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6 results for Credentialing Specialist in Orange, CA

Medical Authorizations Specialist

Los Angeles, CA
onsite
Temporary / Contract
24.07 - 30.12 USD / Hourly
A Hospital in Los Angeles is looking for an experienced Medical Authorizations Specialist to support patient access and revenue cycle operations for a healthcare organization. The Medical Authorizations Specialist position focuses on securing timely insurance approvals, insurance verifications confirming coverage details, and helping patients move forward with needed services without unnecessary delays. The Medical Authorizations Specialist candidate brings strong payer knowledge, sound judgment, and a patient-centered approach in a fast-moving hospital or clinical environment. Responsibilities:• Manage authorization and precertification requests for scheduled and unscheduled services across a range of government and commercial health plans.• Confirm active medical insurance coverage, benefit levels, and service-specific requirements before care is delivered to reduce claim and scheduling issues.• Evaluate provider orders and supporting clinical records to prepare complete submissions that align with payer criteria.• Track open requests, communicate with insurers, and take timely action to obtain determinations within required turnaround times.• Share updates on approval, denial, or pending status with care teams, schedulers, physicians, and patients as needed.• Investigate barriers that could interrupt treatment timelines and work with internal and external parties to resolve them quickly.• Record authorization activity, follow-up efforts, and outcomes accurately within the electronic medical record and related billing systems.• Assist with reconsiderations or appeals when requests are postponed or denied, using documentation that supports medical necessity.• Stay informed on changing payer rules, regulatory expectations, and authorization workflows while protecting patient confidentiality at all times.
2026-09-08T00:00:00Z

Enrollment & Eligibility Specialist

Los Angeles, CA
onsite
Temporary / Contract
22 - 24 USD / Hourly
Key ResponsibilitiesThe Enrollment & Eligibility Specialist will support families throughout the enrollment and eligibility process. Responsibilities may include:<ul><li>Assist with open enrollment activities and other enrollment initiatives.</li><li>Conduct initial intake and eligibility certification for families seeking program services.</li><li>Contact families by phone and email to schedule enrollment appointments, request documentation, and provide status updates.</li><li>Conduct enrollment interviews with parents and guardians to gather required information and explain program requirements.</li><li>Review applications and supporting documentation for accuracy, completeness, and eligibility.</li><li>Verify that required forms and supporting records have been received and properly completed.</li><li>Follow up with families regarding missing, incomplete, or updated documentation.</li><li>Create, organize, and maintain family enrollment and eligibility files in accordance with established procedures.</li><li>Enter and update family information in internal databases and tracking systems.</li><li>Maintain detailed and accurate records of communications, appointments, eligibility determinations, and outstanding items.</li><li>Assist with quality-control reviews to ensure files meet organizational and program requirements.</li><li>Identify documentation discrepancies and work with families to resolve outstanding issues.</li><li>Provide professional and compassionate customer service to families by phone, email, and in person.</li><li>Clearly explain enrollment procedures, eligibility requirements, deadlines, and next steps.</li><li>Help families understand available services and connect them with appropriate community resources and referrals when needed.</li><li>Handle confidential and sensitive family information with discretion.</li><li>Work closely with internal staff to ensure enrollment cases are processed accurately and within required timelines.</li><li>Support general administrative needs related to enrollment, eligibility, documentation, and program compliance.</li><li>Maintain a high level of accuracy while managing multiple families, appointments, files, and deadlines simultaneously.</li></ul>
2026-09-08T00:00:00Z

Medical Insurance Denials Specialist

Los Angeles, CA
onsite
Temporary to Hire
26.6 - 31.98 USD / Hourly
A hospital in Los Angeles is seeking an experienced Medical Insurance Denials Specialist to join its revenue cycle team. The Medical Insurance Denials Specialist will focus on insurance follow-up and collections for HMO and PPO payers, with an emphasis on resolving outstanding balances, researching claim issues, and securing timely reimbursement. The ideal Medical Insurance Deniasl Specialist candidate will also have experience working with UB04 claims in a hospital setting. Key Responsibilities:<ul><li> </li><li>Perform insurance collections follow-up on outstanding hospital claims with a focus on HMO and PPO payers.</li><li>Contact insurance companies and payers to obtain claim status, secure payment, and resolve unpaid or underpaid accounts.</li><li>Review and work hospital UB04 claims to ensure accurate billing and proper reimbursement..</li><li>Investigate and resolve claim denials, rejections, underpayments, and payment delays.</li><li>Submit corrected claims, supporting documentation, and appeals as needed to facilitate payment resolution.</li><li>Follow up on aged accounts receivable and maintain productivity in line with departmental goals.</li><li>Document all collection activity, account updates, and payer communications in the billing system.</li><li>Collaborate with billing, coding, and patient financial services teams to resolve claim discrepancies and improve reimbursement outcomes.</li><li>Monitor payer trends and escalate recurring issues impacting collections.</li></ul>
2026-09-03T00:00:00Z

Medical Biller/Collections Specialist

Los Angeles, CA
onsite
Temporary to Hire
25.55 - 33.9 USD / Hourly
A Hospital in Los Angeles is in the immediate need of a Medical Insurance Collections Specialist to support its hospital-based revenue cycle team. The Medical Insurance Collections Specialist role is ideal for someone who understands insurance follow-up, hospital claims, denials management, appeals and reimbursement workflows in a fast-paced healthcare setting. The Medical Insurance Collections Specialist will help drive payment resolution by researching claim issues, addressing payer delays, resolve denials and working closely with internal teams to improve collection results. Responsibilities:• Manage follow-up activities for unpaid or underpaid hospital insurance claims, with attention to high-volume payer accounts and timely reimbursement.• Review UB04 hospital claims for accuracy, completeness, and billing compliance before pursuing collection resolution.• Research denials, rejections, delayed payments, and partial reimbursements to determine the next steps needed for account resolution.• Prepare and submit corrected claims, appeal packages, and supporting documents to resolve outstanding balances efficiently.• Work aging accounts receivable inventories and maintain daily productivity aligned with departmental expectations.• Record all account actions, payer conversations, and status updates clearly within the billing system.• Partner with billing, coding, and patient financial services teams to resolve claim discrepancies and reduce reimbursement barriers.• Track recurring payer issues and escalate patterns that negatively affect collection performance or payment turnaround times.
2026-09-03T00:00:00Z

Medical Biller/Collections Specialist

Los Angeles, CA
onsite
Temporary to Hire
26.6 - 30.8 USD / Hourly
An Ambulatory Surgery Center in Los Angeles is in the need of a Medical Biller/Collections Specialist. This Medical Biller/Collections Specialist is ideal for someone who understands the full revenue cycle and can confidently manage claims, denials, and payer follow-up for surgical services. The right candidate for the Medical Biller/Collections Specialist role will bring healthcare billing experience, strong insurance knowledge, and the ability to keep accounts moving toward timely reimbursement. Responsibilities:• Manage end-to-end billing and collections activities for surgical services, from charge review through payment follow-up.• Confirm patient coverage, authorization details, and payer information using available electronic records and insurance carrier resources before claims are submitted.• Enter billing data and post charges accurately for surgical cases while maintaining complete and organized account documentation.• Pursue outstanding third-party balances by conducting regular follow-up with commercial and government payers across multiple plan types.• Investigate explanation of benefits, identify denial causes, correct claim issues, and resubmit claims to support reimbursement.• Monitor assigned claim queues and worklists each day to address unresolved accounts, aging items, and billing exceptions in a timely manner.• Review provider documentation, including urgent care and surgical records, to ensure charges are supported and billing can proceed accurately.• Apply appropriate diagnosis, procedure, medication, and supply codes based on clinical documentation and operative reports completed by providers.• Examine aged accounts and unresolved payer responses to resolve denials, appeals, and collection issues efficiently.
2026-09-08T00:00:00Z

Hospital Medical Insurance Denials Specialist

Van Nuys, CA
onsite
Temporary / Contract
24 - 30 USD / Hourly
A leading hospital in the San Fernando Valley is seeking a dedicated Hospital Medical Insurance Denials Specialist to join its team. In this role, you will oversee all aspects of the hospital's billing and collections processes, ensuring timely and accurate reimbursement. The Hospital Medical Insurance Denials Specialist will be responsible for managing billing activities and collections for Medicare managed care, commercial insurance, PPO/HMO, and Medi-Cal managed care accounts. This position requires strong attention to detail, a deep understanding of healthcare billing guidelines, and the ability to work collaboratively with internal departments and insurance payers to resolve outstanding claims. Responsibilities:• Conduct hospital billing and collection processes with accuracy and efficiency• Handle Medicare managed care, commercial, PPO/HMO, and Medical managed care• Provide training for Collector I positions• Appeals and denials management.• Engage in Appeals, Billing Functions, Claim Administration, and Collection Processes as part of the role• Oversee the management of insurance correspondence and maintain accurate records• Monitor patient accounts and take appropriate action to collect insurance payments.
2026-08-28T00:00:00Z