4 results for Denials Specialist in Irvine, CA

Credentialing Specialist

West Hollywood, CA
onsite
Temporary
25 - 45 USD / Hourly
The Credentialing Specialist is responsible for supporting the credentialing, re‑credentialing, and provider enrollment processes to ensure healthcare professionals meet all regulatory, payer, and organizational requirements. This role plays a key part in maintaining compliance, supporting provider onboarding, and ensuring accurate and up‑to‑date credentialing records. The Credentialing Specialist works closely with internal teams, providers, and external agencies to collect, verify, and track required documentation.<ul><li>Coordinate and manage initial credentialing and re‑credentialing for healthcare providers</li><li>Collect, review, and maintain provider documentation (licenses, certifications, education, work history, malpractice coverage, etc.)</li><li>Perform primary source verification in accordance with regulatory and organizational standards</li><li>Track license, certification, and enrollment expiration dates to ensure ongoing compliance</li><li>Maintain accurate provider records within credentialing databases and internal systems</li><li>Communicate with providers and internal stakeholders regarding application status and missing documentation</li><li>Assist with payer enrollment and revalidation processes, as assigned</li><li>Support audits and ensure credentialing files are complete and compliant</li><li>Maintain confidentiality and comply with HIPAA and regulatory requirements</li><li>Perform additional administrative or credentialing support duties as needed</li></ul>Benefits: Medical, Dental and Vision Insurance. 401K Retirement, Sick Time Off and Tuition Reimbursement.
2026-03-21T00:00:00Z

Medical Billing Specialist

La Puente, CA
onsite
Contract / Temporary to Hire
23.75 - 28.23 USD / Hourly
A Larger Medical Center in the La Puente Area is in the need of a d Medical Billing Specialist with strong Medi-Cal insurance experience. The Medical Billing Specialist will play a key part in managing the revenue cycle and ensuring accurate billing for Medi-Cal programs. The Medical Billing Specialist must have expertise to maintain compliance with provider guidelines and optimize reimbursement processes. Experience in OBGYN and/or Perinatal Services is a bit plus. Responsibilities:• Verify patient eligibility for Medi-Cal and confirm Managed Care Plan assignments for services rendered.• Prepare and submit claims accurately using appropriate coding and modifiers, including electronic equivalents of CMS-1500 forms.• Post payments, reconcile accounts, and ensure adjustments and write-offs align with contractual requirements.• Analyze denied or underpaid claims, identify issues, and resubmit them to secure proper reimbursement.• Manage appeals by reviewing Explanation of Benefits and engaging with the appeals process to resolve claim discrepancies.• Maintain secure and compliant records of Protected Health Information used in billing activities.• Assist healthcare providers with billing inquiries and support case management practices to enhance revenue.• Ensure all billing activities align with Medi-Cal Provider Manual and Managed Care Plan guidelines.• Collaborate with internal teams to streamline billing processes and improve efficiency.
2026-04-03T00:00:00Z

Medical Enrollment Specialist

Buena Park, CA
onsite
Temporary
19.12 - 25.09 USD / Hourly
Our healthcare team is seeking a detail-oriented Medical Insurance Enrollment Specialist with at least two years of experience and fluency in Spanish and English. The ideal candidate is passionate about helping patients navigate insurance processes and enjoys a fast-paced, supportive environment.Responsibilities:<ul><li>Process and review medical insurance enrollments for new and existing patients</li><li>Verify insurance coverage, eligibility, and benefits with various payers</li><li>Collaborate with patients, providers, and insurers to resolve enrollment questions and discrepancies</li><li>Maintain accurate and timely data entry in healthcare management systems</li><li>Communicate benefits information and enrollment outcomes to patients in both Spanish and English</li><li>Ensure compliance with HIPAA and company privacy policies</li><li>Provide exceptional customer service while assisting patients with insurance inquiries</li></ul>
2026-04-06T00:00:00Z

Routing Specialist

South Gate, CA
onsite
Contract / Temporary to Hire
20 - 24 USD / Hourly
We are looking for a highly organized Routing Specialist to join our logistics team in South Gate, California. This Contract to permanent opportunity offers a chance to play a key role in managing and optimizing transportation schedules for a leading logistics company. The ideal candidate will excel in coordinating routes, leveraging advanced Excel skills, and ensuring seamless communication across teams. Responsibilities: • Develop and implement efficient routing plans to streamline delivery schedules and enhance operational performance. • Utilize advanced Excel functions, such as pivot tables and VLOOKUPs, for data analysis, shipment tracking, and reporting. • Coordinate with drivers, dispatchers, and warehouse staff to ensure timely and accurate deliveries. • Monitor shipments in real-time and resolve any delays or issues proactively to maintain service quality. • Maintain comprehensive records of routes, schedules, and transportation costs for accurate reporting and analysis. • Communicate effectively with internal teams and external partners to ensure alignment on logistics operations. • Ensure all transportation activities comply with company policies and industry regulations. • Provide support in managing business systems, including ERP and CRM tools, to enhance operational efficiency. • Collaborate with the billing team to ensure accurate invoicing and documentation of services.
2026-04-03T00:00:00Z