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8 results for Credentialing Specialist in Thousand Oaks, CA

Authorizations Specialist

Los Angeles, CA
onsite
Temporary / Contract
25 - 27 USD / Hourly
We are seeking a detail-oriented and patient-focused Authorizations Specialist to join our hospital team. In this role, you will be responsible for obtaining and managing insurance authorizations for outpatient and inpatient services while ensuring compliance with payer requirements. The ideal candidate has strong knowledge of medical insurance, excellent communication skills, and the ability to thrive in a fast-paced healthcare environment. Essential Responsibilities: * Obtain prior authorizations and pre-certifications from commercial, Medicare, Medicaid, and managed care insurance plans.* Verify patient insurance eligibility, benefits, and coverage requirements.* Review physician orders and clinical documentation to ensure authorization requests meet payer guidelines.* Submit authorization requests accurately and follow up to secure timely approvals.* Communicate authorization status to physicians, clinical staff, scheduling teams, and patients.* Monitor pending authorizations and resolve issues that may delay patient care.* Document all authorization activity in the electronic medical record (EMR) and other applicable systems.* Coordinate with insurance companies to appeal denied or delayed authorization requests when appropriate.* Maintain current knowledge of payer policies, authorization requirements, and regulatory guidelines.* Provide exceptional customer service while maintaining patient confidentiality in accordance with HIPAA regulations.* Perform other duties as assigned.
2026-07-13T00:00:00Z

Medical Authorizations Specialist

Los Angeles, CA
onsite
Temporary / Contract
25 - 28.71 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.
2026-07-15T00:00:00Z

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.
2026-07-14T00:00:00Z

Medical Billing Specialist

Beverly Hills, CA
onsite
Temporary / Contract
22.9615 - 26.587 USD / Hourly
A well-established and highly regarded surgical practice in Beverly Hills is seeking an experienced Medical Billing Specialist to join its team immediately. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced medical environment and is passionate about ensuring accurate claims processing and timely reimbursement. The Medical Billing Specialist will be responsible for managing the full billing cycle, including reviewing Explanation of Benefits (EOBs), verifying patient demographics and insurance information, entering billing and procedure details, submitting and following up on Medicare claims, and resolving claim discrepancies. The ideal candidate will have experience navigating Medicare web portals and be proficient with Availity and/or Noridian. Additional responsibilities include tracking claim status and payments in Excel, researching denied or underpaid claims, communicating with insurance carriers regarding reimbursement issues, and maintaining accurate billing documentation while ensuring compliance with Medicare guidelines. Qualified candidates should have previous medical billing experience, strong knowledge of Medicare billing processes, proficiency with Availity and/or Noridian, intermediate Excel skills, and exceptional attention to detail. The ability to prioritize multiple tasks, work independently, and meet deadlines while maintaining a high level of accuracy is essential. If you are a motivated Medical Billing Specialist looking to join a respected surgical practice that values accuracy, teamwork, and exceptional patient support, we encourage you to apply today.
2026-07-16T00:00:00Z

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
2026-07-15T00:00:00Z

Inpatient Coding Specialist

Los Angeles, CA
remote
Temporary / Contract
27 - 50 USD / Hourly
We are looking for an Inpatient Coding Specialist to support accurate inpatient coding and clinical data abstraction for a Contract position. In this role, you will evaluate inpatient medical records, assign diagnosis and procedure codes, and help ensure compliant reimbursement and reporting. The position requires close attention to documentation quality, regulatory standards, and timely account completion across the revenue cycle. Responsibilities:• Examine inpatient charts and translate clinical documentation into accurate diagnosis and procedure codes using applicable classification systems and grouping methodologies.• Determine the appropriate reimbursement grouping for each account while confirming discharge status, admission source details, and present-on-admission indicators are recorded correctly.• Abstract required clinical and demographic data elements according to facility guidelines and regulatory reporting expectations.• Review physician and care team documentation for completeness, identify missing or conflicting information, and pursue clarification when needed to support code assignment.• Manage discharged-not-billed work queues to help move accounts through the revenue cycle within established turnaround expectations.• Partner with clinical documentation improvement staff and providers to strengthen record completeness and support accurate severity and reimbursement outcomes.• Apply coding, billing, and data collection rules consistently to maintain compliance with state, federal, and payer requirements.• Use coding and validation tools such as Epic, 3M applications, encoders, audit platforms, and standard office software to verify information and complete assigned work.• Maintain productivity and quality benchmarks while working independently, organizing priorities effectively, and resolving issues that affect coding accuracy or timeliness.
2026-06-29T00:00:00Z

Inpatient Coding 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>
2026-07-06T00:00:00Z

Medical Revenue Cycle Specialist

Van Nuys, CA
onsite
Temporary / Contract
25 - 29 USD / Hourly
A Medical Center in Los Angeles is seeking a dedicated and driven Medical Revenue Cycle Specialist to join its respectable hospital. The Medical Revenue Cycle Specialist must have extensive knowledge and first-hand experience in dealing with insurance denials management and UB04. The Medical Revenue Cycle Specialist role demands an individual who can demonstrate an exceptional understanding of the medical billing and collections process and the critical thinking skills needed to navigate this challenging landscape.Responsibilities:1. Hospital insurance knowledge of entire billing and collection processes2. Using effective strategies for insurance denials management3. Thorough understanding of the UB04 form and its intricacies4. Resolving patient’s billing complaints and issues5. Communicating insurance coverage and patient liability to patients and staff6. Applying payments, adjustments, and denials to patient accounts7. Identifying and resolving payment discrepancies and reviewing accounts for collection8. Documenting all conversations, emails, and actions taken on account
2026-06-29T00:00:00Z