Operations Specialist III - Medicaid / Medi-Cal (Epic + Utilization Review
location_onPacific Avenue, Long Beach, Los Angeles County, California, 90802, United States
Job Description
About the Opportunity
Pyramid Consulting, Inc. is currently seeking a talented Operations Specialist III to join a leading client in the Healthcare Industry. This role focuses on Medicaid and Medi-Cal operations, combining chart review expertise with utilization review processes. The position is a contract opportunity with a duration of 6+ months and long-term potential, located in Long Beach, CA, with remote work options available.
Role Context
In this role, you will serve as a critical link between clinical documentation, administrative workflows, and regulatory compliance. You will support the Medicaid program's performance metrics and reporting while ensuring the integrity of authorization workflows and payor processes. The ideal candidate will thrive in an environment that values operational efficiency, sustainability, and the ability to work independently to resolve discrepancies and elevate quality concerns.
Equal Employment Opportunity
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Work location
Work model: Remote
Pacific Avenue, Long Beach, Los Angeles County, California, 90802, United States
Long Beach, California
Key Responsibilities
- check_circlePerform comprehensive Medicaid and Medi-Cal chart reviews
- check_circleEnsure documentation completeness and regulatory compliance
- check_circleIdentify and elevate quality or utilization concerns
- check_circleSupport Medicaid program performance metrics and reporting
- check_circleSupport authorization workflows and payor processes
- check_circleNavigate and abstract data within Epic HealthConnect
- check_circleManage assigned review queues and documentation workflows
- check_circleTrack operational performance metrics and suggest improvements
- check_circleCollaborate with clinical and administrative teams to resolve discrepancies
- check_circleReview medical necessity documentation for accuracy
Requirements
- verified1-2+ years healthcare operations experience (3-5 years ideal)
- verifiedStrong Medicaid / Medi-Cal background
- verifiedExperience with Epic EHR (Kaiser HealthConnect highly preferred)
- verifiedUtilization Review exposure (authorization workflows, Tapestry preferred)
- verifiedExperience conducting chart reviews (clinical or administrative)
- verifiedHigh School Diploma required; Associate or Bachelor’s degree preferred
Benefits & Perks
Skills, education and keywords
Skills: medicaid, medi-cal, epic, healthconnect, utilization review, chart review, tapestry, anthem, blue shield.
Education: High School Diploma required; Associate degree preferred; Bachelor's degree preferred.