Top 1632 Regulatory compliance Jobs in Riverside, Ca

Denial and Appeals Management Clerk
Riverside-San Bernardino Co. Indian Health, Inc —Grand Terrace, CA
- $22 - $23 an hour
- Weekends as needed
- Hybrid work
- Background check
- BLS Certification
- HIPAA
- Health insurance
- Dental insurance
8d
Regulatory Compliance Specialist
Related —California
- $75,000 - $90,000 a year
- Full-time
- 5 years
- Mid-level
- Real Estate License
- Health savings account
- AD&D insurance
Compliance Lead
Fullscript —Riverside, CA
- $125,000 - $150,000 a year
- Email
- Remote
- 7 years
- HIPAA
- Senior level
Quick Apply
6d
Compliance Coordinator
LSMA Management Inc —San Bernardino, CA
- $28.85 - $33.65 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- Office
Sr. Regulatory Compliance Specialist
Ventura Foods —Irvine, CA
- $63,436.25 - $96,715.21 a year
- Remote
- Bachelor of Science
- Writing skills
- 3 years
- Profit sharing
- Paid holidays
14d
PACE Compliance Analyst-Temporary
Neighborhood Healthcare —Riverside, CA
- $73,500 - $104,400 a year
- Temporary
- CPR Certification
- BLS Certification
- Mid-level
Quick Apply
Clinical Data Analyst
KPC GLOBAL MEDICAL CENTERS INC. —Corona, CA
- $40.86 - $50.48 an hour
- Full-time
- Mid-level
- Master's degree
- SQL
Quick Apply
Assisted Living Coordinator – Senior Living Community
Sunrise Senior Living —Riverside, CA
- $70,720 - $91,676 a year
- Weekends as needed
- Mid-level
- Supervising experience
- Recruiting
- Paid holidays
- Health insurance
Admission Coordinator
BRISTOL HOSPICE - INLAND EMPIRE LLC —Riverside, CA
- $23 - $26 an hour
- Full-time
- 18 years or older
- Mid-level
- Office
- Mileage reimbursement
- Health savings account
Quick Apply
4h
Compliance Auditor II
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Disability insurance
- Health insurance
12d
BSA Specialist
SchoolsFirst FCU —Riverside, CA
- $29.79 - $44.68 an hour
- Full-time
- Hybrid work
- Basic math
- Research
- Mid-level
Data Governance Analyst
Inland Empire Health Plan —Rancho Cucamonga, CA
- $118,601.60 - $157,144.00 a year
- Full-time
- Hybrid work
- HIPAA
- Mid-level
- Office
- Disability insurance
- Health insurance
Quality Assurance Coordinator
Philips —Ontario, CA
- $26 - $41 an hour
- Full-time
- Microsoft Outlook
- Mid-level
- Office
- Health savings account
- Employee stock purchase plan
7d
Environmental Compliance Specialist
Luxfer Gas Cylinders —Riverside, CA
- $85,000 - $95,000 a year
- Full-time
- Pass drug screening
- Research
- Mid-level
- Paid holidays
- Health insurance
1d
Research and Development Specialist Chemist
GAR Labs, Inc. —Riverside, CA
- $30 - $35 an hour
- Full-time
- Mid-level
- In-person
- Dental insurance
- 401(k)
Quick Apply
7d
Environmental Analyst (Administrative Services Analyst II)
Riverside County Flood Control and Water Conservation District —Riverside, CA
- $74,797.02 - $99,284.55 a year
- Background check
- Mid-level
- Finance
- Paid holidays
- Disability insurance
6d
Treasury Analyst - Cash Management
Monster Energy —Riverside, CA
- $55,770 - $74,360 a year
- Mid-level
- Office
- Finance
Quick Apply
RUHS Compliance Program Manager
County of Riverside —Riverside, CA
- $101,430.89 - $148,651.68 a year
- Background check
- HIPAA
- 3 years
- Paid holidays
- Disability insurance
8d
Mortgage Loan Processor
NEXA Lending —San Bernardino, CA
- From $50,000 a year
- Contract
- Remote
- Management
- Customer service
- Basic math
Quick Apply
Regional Safety and Compliance Manager
Lineage Logistics —Riverside, CA
- $92,100 - $165,800 a year
- Full-time
- Hybrid work
- Up to 50% travel
- 5 years
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply

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Denial and Appeals Management Clerk

Riverside-San Bernardino Co. Indian Health, Inc -
Grand Terrace, CA

Apply Now

Job Details

Full-time
$22 - $23 an hour
8 days ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Employee discount
Life insurance
Retirement plan

Qualifications

Appeals
Medicare
Commercial insurance knowledge
Managed care organization experience
BLS Certification
Regulatory compliance in claims processing
HIPAA
Medical coding guidelines
High school diploma or GED
Cultural competency
Health information regulatory compliance
Medical explanation of benefits reviews
Medical claims submission
Medical Billing Certification
Clinical confidentiality policies
Insurance claims appeal handling
Medical terminology

Full Job Description

Summary:

Applicant must possess a high school diploma or equivalent. An associate degree in healthcare administration or finance is preferred. Certification as a Certified Professional Biller (CPB) is required. A minimum of two years of experience in healthcare revenue cycle, medical billing, claims processing, collections, and denial management is required. Experience with Medicare, Medi-Cal, Managed Care, and Commercial Insurance payers is required. Experience in an FQHC, Tribal Health, or community health center is preferred. NextGen experience is preferred.Must have knowledge of medical terminology, coding concepts, claim adjudication, EOBs, ERAs, payer portals, denial and appeals management, timely filing limits, and appeal processes. Experience with EHR/practice management systems, NextGen, and clearinghouses such as Waystar is preferred. Must understand healthcare regulations, coding standards, and payer requirements related to claim denials and appeals. Must be able to maintain confidentiality and ensure HIPAA compliance while prioritizing workload and consistently meeting productivity goals. Applicant must have a CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation or within 90 days of employment. The Denials and Appeals Management Clerk is responsible for reviewing, researching, resolving, and appealing denied or underpaid claims to maximize reimbursement and reduce accounts receivable delays. This position works closely with third-party payers, billing, coding, credentialing, providers, and internal departments to ensure timely payment, accurate claim submission, and compliance with applicable regulations. The role also analyzes denial trends, identifies payer issues, supports process improvement, and helps prevent future denials.This position is eligible for a hybrid work schedule. Must be able to work with the Indian Community and be sensitive to the Indian culture and its needs.

Major Duties and Responsibilities:

Review and prioritize high dollar and timely filing-sensitive denied claims from mail, clearinghouses, payer portals, and work queues.
Analyze denied claims, reason codes, and determine appropriate corrective actions.
Identify root causes related to coding, insurance eligibility, referral, authorization, provider documentation, or billing errors.
Correct claims and resubmit within payer filing limits
Monitor aged, denied claims, and maintain denial work queues.
Document all actions and follow-up activities in the practice management system.
Stay current on changes to payer policies, billing regulations, and reimbursement guidelines.
Adhere to patient privacy and confidentiality requirements, including HIPAA regulations.
Prepare and submit first-level and second-level appeals as appropriate.
Gather supporting medical records, referrals, authorizations, and documentation.
Draft appeal letters citing payer policies, medical necessity, coding guidelines, and regulatory requirements.
Track appeal status through payer portals, telephone calls, and payer response deadlines until resolution.
Escalate unresolved claims to management when appropriate or payer representatives.
Coordinate peer-to-peer reviews and reconsideration requests when necessary.
Identify denial trends by payer and denial reason and recurring issues.
Assist in denial prevention education and implement corrective action plans.
Collaborate with coding, billing, patient registration, medical records, and providers to prevent future denials.
Maintain denial logs and appeal tracking spreadsheets.
Support quality assurance and internal audits.
Participate in revenue cycle meetings and payer issue resolution.
Monitor denial rates and appeal outcomes.
Assist in preparing monthly reports that include denial volume, top denial categories, appeal success rates, timely filing issues, and underpayment trends.
This position requires working weekends and evenings, if needed.
Other duties assigned relevant to the position, with relevant training and competency assessment documented.

Qualifications

Education:

High School Diploma or Equivalent required. Associate degree in healthcare administration, or finance preferred.

Certification as a Certified Professional Biller (CPB) is required.

Experience:

A minimum of two years’ experience in healthcare revenue cycle, medical billing, claims processing, collections, and denial management is required. Experience with Medicare, Medi-Cal, Managed Care, and Commercial Insurance payers is required.
Experience in an FQHC, Tribal Health, or community health center is preferred.

Certification:

CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation. Certification may obtained within 90 days of employment.

Knowledge of:

Knowledge of medical terminology, CPT, HCPCS, ICD-10-CM Coding concepts, and claim adjudication. Explanation of benefits (EOBs), Electronic Remittance Advice (ERAs), and payer portals. Denial and Appeals Management Clerk. Familiarity with timely filing limits and appeal processes. Proficiency with Electronic Health Records and Practice Management systems (NextGen Preferred). Experience using clearinghouses such as Waystar is preferred. Knowledge of healthcare regulations, coding standards, and payer requirements relevant to claim denials and appeals.

Skill:

Strong analytical, organizational, and problem-solving skills Excellent verbal and written communication skills Microsoft Office applications. Must understand or be willing to receive Native American cultural competency training and employ cultural awareness with our Native American community.

Ability to:

Demonstrated ability to interpret claim denials, review documentation, and develop effective appeal strategies. Proven ability to investigate denials, identify root causes, and implement corrective actions. Ability to prioritize workload and consistently meet productivity goals. Ability to maintain confidentiality and ensure HIPAA compliance. Must be able to work with the Indian Community and be sensitive to the Indian culture and its needs.

Physical Demands:

This position requires prolonged sitting and computer use, occasional lifting of 20 to 25 pounds, and proficiency with computers, keyboards, and standard office equipment. Dexterity of hands with coordination of eye and hand movement.

Remote Work Eligibility:
This position may be eligible for a hybrid work schedule, eligibility is subject to supervisor approval, position requirements, and organizational needs.

Appointment Type:

Full-Time, Non-Exempt

Compensation:

$22.00–$23.00 per hour ($45,760–$47,840 annually, depending on experience and internal equity)

Clinic Location:

San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)

Pay: $22.00 - $23.00 per hour

Benefits:

401(k)
Dental insurance
Employee assistance program
Employee discount
Health insurance
Life insurance
Paid time off
Retirement plan
Vision insurance

Work Location: In person

Apply Now

Refine Your Search

regulatory compliance jobs in riverside, ca

Denial and Appeals Management Clerk

Regulatory Compliance Specialist

Compliance Lead

Compliance Coordinator

Sr. Regulatory Compliance Specialist

PACE Compliance Analyst-Temporary

Clinical Data Analyst

Assisted Living Coordinator – Senior Living Community

Admission Coordinator

Compliance Auditor II

BSA Specialist

Data Governance Analyst

Quality Assurance Coordinator

Environmental Compliance Specialist

Research and Development Specialist Chemist

Environmental Analyst (Administrative Services Analyst II)

Treasury Analyst - Cash Management

RUHS Compliance Program Manager

Mortgage Loan Processor

Regional Safety and Compliance Manager

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