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8 results for Credentialing Specialist in Gardena, CA

Medical Credentialing Specialist

Mission Hills, CA
onsite
Temporary / Contract
32 - 45 USD / Hourly
A healthcare company is seeking an experienced Medical Credentialing Specialist to join our Medical Staff Services department. This Medical Credentialing Specialist is responsible for managing the full credentialing lifecycle for physicians and advanced practice providers, with a primary focus on initial appointments, reappointments, and clinical privileges. The Medical Credentialing Specialist is detail-oriented, highly organized, and experienced in navigating the complex regulatory requirements governing hospital credentialing. This position requires prior experience using MD-Staff software to support credentialing, privileging, and provider data management. Key Responsibilites:<ul><li>Manage the credentialing and privileging process for physicians and allied health professionals, including initial appointments, reappointments, temporary privileges, and privilege modifications, using MD-Staff to maintain accurate and current provider records.</li><li>Review applications for completeness, obtain required documentation, and perform all primary source verifications, including licensure, education, training, board certification, DEA registration, references, malpractice history, NPDB queries, and sanctions/exclusion screenings.</li><li>Prepare and maintain credentialing files, reports, and committee-ready documentation in MD-Staff for review by Department Chairs, the Credentials Committee, Medical Executive Committee (MEC), and Governing Board, while tracking expiration dates and reappointment timelines to ensure continuous compliance.</li><li>Ensure adherence to Medical Staff Bylaws, hospital policies, CMS Conditions of Participation, The Joint Commission standards, and all applicable state and federal regulations.</li><li>Partner with Human Resources, Provider Enrollment, Risk Management, department leaders, and hospital leadership to support provider onboarding, reporting, committee materials, accreditation readiness, and high-quality service to providers and stakeholders.</li></ul>Benefits: Health, Dental, Vision, 401k, and Sick Time Off.
2026-08-01T00:00:00Z

Credentialing Manager

Long Beach, CA
onsite
Temporary / Contract
32 - 45 USD / Hourly
A healthcare company is looking for an experienced Credentialing Manager to lead credentialing and provider data activities for a healthcare organization in Long Beach, California. This Credentialing Manager position will guide daily operations related to provider onboarding, recredentialing, enrollment support, and data accuracy while maintaining adherence to regulatory and health plan standards. The Credentialing Manager also partners with internal leaders to strengthen workflows, support audit readiness, and promote consistent credentialing practices across the function. Key Responsibilities:• Direct the day-to-day work of credentialing and provider data staff, setting priorities and providing operational guidance.• Lead provider onboarding, reappointment cycles, payer enrollment activity, and privileging coordination to keep processes moving efficiently.• Maintain compliance with applicable accreditation standards, delegated credentialing obligations, and state and federal regulations.• Review credentialing records, provider rosters, and supporting documentation to ensure information remains complete, current, and accurate.• Track team volume and turnaround times, remove workflow obstacles, and support timely resolution of credentialing issues.• Prepare the department for internal and external reviews by conducting audits and addressing gaps before formal assessments occur.• Work with leadership to refine credentialing policies, improve reporting, and enhance departmental procedures.• Oversee provider data integrity across systems and records to support reliable downstream use and regulatory reporting. Benefits: Health, Dental, Vision, 401k, and Sick Time Off.
2026-07-31T00:00:00Z

Medical Billing Specialist

Van Nuys, CA
onsite
Temporary / Contract
25 - 30 USD / Hourly
A leading hospital in the Valley is seeking a detail-oriented Medical Billing Specialist to join its revenue cycle team. This role is responsible for ensuring accurate and timely claim submission, follow-up, and resolution of managed care billing issues. The ideal candidate will have strong knowledge of medical billing processes, payer requirements, and accounts receivable follow-up within a hospital environment. Key Responsibilities:<ul><li>Demonstrate the ability to determine the accuracy of pertinent medical, coding, eligibility, authorization, demographic, and financial information, and make any required corrections.</li><li>Determine payer documentation requirements for payment and ensure all necessary supporting documentation is available for claim submission. </li><li>Transmit and submit clean claims to payers within three working days of receipt, while maintaining a productivity standard of 200 claims per day. </li><li>Update the computer system to reflect claim submission and transmission activity. </li><li>Review payer correspondence and provide corrections and/or additional documentation within three working days. </li><li>Review payment data for suspensions, underpayments, and denials, and submit appropriate responses, including corrected insurance forms and rebills as needed. </li><li>Review bi-monthly accounts receivable reports to identify claims that have been submitted but remain unresolved or unacknowledged, as well as claims that have not yet been submitted, and take appropriate action to ensure timely resolution. </li><li>Prepare adjustments needed to ensure account balances reflect payable amounts and forward them to management for review and authorization. </li></ul>
2026-07-28T00:00:00Z

Medical Coder Specialist

Los Angeles, CA
remote
Temporary / Contract
35 - 39 USD / Hourly
Job Responsibilities:<ul><li>Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes leading to the assignment of the correct Medicare Severity-Diagnosis Related Group MS-DRG or All Patient Refined Diagnosis Related Group APR-DRG. The Inpatient Coding Specialist I is responsible for verification of the patient’s discharge disposition assigning the correct sources of admission for state regulation reporting purposes and ensuring the appropriate present on admission POA indicators are assigned to each code. The assigned codes must support the reason for the visit that is documented by the provider in order to support the care provided.</li><li>Correctly abstracts required data per facility specifications.</li><li>Responsible for monitoring Discharged Not Billed accounts and as a team ensures timely compliant processing of inpatient accounts through the revenue cycle.</li><li>Collaborates with Clinical Documentation Specialists CDSs and members of the medical staff to ensure completeness of documentation in the medical records so that appropriate codes and ultimately the correct Diagnosis Related Group DRG may be assigned.</li><li>Responsible for ensuring accuracy and maintaining established quality and productivity standards.</li><li>Demonstrates a high degree of independence in performance of responsibilities working effectively without direct supervision. Exhibits strong time management problem solving and communication skills.</li><li>Possesses critical thinking good judgment and decision making skills</li><li>Demonstrates excellent written and oral communication skills</li><li>Remains abreast of current Centers for Medicare and Medicaid Services CMS requirements as well as Correct Coding Initiative CCI edits Hospital Acquired Conditions HACs Patient Safety Indicators PSIs and when applicable National Coverage Determinations NCDs and Local Coverage Determinations LCDs including the addition of appropriate modifiers to ensure a clean claim the first time through.</li><li>Maintains competency and accuracy while utilizing tools of the trade such as the 3M encoder 3M Audit Expert process 3M AES 3M Clinical Documentation Improvement System 3M CDIS and abstracting systems as well as all reference materials.</li><li>Attends required system hospital and departmental meetings and educational sessions as established by leadership as well as completion of required annual learning programs to ensure continued education and growth.</li><li>Employees must abide by all Joint Commission requirements including but not limited to sensitivity to cultural diversity patient care patients rights and ethical treatment safety and security of physical environments emergency management teamwork respect for others participation in ongoing education and training communication and adherence to safety and quality programs sustaining compliance with National Patient Safety Goals and licensure and health screenings.</li></ul>
2026-07-27T00:00:00Z

Medical Collections Specialist

Burbank, CA
onsite
Temporary / Contract
25 - 31 USD / Hourly
A Hospital in Los Angeles is seeking a Medical Collections Specialist with experience in credit balances. The Medical Collections Specialist must be successful with investigating, tracking, and resolving denied medical insurance claims. The Medical Collections Specialist must have 2 years medical billing and medical insurance collections experience, Responsibilities: <ul><li>Investigating and resolving denied claims from various insurance providers.</li><li>Reviewing credit balances and denials management. </li><li>Conduct thorough and detailed review of patient bills, insurance benefits, and medical records to identify discrepancies and ensure proper billing.</li><li>Follow up on outstanding claim denials and secure reimbursement where possible.</li><li>Liaise with insurance companies, healthcare providers, and patients to rectify claims denials and resolve discrepancies.</li><li>Responsible for identifying patterns and trends in claim denials and propose solutions for reducing denial rates.</li><li>Submit appeals and reconsideration requests to insurance companies for denied claims.</li><li>Strong understanding of HMO and PPO.</li></ul>
2026-07-28T00:00:00Z

Benefits Specialist

El Segundo, CA
onsite
Temporary / Contract
18.05 - 24 USD / Hourly
<ul><li>Process employee benefit enrollments, life event changes, and terminations</li><li>Answer employee questions regarding medical, dental, vision, life insurance, disability, HSA, and retirement benefits</li><li>Assist with open enrollment and employee communications</li><li>Maintain accurate employee records and ensure compliance</li><li>Coordinate with insurance carriers, brokers, and internal departments</li><li>Cross-train on 401(k) administration with an experienced team member</li><li>Utilize UKG and other HR systems (training provided as needed)</li></ul>We're Looking For<ul><li>Entry-level candidates interested in Human Resources or Benefits are encouraged to apply</li><li>Some exposure to HR, benefits, payroll, office administration, or customer service is helpful</li><li>Strong Microsoft Office skills</li><li>Excellent attention to detail and organizational skills</li><li>Friendly, professional communication skills</li><li>Ability to learn new systems quickly</li><li>Experience with UKG Pro or PlanSource is a plus but not required</li></ul>
2026-07-30T00:00:00Z

Hospital Medical Collections Specialist

Van Nuys, CA
onsite
Temporary to Hire
24 - 31.7 USD / Hourly
We are looking for a Hospital Medical Collections Specialist to join a healthcare organization in the San Fernando Valley. The Hospital Medical Collections Specialist supports the revenue cycle by following up on outstanding hospital accounts, resolving payer issues, and helping improve reimbursement outcomes across inpatient and outpatient services. The Hospital Medical Collections Specialist must bring strong hospital billing and collections experience, along with a working knowledge of managed care, government, and commercial insurance plans. Responsibilities:• Pursue payment on outstanding hospital claims by reviewing account status, contacting payers, and addressing barriers that delay reimbursement.• Investigate denials, underpayments, and rejected claims, then take appropriate action through corrections, reconsiderations, or formal appeals.• Manage collections activity across a range of hospital accounts, including inpatient and outpatient balances tied to commercial and managed care plans.• Work through payer-specific requirements for Medicare managed care, Medi-Cal managed care, PPO, HMO, and other commercial coverage types to secure accurate payment.• Document follow-up activity thoroughly and maintain organized account notes to support timely resolution and audit readiness.• Partner with internal revenue cycle and billing teams to clarify account issues, correct claim data, and reduce preventable payment delays.• Review aging accounts to prioritize high-impact follow-up and escalate complex reimbursement issues when needed.• Contribute to onboarding and knowledge-sharing efforts for entry-level collection staff as needed.
2026-07-29T00:00:00Z

Quality Assurance Specialist

Costa Mesa, CA
onsite
Temporary to Hire
38 - 44 USD / Hourly
We are looking for a Quality Assurance Specialist to support incoming quality operations in California. This contract position with permanent potential focuses on keeping materials moving efficiently through inspection, testing, and cross-site coordination so production timelines stay on track. The ideal candidate is highly organized, proactive in resolving delays, and comfortable working in a fast-paced environment where accuracy, urgency, and accountability are essential. Responsibilities: • Oversee the flow of incoming hardware and materials, identifying priority items that require immediate quality review or expedited handling. • Coordinate the full movement process for parts needing additional inspection, metrology review, functional testing, or specialized processing before final release. • Work closely with materials and warehouse teams to ensure receipts, transfers, staging activities, and inventory transactions are completed correctly and on schedule. • Arrange and carry out movement of parts between facilities, including preparing items for transport and ensuring timely delivery to the appropriate site. • Partner with quality, production, and site leaders to align daily priorities, remove bottlenecks, and maintain expected turnaround times. • Monitor open material flow activities across locations, provide routine status updates to leadership, and escalate issues that could impact delivery or inspection timelines. • Maintain accurate part traceability by updating location and status records and resolving inventory discrepancies as they arise. • Contribute to process improvement efforts focused on reducing cycle time, strengthening handoff practices between sites, and improving overall material flow performance. • Handle and package hardware according to company standards to protect product integrity during storage and transport. • Investigate and troubleshoot inventory variances or related escalations to support operational accuracy and continuity.
2026-07-30T00:00:00Z