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8 results for Credentialing Specialist in Pasadena, CA

Medical Credentialing Specialist

Santa Monica, CA
onsite
Temporary to Hire
31.97 - 45 USD / Hourly
A National Hospital System in in Los Angeles is in the immediate need of a Medical Credentialing Specialist to support credentialing and privileging activities for physician staff. This Medical Credentialing Specialist plays an important role in maintaining accurate provider records, supporting compliance efforts, and coordinating documentation for appointment and reappointment workflows. The Medical Credentialing Specialist must bring prior experience in a hospital or healthcare environment, strong working knowledge of MD Staff, and the ability to manage sensitive information with accuracy and care. MD Staff Software is a MUST. Key Responsibilities:• Oversee the end-to-end credentialing cycle for physicians, including new appointments, renewals, and ongoing status maintenance.• Review and validate provider documentation such as licenses, education, certifications, employment history, and references.• Administer privilege requests and updates by tracking clinical privileges and ensuring alignment with governing bylaws and organizational standards.• Maintain complete and current practitioner files within the MD Staff platform, ensuring data accuracy and documentation readiness.• Track expiring credentials and follow up proactively to obtain renewed licenses, certifications, and other required materials before deadlines.• Assemble credentialing packets and prepare supporting materials for review by committees, leadership groups, and governing bodies.• Help uphold adherence to accreditation and regulatory expectations, including Joint Commission standards and internal medical staff requirements.• Serve as a point of contact for physicians, department leaders, and stakeholders regarding application progress, missing items, and approval status.• Contribute to audits, survey preparation, policy revisions, and process improvement initiatives related to medical staff services. Benefits: Medical, Dental and Vision Insurance. 401K Retirement, Sick Time Off and Tuition Reimbursement.
2026-05-21T00:00:00Z

Part Time Medical Enrollment Specialist

Buena Park, CA
onsite
Temporary / Contract
20 - 28 USD / Hourly
A Health Plan in Buena Park for a Part Time Enrollment Specialist who is Bilingual in Spanish and English to join its team. The Part Time Enrollment Specialist will play a vital role in assisting patients with their health insurance enrollment through programs such as Covered California and Medi-Cal. This Part Time Enrollment Specialist is an excellent opportunity for someone passionate about helping individuals navigate the complexities of healthcare coverage. Bilingual in Spanish is a MUST. Key Responsibilities:• Assist patients in completing applications and verifying their eligibility for health insurance programs, including Covered California and Medi-Cal.• Provide clear explanations of insurance options, benefits, and coverage to help patients make informed decisions.• Ensure all enrollment records are accurate by verifying documentation and resolving discrepancies.• Maintain up-to-date records of enrollment activity and manage data entry into internal systems.• Conduct follow-ups with patients to finalize incomplete applications or handle renewal processes.• Collaborate with community outreach teams to support enrollment initiatives and drive awareness.• Deliver excellent customer service by addressing patient inquiries and concerns promptly.• Stay informed about changes in health insurance policies to provide accurate guidance to patients. Benefits: Medical, Dental and Vision Insurance. 401K Retirement, Sick Time Off and Tuition Reimbursement. Please send your resume to Mike [dot] Romero [at] RobertHalf [dot] [com]
2026-05-12T00:00:00Z

Managed Care Medical Billing Specialist

Los Angeles, CA
onsite
Temporary to Hire
23.75 - 32.51 USD / Hourly
A leading hospital in Los Angeles is seeking a detail-oriented Managed Care 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 Managed Care Medical Billing Specialist 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>Preepare adjustments needed to ensure account balances reflect payable amounts and forward them to management for review and authorization. </li></ul>
2026-05-20T00:00:00Z

Medical Collections Specialist

North Hollywood, CA
onsite
Temporary / Contract
23.19 - 30.01 USD / Hourly
A respected hospital in the San Fernando Valley is seeking an experienced and results-driven Hospital Medical Collections Specialist to join its revenue cycle team. This role is ideal for a motivated professional with a strong background in hospital collections, payer follow-up, and denial resolution. The ideal candidate will play a key role in accelerating reimbursements, reducing aging accounts receivable, and ensuring accurate resolution of inpatient and outpatient claims across a variety of payer sources.The hospital is open to candidates with 2+ years of medical collections experience, particularly within an acute care or hospital setting.Key Responsibilities<ul><li>Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers</li><li>Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution</li><li>Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs</li><li>Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims</li><li>Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history</li><li>Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes</li><li>Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates</li><li>Monitor assigned accounts to reduce aging AR and improve overall collection performance</li><li>Support departmental goals related to cash collections, denial management, and revenue cycle efficiency</li></ul>
2026-05-18T00:00:00Z

Medical Biller/Collections Specialist

Los Angeles, CA
onsite
Temporary to Hire
24 - 28.99 USD / Hourly
A Federally Qualified Health Center (FQHC), is seeking an experienced Medical Biller/Collector to join their revenue cycle team. This Medical Biller/Collector will be responsible for billing, follow-up, and collections activities to ensure timely reimbursement from insurance carriers, government payers, and patients. The ideal candidate for the Medical Biller/Collector role will have strong knowledge of medical billing processes, payer guidelines, and accounts receivable follow-up. Key Responsibilities: Submit accurate and timely medical claims to insurance carriers and government payers Follow up on unpaid, denied, or underpaid claims and resolve billing discrepancies Work accounts receivable reports and maintain collection efforts to reduce outstanding balances Investigate claim rejections and denials, and take corrective action for resubmission or appeal Post payments, adjustments, and denials as needed Communicate with payers, patients, and internal staff regarding billing questions and account resolution Maintain compliance with billing regulations, payer requirements, and organizational policies Support revenue cycle activities including claims review, payment reconciliation, and account research Document collection activity and account status updates accurately in the billing system
2026-05-18T00:00:00Z

Medical Biller/Collections Specialist

Corona, CA
onsite
Temporary / Contract
21 - 24 USD / Hourly
Are you a driven and detail-oriented detail oriented with strong experience in billing and collections? Do you enjoy learning and adapting to new systems in a dynamic work environment? We’re looking for a Medical Billing/Collections Specialist to join our team and contribute to the success of our mental health practice. This role involves working within our proprietary Windows-based billing software—a user-friendly system that’s easy to master—with training and support available every step of the way. The right candidate will bring at least 2 years of billing and collections experience, demonstrate common sense, and show a willingness to ask questions when facing challenges. You won’t need coding expertise, but you should have a clear understanding of medical billing processes. Key Responsibilities Utilize in-house proprietary billing software to manage billing and collections tasks. Process accounts with accuracy, maintaining compliance with billing procedures and organizational standards. Take initiative to master the software tools provided, ensuring correct workflows and timely account management. Address billing issues and resolve account discrepancies while adhering to ICD-10 standards (no coding experience required). Progress through a structured training program that starts with simpler accounts and builds toward more complex tasks as your understanding deepens. Communicate effectively with teammates, supervisors, and external stakeholders to achieve timely resolutions for billing inquiries. Exhibit a proactive, aggressive attitude toward learning and performing your duties at a high standard.
2026-05-21T00:00:00Z

Medicare Managed Care Medical Collections Specialist

Los Angeles, CA
onsite
Temporary to Hire
25.3365 - 33.01 USD / Hourly
A hospital in Los Angeles is seeking a Medicare Managed Care Medical Collections Specialist to support its revenue cycle team. The Medicare Managed Care Medical Collections Specialist is responsible for follow-up on unpaid claims, insurance appeals, denial resolution, and insurance accounts receivable activities to help maximize reimbursement and reduce aging balances. Key Responsibilities:<ul><li>Call insurance companies, payers, and/or patients to secure payment on unpaid claims. </li><li>Perform timely follow-up on outstanding insurance accounts receivable to ensure appropriate reimbursement. </li><li>Manage and prioritize daily workload to maximize collection efforts and minimize delays in payment resolution. </li><li>Submit and track insurance appeals related to denied or underpaid claims. Based on general knowledge.</li><li>Review denials, determine root cause, and take corrective action to support claim resolution. </li><li>Gather and provide required documentation to payers to support payment or appeal requests. </li><li>Work closely with internal departments to resolve billing discrepancies and improve claim turnaround times. </li><li>Maintain accurate account notes and update billing systems with collection and follow-up activity. </li><li>Monitor unpaid claims to ensure timely escalation and resolution. </li></ul>Qualifications:<ul><li>Previous experience in medical collections, insurance follow-up, or healthcare accounts receivable required. </li><li>Experience with Medicare managed care collections in a hospital or healthcare setting preferred. </li><li>Strong knowledge of insurance appeals, denial management, and insurance AR follow-up. </li><li>Familiarity with medical billing processes, payer guidelines, and reimbursement practices. </li><li>Strong communication, negotiation, and problem-solving skills. </li><li>Ability to organize and prioritize a high-volume workload in a fast-paced environment. </li><li>Proficiency with hospital billing systems and electronic medical or revenue cycle platforms preferred. </li></ul>
2026-05-22T00:00:00Z

Hospital Medical Collections Specialist

Van Nuys, CA
onsite
Temporary to Hire
23.12 - 30.12 USD / Hourly
A Hospital in the San Fernando Valley are looking for an experienced Hospital Medical Collections Specialist. The Hospital Medical Collections Specialist ideal for someone with a strong background in medical revenue cycle activities and a solid understanding of payer follow-up across government and commercial plans. The Hospital Medical Collections Specialist will help drive timely reimbursement by resolving outstanding accounts, addressing denials, and working through appeals for both inpatient and outpatient hospital claims. The hospital is open to candidates with at least 2 years of experience. Responsibilities:• Pursue payment on outstanding hospital accounts by conducting thorough follow-up with insurance carriers and other payers to secure accurate and timely reimbursement.• Review inpatient and outpatient claims to identify billing issues, payment delays, denials, and underpayments, then take appropriate action to move accounts toward resolution.• Manage collection activity across a range of payer types, including Medicare managed care, Medi-Cal managed care, commercial plans, and HMO or PPO coverage.• Prepare and submit appeals, reconsiderations, and supporting documentation to challenge denied or incorrectly processed claims.• Investigate account discrepancies by analyzing billing records, payer responses, and remittance details to determine the next steps for resolution.• Coordinate with internal teams to correct claim information, resolve documentation gaps, and improve the collection of hospital receivables.• Maintain detailed account notes and status updates to ensure clear documentation of collection efforts and payer communications.
2026-05-20T00:00:00Z