** California DOFR experience is REQUIRED. If you have not personally applied an executed delegated risk contract at a California IPA, MSO, or health plan — not advised on one, applied one — please do not apply. I** Position: DOFR Specialist Remote — California preferred, PST required 1099 Independent Contractor Start: Immediate Who we are Gabeo is a Bay Area health tech startup building AI that adjudicates California DOFR contracts at scale. Our model classifies every claim through service category determination, sub-service interpretation, and DOFR mapping before routing financial responsibility to the correct entity — IPA, Hospital, or Plan. We work with California health plans and IPAs where misrouted claims mean real financial exposure. We need a human expert to validate our AI output, catch its errors, and close the loop so it gets smarter. The problem you'll solve DOFR disputes don't live in the contract. They live in the sub-service layer — the point where a J-code, a CPT family, a revenue code, and a site of service combine into something the contract language never cleanly anticipated. You'll own that layer. "J9310 rituximab. IPA-contracted outpatient infusion center. DOFR lists chemotherapy as a Hospital carve-out. IPA argues it's an injectable — not chemotherapy — and they own it. How do you resolve it and what do you cite?" What you'll do Audit AI-generated DOFR entity assignments against executed California contract terms Determine correct service and sub-service category for disputed claims — chemotherapy, biological, infusion, injectable, diagnostic — and document the cited authority behind every determination Validate drug and administration responsibility by site of service, Medicare Part B coverage status, and CPT administration hierarchy Identify DOFR configuration gaps: missing categories, incorrect entity names, outdated carve-out definitions, out-of-area errors Translate every finding into a structured issue the engineering team can act on directly Produce financial exposure estimates by health plan for internal review and external audit What you bring 5+ years in California managed care claims adjudication, contracting, or delegated risk operations Direct experience applying DOFR contracts at a California IPA, MSO, or health plan Demonstrated wins resolving sub-service category disputes using cited coding and policy authority Familiarity with both professional (CMS-1500) and institutional (UB-04) claim types Active CPC (AAPC), CCS, or RHIA (AHIMA) certification Clear written output — findings must be readable by both operations and AI engineering teams Career path we're looking for Started as a certified coder. Moved into claims auditing or coding compliance at a California IPA or MSO. Got pulled into DOFR disputes because you were the only person in the room who could argue the coding basis for a category assignment, and win. What we offer Competitive 1099 contract rate Intellectually serious work, your findings directly improve a production AI system, not a report no one reads Flexible remote engagement with a focused, senior team Who We Are Gabeo.ai is a cutting-edge health tech startup based in the Bay Area (USA), collaborating with industry leaders like Astrana Health, Athena Health and Rebound Orthopedics. Our goal? Transform the healthcare revenue cycle by using advanced AI to tackle denied medical claims, one of the sector’s biggest financial headaches. At Gabeo.ai, we pride ourselves on: Innovation + Speed: We push boundaries and welcome out-of-the-box thinking. Collaboration: We’re a tight-knit team that values open communication. Impact: Your work will directly influence our AI-driven products and customer outcomes.