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5 results for Credentialing Specialist in Irvine, CA

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.
2026-08-03T00:00:00Z

Medical Credentialing Manager

Long Beach, CA
onsite
Temporary / Contract
36.12 - 48.01 USD / Hourly
A respected healthcare organization is seeking an experienced Credentialing Manager to lead credentialing operations and provider data management for its Long Beach, California team. In this leadership role, you'll oversee the full credentialing lifecycle—including provider onboarding, recredentialing, enrollment support, and data integrity—while ensuring compliance with regulatory requirements and health plan standards. You'll also collaborate with cross-functional leaders to optimize processes, strengthen audit readiness, and drive operational excellence across the credentialing function.Key Responsibilities:<ul><li>Lead and mentor the credentialing and provider data team, setting daily priorities and ensuring efficient operations.</li><li>Oversee provider onboarding, recredentialing, payer enrollment, and privileging activities to support a seamless provider experience.</li><li>Ensure compliance with accreditation standards, delegated credentialing requirements, and applicable state and federal regulations.</li><li>Review credentialing files, provider rosters, and supporting documentation to maintain complete, accurate, and up-to-date records.</li><li>Monitor team productivity, turnaround times, and workflow performance, proactively resolving issues that impact service levels.</li><li>Prepare for internal and external audits by conducting routine reviews, identifying gaps, and implementing corrective actions.</li><li>Partner with leadership to enhance credentialing policies, reporting capabilities, and operational workflows.</li><li>Safeguard provider data integrity across systems to support accurate reporting, compliance, and downstream operational needs.</li></ul>Benefits: Comprehensive Health, Dental, and Vision insurance, 401(k) retirement plan, and Paid Sick Time.
2026-08-05T00:00:00Z

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