Healthcare Compliance Specialist
4 days ago
L.A. Care Health Plan, a leading provider of healthcare services in Los Angeles County, is seeking an experienced Healthcare Compliance Specialist to join our team. In this critical role, you will be responsible for investigating and resolving member and provider complaints and appeals, ensuring compliance with regulatory requirements such as CMS, DHCS, DMHC, MRMIB, and NCQA.
**Job Summary**
The ideal candidate will have at least 2 years of experience in managed care, specifically in resolving member and provider complaint and appeals issues, including eligibility, access to care, claims, benefit, and quality of care concerns. They will possess strong analytical, oral, written, and presentation skills, as well as the ability to exercise independent judgment and work effectively in a fast-paced environment.
**Key Responsibilities**
* Investigate and resolve administrative complaints, complex provider appeals, and State Fair Hearing cases in compliance with regulatory requirements
* Intake, acknowledge, prepare case files, and route complaints to appropriate internal departments for investigation and resolution
* Ensure integrity of A&G database by thorough, timely, and accurate assignment of cases
* Prepare and analyze monthly appeal and grievance reports to meet internal and external reporting requirements
**Requirements**
* Associate's degree or equivalent education and/or experience required
* At least 2 years of experience in managed care with specific experience in resolving member and provider complaint and appeals issues
* Strong knowledge of medical terminology and advocacy experience preferred
* Ability to work effectively in a team environment and communicate with various stakeholders
**Salary Range**
The estimated salary range for this position is $66,624 - $83,131 per year, based on location and experience.
**Benefits**
L.A. Care offers a comprehensive benefits package, including paid time off, tuition reimbursement, retirement plans, medical, dental, and vision coverage, wellness program, and volunteer time off.
-
Healthcare Compliance Specialist
2 weeks ago
Los Angeles, California, United States Kheir Clinic (FQHC) Full timeAbout the RoleAs a Healthcare Compliance Specialist at Kheir Clinic (FQHC), you will play a critical role in ensuring our organization maintains the highest standards of compliance and regulatory adherence. This position requires a detail-oriented professional with excellent organizational skills, knowledge of healthcare laws and regulations, and experience...
-
Healthcare Compliance Specialist
3 weeks ago
Los Angeles, California, United States Above the Bar Full timeAbove the Bar is seeking a Health Care Litigation Associate to join their team. This role involves working on high-profile cases for health plans and hospitals, handling complex litigation, including reimbursement disputes and regulatory compliance.The ideal candidate will have 3+ years of litigation experience and an interest in healthcare law. They will...
-
Clinical Compliance Specialist
8 hours ago
Los Angeles, California, United States KHEIR Center Full timeJob SummaryWe are seeking a highly skilled Clinical Compliance Specialist to join our team at the KHEIR Center. The successful candidate will be responsible for managing the credentialing process for healthcare providers, ensuring compliance with accreditation standards, regulatory requirements, and organizational policies.The estimated annual salary for...
-
Medical Compliance Specialist
4 weeks ago
Los Angeles, California, United States KHEIR Center Full timeWe are seeking a highly detail-oriented and organized Medical Compliance Specialist to join our team at the KHEIR Center in Los Angeles. The ideal candidate will have excellent communication skills, a commitment to upholding the highest standards of ethical conduct, and a strong understanding of healthcare laws and regulations.The Medical Compliance...
-
Healthcare Compliance Auditor
8 hours ago
Los Angeles, California, United States St Johns Community Health Full timeAbout the RoleAs a Healthcare Compliance Auditor at St. John's Community Health, you will play a crucial role in ensuring the accuracy and compliance of our referral processes.Salary: $70,000 - $90,000 per year, based on qualifications.Key Responsibilities:Conduct thorough audits of referrals to identify potential risks and non-compliance.Analyze data to...
-
Healthcare Compliance Coordinator
4 days ago
Los Angeles, California, United States Preferred IPA of California Full timeJob SummaryWe are seeking a skilled Compliance Coordinator or Quality Compliance Nurse to join our team at Preferred IPA of California.As a key member of our healthcare team, you will be responsible for supporting the development and implementation of our Quality Management Program, as well as managing Health Plan Audits and responding to Appeals and...
-
Compliance Quality Assurance Specialist
4 weeks ago
Los Angeles, California, United States IDR Healthcare Full timePosition Overview:Innovative Quality Assurance and Compliance ExpertIDR Healthcare is seeking a dynamic and experienced Compliance QA Professional to join our team in the gaming industry. This role is an exciting opportunity for individuals passionate about quality assurance and compliance. If you are looking for a challenging position within a team-oriented...
-
Product Compliance Specialist
3 weeks ago
Los Angeles, California, United States Merle Norman Cosmetics, Inc. Full timeJob SummaryAs a Product Compliance Specialist at Merle Norman Cosmetics, Inc., you will play a critical role in ensuring the quality and compliance of our products. We are seeking a skilled professional to join our team and contribute to our mission of helping people look and feel their best.With a strong background in quality assurance and regulatory...
-
Financial Compliance Specialist
6 days ago
Los Angeles, California, United States Vertical Careers, Inc. Full time**About the Role:**We are seeking a highly skilled Financial Compliance Specialist to join our team at Vertical Careers, Inc. This is an exciting opportunity for a detail-oriented professional with experience in e-billing and compliance to contribute to our mission.The successful candidate will be responsible for reviewing outside counsel guidelines,...
-
Tax Preparation and Compliance Specialist
2 weeks ago
Los Angeles, California, United States destinationone Consulting Full timeJob Overviewdestinationone Consulting specializes in recruitment across various sectors, including CleanTech, Education and EdTech, Government (Municipal, State/Provincial, and Federal), Health and MedTech, Healthcare and Wellness, Legal, Not-For-Profit, and Public Accounting.We are committed to building a robust talent database, enabling our recruiters to...
-
Law Firm Compliance Specialist
5 hours ago
Los Angeles, California, United States The United Firm | La Liga Defensora, APC Full timeCompliance Specialist - Law FirmWe are seeking a highly skilled Compliance Specialist to join our team at The United Firm | La Liga Defensora, APC.About the RoleThis role involves providing expert guidance and support to attorneys and staff on ethical issues that arise in client matters, as well as developing and implementing firm-wide policies and...
-
Regulatory Compliance Specialist
2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob Summary:At L.A. Care Health Plan, we are seeking a highly skilled Audit Readiness Specialist II to join our team. As a key member of our Customer Solution Center, you will be responsible for ensuring regulatory compliance and audit readiness across our operations. This role is a critical part of our mission to provide access to quality healthcare for Los...
-
Healthcare Coding Specialist
24 hours ago
Los Angeles, California, United States MedPOINT Management Full timeJob Title: Healthcare Coding SpecialistAbout MedPOINT Management:MedPOINT Management is a leading healthcare management company dedicated to providing high-quality services to our clients. We are seeking an experienced Healthcare Coding Specialist to join our team.Job Description:The successful candidate will be responsible for reviewing and auditing medical...
-
Senior Compliance Data Specialist
3 weeks ago
Los Angeles, California, United States Saxon Global Full timeJob Title: Financial Data Governance SpecialistWe are seeking a skilled Financial Data Governance Specialist to join our team at Saxon Global.Key Responsibilities:Collaborate with cross-functional teams to identify compliance-related data requirements and translate them into actionable insights.Conduct comprehensive analysis of complex data sets to identify...
-
Auditing and Compliance Specialist
2 days ago
Los Angeles, California, United States NBCUniversal Full timeAbout the RoleThis is a unique chance to work with a leading media and entertainment company like NBCUniversal. As an Auditing and Compliance Specialist, you will play a crucial role in maintaining accurate employee data and ensuring adherence to regulatory requirements.Your primary duties will involve auditing HR data, investigating discrepancies, and...
-
Ethical Compliance Specialist
4 weeks ago
Los Angeles, California, United States Wilson Sonsini Full timeOverviewAt Wilson Sonsini, we are the premier legal advisor to technology, life sciences, and other growth enterprises worldwide. We represent companies at every stage of development, from entrepreneurial start-ups to multibillion-dollar global corporations, as well as the venture firms, private equity firms, and investment banks that finance and advise...
-
Director of Healthcare Law and Compliance
2 days ago
Los Angeles, California, United States L.A. Care Health Plan Full timeAbout the Role:L.A. Care Health Plan is a leading provider of health coverage to low-income Los Angeles County residents. We are seeking an experienced Director of Healthcare Law and Compliance to join our team.Job Summary:The Director of Healthcare Law and Compliance will be responsible for providing legal guidance on complex healthcare matters and ensuring...
-
Regulatory Compliance Specialist
6 days ago
Los Angeles, California, United States Trusaic Full timeJob DescriptionWe are seeking a highly skilled Regulatory Compliance Specialist to join our team at Trusaic. The ideal candidate will have 1-2 years of client service experience and a strong ability to build and maintain relationships with high-level client decision-makers and stakeholders.The successful candidate will be responsible for developing,...
-
Grants Management and Compliance Specialist
1 week ago
Los Angeles, California, United States St Johns Community Health Full timeJob SummaryWe are seeking a highly skilled Grants Management and Compliance Specialist to join our team at St. John's Community Health. In this role, you will be responsible for overseeing all aspects of grants management, ensuring timely compliance with federal, state, and local regulations. This includes supervising Grant Administrators, managing timelines...
-
Senior Financial Compliance Specialist
3 weeks ago
Los Angeles, California, United States Jobot Full timeJob Overview">We are seeking a seasoned Senior Financial Compliance Specialist to join our progressive Accounting and Finance team at Jobot, a Large LA-based organization with multiple locations.