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5 results for Credentialing Specialist in Thousand Oaks, 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

Enrollment Specialist

Santa Barbara, CA
onsite
Temporary / Contract
24.7 - 28.6 USD / Hourly
We are looking for an Enrollment Specialist to support client access to healthcare-related community services in Santa Barbara, California. This Long-term Contract position focuses on enrollment coordination, eligibility monitoring, documentation accuracy, and service quality oversight for individuals receiving homeless services. The person in this role will help maintain compliance with program standards while partnering with staff to improve workflows and support timely reimbursement activities. Responsibilities:• Guide eligible clients through enrollment into programs, completing and processing required forms accurately and on time.• Partner with homeless services teams to monitor ongoing client eligibility, update records, and help prevent interruptions in approved coverage or support.• Examine case management documentation to confirm services are properly recorded, clinically appropriate, and aligned with reimbursement standards.• Coordinate with program and case management staff to track authorization timelines and support timely submission of renewal requests before expiration.• Review claims-related records and supporting documentation in the Health Management Information System to promote accurate billing and complete file maintenance.• Participate in meetings with internal teams and external partners to address service quality, operational needs, and continuous improvement efforts.• Provide additional administrative and program support as needed to assist with successful day-to-day execution of CalAIM initiatives.
2026-08-06T00:00:00Z

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