will support the accurate capture of charges, identify meaningful opportunities to improve, and work closely with physician leadership and partnering with Compliance to provide education and training. Performance Review: Provides ongoing reporting of revenue performance to a variety of audiences including Chairs, Faculty, DFA's, Division and Clinic Chiefs, Executive Director, Mid-Revenue Cycle, the Director of Revenue Integrity and others as appropriate.
Health Plan Oversight Auditor San Francisco Health PlanHealth Plan Oversight AuditorSan Francisco, CA$78,875–$91,635 / yearSFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. ABOUT SFHP: Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County.
["FQHC Billing Account Manager","FQHC Billing Account Manager"] Nexus HR["FQHC Billing Account Manager","FQHC Billing Account Manager"]Santa Fe SpringsThe RCM Billing Account Manager is responsible for overseeing all aspects of Revenue Cycle Management (RCM), including billing operations, coding compliance, claims submission, denial management, and reimbursement optimization for FQHC clients. Serve as a trusted advisor on FQHC billing rules, UDS reporting, wraparound payments, PPS/APM reimbursement models, sliding fee schedules, and Medicaid/Medicare billing.
Charge Integrity Specialist - PFS Revenue Integrity - Sharp Corporate - Day Shift - Full Time Sharp HealthplanCharge Integrity Specialist - PFS Revenue Integrity - Sharp Corporate - Day Shift - Full TimeSan Diego, CA$49.70–$64.13 / hourTo be the operational subject matter expert on all charge integrity solutions, support charge description master maintenance efforts, coordinate revenue enhancement opportunities for all entities supported by the System Revenue Integrity Department and in alignment with the overall mission of Sharp HealthCare. Works with revenue integrity, finance and clinical leadership to develop, implement charge capture entry, validation, reconciliation and correction processes; developing and implementing protocols, policies and procedures to support charge capture accuracy and timeliness.
Special Investigation Unit Investigator III L.A. Care Health PlanSpecial Investigation Unit Investigator IIILos Angeles, CAThe Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. claims history, provider files) to determine provider billing patterns and detect potential fraudulent or abusive billing practices or vulnerabilities in Medi-Cal/Medicare policies and initiates appropriate action.
Senior Billing Specialist DeNova Collaborative Health LLCSenior Billing SpecialistCAJob Purpose: Join Denova Collaborative Health as a Senior Billing Specialist, where your expertise in complex medical billing and revenue cycle operations helps ensure clean, compliant claims and maximizes reimbursement. In this advanced role, you will take ownership of high-dollar and complex claims, identify root causes of recurring billing issues, recommend process improvements, and serve as a resource for the billing team.
Practice Coordinator III UCSF Medical CenterPractice Coordinator IIIEmeryville, CAo Complete moderate to complex authorization independently o Work applicable work queues o Right Fax o Use of Authorization/Certification Table o Ensure they have access to all Payer websites and can utilize all proficiently o Efficiently obtain authorizations within or exceeding productivity requirements o Review and verify benefits as needed; update in Apex o Staff message o Route authorization queries to practice (My Chart) o Patient Schedule (My Chart) o Letters o Pools o Patient look up o Comment field o Quick note o Scanning. Additionally, many cases require complex admission, discharge and planning coordination involving hospital reservations and authorizations related to study patients on protocol, transfers from outside hospitals and post transfer urgent authorizations and surgical planning.
Outpatient Trainer ExlService Holdings IncOutpatient TrainerCARemote$85,000–$90,000 / yearMinimum 5 years coding experience: Professional or hospital coding with thorough understanding of ICD-10 Coding; HCPCS/CPT coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC). EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates.
NewPlan Configuration Specialist CCH Community Health SystemPlan Configuration Specialist CCHFresno, CaliforniaHigh School Diploma, High School Equivalency (HSE), or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate AND an additional two (2) years of related experience may be substituted in lieu of associate’s degree. The Specialist assists with new implementations, annual renewals, plan maintenance, and routine system updates while developing expertise in health plan configuration, claims adjudication, and benefit administration.
Coding Analyst, Care Delivery Organization - Fully remote Alignment Healthcare IncCoding Analyst, Care Delivery Organization - Fully remoteCARemote$58,531–$87,797 / yearWorking closely with clinical documentation teams, and CDO provider partners - including PCPs, specialists, and clinical support staff - this role delivers accurate HCC code assignments, conducts structured provider coding audits, and provides targeted education that improves documentation quality and risk capture at the point of care. The Coding Analyst''s work directly drives RAF score accuracy, revenue integrity, and the quality of clinical documentation across the CDO''s provider network, making this role both a production function and a trusted clinical partner in Alignment''s Medicare Advantage operations.
Revenue Cycle Healthcare Manager UCSF Medical CenterRevenue Cycle Healthcare ManagerEmeryville, CAThe incumbent will also serve to oversee compliant professional fee billing to include maintaining a compliance manual or website of resources for the team, conducting service audits, and providing written reports to the Medical Center compliance office, department chair, and department directors. The Associate Director will work with appropriate centralized and departmental staff to ensure that the practices overseen engage in regular compliance education for appropriate physicians, residents, fellows and administrative staff.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Remote) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Remote) (Exempt) (Non-Union)Alhambra, CARemote$99,507–$130,000 / yearThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)Alhambra, CaliforniaRemote$99,507–$130,000 / yearThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union)Los Angeles, CA$99,507–$164,559 / yearThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Revenue Cycle Manager Family Healthcare NetworkRevenue Cycle ManagerVisalia, CAA combination of relevant experience and completion of a high school diploma with a minimum cumulative GPA of 2.5, or General Educational Development (GED) with a minimum overall score of 162.5, and healthcare-related knowledge frequently acquired through completion of a trade school, para-professional, or certificate-type program. Professional & Technical Knowledge: Effective June 1, 2026, all individuals hired into the role must: Possesses proficiency in written and verbal communication, basic mathematics, computer applications, and technical systems, frequently acquired through one of the following: Completion of a Bachelor's Degree program with a recognized major and a minimum cumulative GPA of 2.5; or.
Payer Coding Ops Hourly Datavant LLCPayer Coding Ops HourlyCA$25–$26 / hourGuided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health.
Director of Revenue Management UCSF Medical CenterDirector of Revenue ManagementSan Francisco, CA$148,700–$360,900 / yearThe Director collaborates extensively with clinical departments, Health Information Management, Patient Financial Services, Compliance, Internal Audit, Health Plan Strategy, Finance, and Information Technology teams to ensure revenue integrity requirements are embedded into operational and technical workflows. The Director contributes to short- and long-range planning for revenue cycle strategies, processes, tools, and systems; establishes departmental goals, budgets, and staffing plans; and develops policies that affect revenue integrity and revenue cycle functions across UCSF Health.
NewManager, Compliance - Clinical Documentation Coding & Auditing Services Kaiser PermanenteManager, Compliance - Clinical Documentation Coding & Auditing ServicesPasadena, CAEssential Responsibilities: Pursues professional growth and provides developmental opportunities for others by soliciting and acting on performance feedback; building collaborative, cross-functional relationships; training and developing talent for growth opportunities; delegating tasks and decisions; fostering open dialogue amongst team members; executing performance management guidelines and expectations; and working closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Manages designated work unit by translating business plans into tactical action items; ensuring all policies and procedures are followed; delegating tasks to meet goals and objectives; overseeing the completion of work assignments; aligning team efforts; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; removing obstacles that impact performance; and guiding performance and developing contingency plans accordingly.
NewCompliance Billing & Coding Auditor II (Remote) Stanford Health CareCompliance Billing & Coding Auditor II (Remote)CARemote$52.69–$69.82 / hourResponsibilities include assessing the adequacy and accuracy of documentation supporting billed services, including ICD, CPT, HCPCS, and other third-party payer codes, as well as adherence to Teaching Physician guidelines, Evaluation & Management criteria, DRG and APC assignments, medical necessity, and reimbursement accuracy. Billing and Coding Compliance Auditor II is the full proficiency or journey level of the Billing and Coding Compliance Auditor Family where employees are responsible for independently performing the full range of duties of moderate difficulty and complexity as outlined under the Job Duties.
SENIOR COOK / NORTH COUNTY Los Angeles CountySENIOR COOK / NORTH COUNTYLos Angeles County, CA$47,961.84–$64,628.88 / yearFull-time work experience*: monitoring and arranging food inventory based on freshness and expiration dates; cooking complete (breakfast, lunch, and dinner) large quantity meals; preparing and cooking complete (breakfast, lunch, and dinner) meals in accordance with health and safety regulations; ensuring that the utensils and work areas are clean; modifying food items, as necessary, to meet changing demands/needs; preparing food items for the next shift or day. Veteran'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.
Coding Compliance Auditor Community Medical CenterCoding Compliance AuditorFresno, CAExperience performing medical record and billing audits/reviews, including clinical documentation, medical terminology, codes (CPT, HCPCS, ICD-10-CM, and revenue), and reviews for charge and reimbursement accuracy required. As a Coding Compliance Auditor, you will be responsible for conducting coding and documentation audits to ensure accurate code assignment, appropriate billing, integrity of the medical record, and compliance with federal and state healthcare program requirements.
Medical Staff Analyst UCSF Medical CenterMedical Staff AnalystSan Francisco, CAThe University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care.
NewClinic Provider Liaison Eisenhower Medical CenterClinic Provider LiaisonCA$35.42–$53.80 / hourSkills, Knowledge, Abilities: Ability to coordinate educational sessions for multiple types of providers, Ability to demonstrate an awareness and understanding of medical insurances, contracts and related provider requirements related to such, Ability to demonstrate personal initiative, poise and confidence, accept challenges, and possess a proven working knowledge of EMR and Billing systems, Ability to identify and research current and proposed CMS guidelines and updates as it relates to current and pending service lines, Ability to prepare and distribute reports Excellent skills in documentation, data analysis, trend analysis, Ability to work flexible shifts and hours, Ability to work independently and out in field Must be able to travel within a 50 mile radius daily, Knowledge of general medical office practice workflow, Knowledge of physician practice processes including front, in room and back office, Possesses good time management and organizational skills Customer and results oriented Good listening skills Reliable, excellent follow through and effective utilization of organizational resources, Possesses strong relationship building and interpersonal skills; articulate in written and oral communication, Strong skills in Excel, Word, PowerPoint. Licensure/Certification: Required: Valid CA driver's license and exceptional DMV driving record; Certified Professional Coder (CPC) from the American Academy of Professional Coders (AAPC).
Diagnosis-Related Group (DRG) Trainer ExlService Holdings IncDiagnosis-Related Group (DRG) TrainerCARemote$85,000–$95,000 / yearEXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others.
Profee Coding Consultant - Full Time Datavant LLCProfee Coding Consultant - Full TimeCA$20–$28 / hourGuided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. Collaborating closely with key stakeholders such as clients and healthcare leaders, you'll meet and exceed customer expectations through identifying and proposing solutions, and being a responsible and reliable teammate.
Risk Adjustment Documentation & Coding Educator (CRC Required) Privia Health Group, IncRisk Adjustment Documentation & Coding Educator (CRC Required)CA$70,000–$85,000 / yearThe Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers. Ensure all audited charts meet CMS documentation requirements (e.g., MEAT criteria: Monitor, Evaluate, Assess, Treat) and ensuring data integrity, regulatory compliance, and optimal risk score accuracy through rigorous medical record auditing.
Supervisor, Quality Assurance California Dairies IncSupervisor, Quality AssuranceLos Banos, CAThe Quality Assurance Supervisor will be responsible to support and maintain the company Quality Systems programs, support and enforce the SQF, QA, GMP, and Safety policies and procedures including production needs, support and assist in maintaining the HACCP program and its pre-requisite programs, support and maintain the Food Safety/Food Security/Biosecurity programs, and aid in customer complaint investigations and response. Join the California Dairies, Inc. (CDI) team, a farmer-owned cooperative dedicated to sustainably producing the highest quality dairy products while fostering a culture of innovation and collaboration.
Claims Examiner 2-Managed Care Loma Linda University Medical CenterClaims Examiner 2-Managed CareRedlands, CAAble to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Profee Coding Consultant - PRN Datavant LLCProfee Coding Consultant - PRNCA$20–$28 / hourGuided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. Collaborating closely with key stakeholders such as clients and healthcare leaders, you'll meet and exceed customer expectations through identifying and proposing solutions, and being a responsible and reliable teammate.
HCC Coding Specialist ADPHCC Coding SpecialistSherman Oaks, CaliforniaAbout Us: MedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, dedicated to supporting high-quality, coordinated patient care across Southern California. We foster a collaborative and supportive work environment where talented professionals can thrive and grow their careers in healthcare management.
Sr. Patient Account Associate Adventist Health SystemSr. Patient Account AssociateRoseville, CAOur compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God''s love by inspiring health, wholeness and hope. Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities.
FQHC Billing Account Manager Nexus HR ServicesFQHC Billing Account ManagerSanta Fe Springs, CAThe RCM Billing Account Manager is responsible for overseeing all aspects of Revenue Cycle Management (RCM), including billing operations, coding compliance, claims submission, denial management, and reimbursement optimization for FQHC clients. Serve as a trusted advisor on FQHC billing rules, UDS reporting, wraparound payments, PPS/APM reimbursement models, sliding fee schedules, and Medicaid/Medicare billing.
HCC Coding Specialist MedPOINT ManagementHCC Coding SpecialistSherman Oaks, CAFull timeMedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, dedicated to supporting high-quality, coordinated patient care across Southern California. We foster a collaborative and supportive work environment where talented professionals can thrive and grow their careers in healthcare management.
Medical Claims Examiner Ultimate Staffing ServicesMedical Claims ExaminerPasadena, California$21–$29 / hourThis role ensures accurate and timely processing of claims while maintaining compliance with federal and state regulations and providing high‑quality service to providers and members. The Medical Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical insurance claims in accordance with policy provisions, regulatory guidelines, and organizational procedures.
NewSenior Clinical Reimbursement Specialist Veracyte IncSenior Clinical Reimbursement SpecialistSan Diego, CARemote$86,098–$107,850 / yearSuccess in this role requires advanced knowledge of reimbursement systems (including payer utilization management and claims adjudication), fluency in payer medical policies, sound and independent clinical judgment on complex cases, and the ability to influence outcomes through both direct case ownership and informal leadership. Our Veracyte Diagnostics Platform delivers high-performing cancer tests that are fueled by broad genomic and clinical data, deep bioinformatic and AI capabilities, and a powerful evidence-generation engine, which ultimately drives durable reimbursement and guideline inclusion for our tests, along with new insights to support continued innovation and pipeline development.
Clinical Appeals Senior Consultant Craneware, Inc.Clinical Appeals Senior ConsultantCAAs a Clinical Appeals Senior Consultant, you serve as a strategic liaison between clinical and financial stakeholders, ensuring healthcare services are accurately documented, coded, billed, and reimbursed by leading clinical appeals, denial management, and chart audit initiatives. Vacancy NameClinical Appeals Senior Consultant CompanyCraneware Inc SpecialityCustomer Management CategoryPermanent Location Country Office LocationHome based - US Additional Locations Introduction to Craneware.
Billing Specialist United Health Centers of the San Joaquin ValleyBilling SpecialistFresno-Corporate, CaliforniaMust be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn. As a Billing Specialist, one can look forward to ensuring that United Health Centers is able to obtain payment from appropriate parties.
Health Plan Enrollment Analyst Integrated Resources, IncHealth Plan Enrollment AnalystSan Francisco, CaliforniaContractorJob DescriptionThis position is responsible for developing and overseeing the processes ensuring that all billing providers (approximately 2000) at Client and affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue (approximately $500 million annually) in the course of patient care. Minimum of 8-10 years of work experience in healthcare environment with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations.
Business Analyst, Clinical & Reimbursement Policy Clover Health Investments CorpBusiness Analyst, Clinical & Reimbursement PolicyCARemote$107,000–$130,000 / yearSuccess in this role looks like: By the end of your initial 90-day period: You will have established a recurring review framework and a comprehensive project plan for Clover''s clinical and reimbursement policy library to ensure baseline quality and strict adherence to clinical guidelines. In this high-impact role, you will be responsible for the end-to-end lifecycle of Clover's clinical and reimbursement policies, ensuring they are accurately interpreted, regularly updated, and seamlessly integrated into our claims environment.
Medical Billing Specialist American Family Care Ladera RanchMedical Billing SpecialistLadera Ranch, California$18–$23 / hourmagazine as one of the fastest-growing companies in the U.S., AFC's stated mission is to provide the best healthcare possible, in a kind and caring environment, while respecting the rights of all patients, in an economical manner, at times and locations convenient to the patient. Today, with more than 250 clinics and 800 in-network physicians caring for over 6 million patients a year, AFC is the nation's leading provider of urgent care, accessible primary care, and occupational medicine.
NewAccounts Receivable Specialist Wu PediatricsAccounts Receivable SpecialistTemple City, CARemoteFull timeWu Pediatrics is a trusted pediatric practice serving the Temple City, CA community with compassionate, high-quality healthcare for children of all ages. In this role, you'll play a vital part in keeping our practice financially healthy so we can continue delivering exceptional care to the children and families we serve.