td>- Reviews the assignment and sequencing of codes for the principal diagnosis, principal procedure, complications and comorbid (CC) conditions, and other significant invasive and non-invasive procedures that should be coded according to ICD-10-CM official guidelines for coding and reporting, published by the U.S. Department of Health and Human Services (DHHS) and the AHA Coding Clinic for ICD-10-CM.
- Applies Medicare Outpatient Prospective Payment System (OPPS) coding assignment requirements regarding the following: Modifiers approved for Hospital Outpatient use, CPT consistent with HCPCS Level II , Medical Necessity Justification (i.e., linking diagnosis to procedure/service performed), Evaluation and Management code assignment, when necessary.
Los Angeles, CA29 days ago A minimum of 2 years of experience with outpatient/ambulatory care coding or inpatient acute care coding required, with familiarity with ICD-10-CM, CPT-4 coding and APC payment methodologies required. Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. Work At Home, CA17 days ago Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures. Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred. This role is a unique opportunity for an experienced medical coder with robust multi-specialty auditing experience, excellent communication and self-presentation skills, the drive to help a high-growth startup scale, and the desire to transform the future of medical coding. Using AI, we automate the translation of clinical notes into the billing codes used for provider reimbursement-a process that costs US hospitals $15B+ annually, plus tens of billions more in errors and denied claims. Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities. Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts. Manager Risk Adjustment Audit, the Risk Adjustment Coder is responsible for reviewing medical records to apply appropriate diagnosis coding in compliance with International Classification of Diseases, Tenth Revision (ICD-10) coding guidelines for the purposes of risk adjustment. - Review and validate provider-submitted and/or vendor-submitted medical record documentation and ICD-10 diagnosis codes to identify and correct any inaccuracies or discrepancies to ensure accuracy and compliance of risk adjustment.
li>Work with various leadership and clinical departments to design relevant trainings specific to an identified need of the clinical department as well as the direct communication, both virtual and onsite, with physicians to insure adequate training and conceptual mastery. City of Hopes growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. p>OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. Los Angeles, CA9 days ago p>As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. Under the direction of the Physician Billing Office (PBO) Coding Director, the Coding Department Supervisor oversees the daily operations of a team of certified coding professionals. Los Angeles, California30+ days ago Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. Missing Translation: layouts.eu_consumer_core.application.custom_footer.footer_title. Anesthesia Coding Trainer Job in USA | www.teamhealthcareers.com Now that you know what we're looking for in talent, let us tell you why you'd want to work at NeoGenomics: As an employer, we promise to provide you with a purpose driven mission in which you have the opportunity to save lives by improving patient care through the exceptional work you perform. Position Summary: As a Certified Coding Specialist, you will analyze medical records and abstracts clinical data by assigning codes from patient records in accordance to coding classification systems. Education• High School Diploma, High School Equivalency (HSE) or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required Experience• 2 years of professional coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS modifiers required Licenses and Certifications• One of the following is requiredo CCS - Certified Coding Specialisto CPC - Certified Professional Codero CPMA - Certified Professional Medical Auditoro RHIT - Registered Health Information Techniciano RHIA - Registered Health Information Administrator. Works closely with clinical departments and Revenue Cycle Services to ensure compliance with coding guidelines, government, payer and internal charge capture policies. Los Angeles, CA30+ days ago The Senior Coding Auditor reviews and audits current and retro accounts, and reports audit outcomes regarding charge errors, percentage of savings or losses for the facility, data processing errors, the performance of the hospital charging system as well as documentation and justification within the medical record and itemized bill. The Senior Coding Auditor performs detailed audits of medical cases to ensure accuracy of assigned codes, charges, availability of documented medical records, medical accounts and compares the cases with the itemized bill and overall procedures. Los Angeles, CA30+ days ago Ability to effectively prioritize and manage multiple tasks to ensure successful completion targeted deadlines-Proficient in Windows 7 and MS Office (Excel, PowerPoint, Visio, Word)- Familiarity with validation of computer systems and/or GMP environments is essential.- Work as Signal Analyst during signal management activities including extractions of signal detection reports ensuring document filing and archivingEnsure quality and compliance with the legal requirements for pharmacovigilance tasks and responsibilities:1. ul>- Through continuous process improvement efforts, works to ensure that every legitimate charge for services provided makes it to billing and that proper reimbursement is received for those services;
- Works with the departments and Technical Services to ensure the flow from the department's charge capture process to billing is error free and all charges from the departments are making it to billing;
- Responsible for finding root cause reasons and proposing solutions for issues leading to revenue leakage and/or reduced reimbursement;
- Assists in overseeing Mosaic's charge capture system to promote its accuracy and integrity across revenue-generating departments;
- Works with Patient Financial Services (PFS) to review items routinely being held by the claim scrubber that are charge/coding related and comes up with recommended resolutions that helps expedite cash flow; Liaison to PFS to review denials that are charge/coding related and with Contracts if payers are not paying as expected based on contract terms due to charge/coding issues; Summarizes hospital or health system-wide charge audit findings to executive staff, board members,
- Investigates billing errors and impacts to reimbursement potentially caused by inappropriate documentation, coding, medical necessity exceptions or charging and works in collaboration to come up with an action plan to resolve;
- Coordinates the hospital charge audit and RAC process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities.
- Through continuous process improvement efforts, works to ensure that every legitimate charge for services provided makes it to billing and that proper reimbursement is received for those services;
- Works with the departments and Technical Services to ensure the flow from the department's charge capture process to billing is error free and all charges from the departments are making it to billing;
- Responsible for finding root cause reasons and proposing solutions for issues leading to revenue leakage and/or reduced reimbursement;
- Assists in overseeing Mosaic's charge capture system to promote its accuracy and integrity across revenue-generating departments;
- Works with Patient Financial Services (PFS) to review items routinely being held by the claim scrubber that are charge/coding related and comes up with recommended resolutions that helps expedite cash flow; Liaison to PFS to review denials that are charge/coding related and with Contracts if payers are not paying as expected based on contract terms due to charge/coding issues; Summarizes hospital or health system-wide charge audit findings to executive staff, board members,
- Investigates billing errors and impacts to reimbursement potentially caused by inappropriate documentation, coding, medical necessity exceptions or charging and works in collaboration to come up with an action plan to resolve;
- Coordinates the hospital charge audit and RAC process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities.
Beverly Hills, CA30+ days ago Responsibilities include, but are not limited to: • Accessing data through a variety of databases • Creating accurate, meaningful and relevant reports for diverse audiences • Assisting with the administration and implementation of financial initiatives • Assisting in the interpretation of policies/procedures/practices. We offer learning programs, tuition reimbursement and performance-improvement projects so you can achieve certifications and degrees while gaining the knowledge and experience needed to advance your career. Long Beach, CA21 days ago In this role, you will play a critical role in ensuring payment and medical policy logic is accurately translated into system configuration, directly impacting claims accuracy, regulatory compliance, and cost of healthcare outcomes, while influencing cross-functional decision-making through expert analysis and identification of improvement opportunities. This role is responsible for analyzing data, defining business requirements, and driving operational improvements related to payment policy, medical policy, and coding related processes, while also contributing to the development of annual operating plans, budgets, forecasts, and cost/benefit analyses for new initiatives. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. With an enterprise approach that streamlines payer-provider decision-making across the care continuum-including policy, prior authorization, payment accuracy, and more-the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction. Woodland Hills, CA18 days ago Minimum Requirements: Requires a HS Diploma or equivalent and a minimum of 5 years of claims processing or customer service experience with managing complex claims, provider, or member issues; or any combination of education and experience which would provide an equivalent background. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will act as a subject matter expert, overseeing reporting processes, analyzing fraud patterns, and collaborating with internal teams and regulatory agencies to strengthen program integrity. Our client supports large scale public healthcare programs and emphasizes compliance, accountability, and innovation to protect critical resources. li>Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. Provides support and ownership for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities and improve financial performance. The ideal candidate is highly analytical, detail-oriented, and experienced leading testing efforts across complex payer environments involving medical, pharmacy, and dental/vision claims. - Perform testing and validation of HIPAA-compliant EDI transaction sets including 837, 835, 270/271, 276/277, and 834 transactions.
Los Angeles, CA30+ days ago Coding/Compliance Certification preferred • Resolute Hospital Billing Administration, Charge Router and/or Charge Master Epic Applications Certifications, preferred • Three to five years of related health care administration/financial or revenue cycle analysis experience required. Will support the Revenue Cycle Operations Department through the identification, quantification and execution of special projects identifying areas of increased net revenue opportunities related to charging. Los Angeles, CA30+ days ago This is an opportunity to work collaboratively with clinical, financial, and operational teams while serving as a subject matter expert in revenue cycle compliance and charge capture processes. - Proficiency in Epic (including SlicerDicer), Microsoft Office, and revenue cycle tools such as Optum 360 Charge Assist and Revenue Cycle Pro.
Requsition ID: 438169 Company: Providence Jobs Job Category: Research Job Function: Clinical Support Job Schedule: Full time Job Shift: Day Career Track: Clinical Professional Department: 5018 HCS MEDICAL MANAGEMENT OR REGION Address: OR Portland 4400 NE Halsey St Work Location: Providence Health Plaza (HR) Bldg 1-Portland Workplace Type: Remote Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Los Angeles, CA30+ days ago p>Country Code+1+1242+1246+1264+1268+1284+1340+1441+1473+1649+1664+1670+1671+1684+1758+1767+1784+1849+1868+1869+1876+1939+20+211+212+213+216+218+220+221+222+223+224+225+226+227+228+229+230+231+232+233+234+235+236+237+238+239+240+241+242+243+244+245+248+249+250+251+252+253+254+255+256+257+258+261+262+264+265+266+267+268+269+27+290+291+297+298+299+30+31+32+33+34+345+350+351+352+353+354+355+356+357+358+359+36+370+371+372+373+374+375+376+377+378+379+380+381+382+385+386+387+389+39+40+41+420+421+423+43+44+45+46+47+48+49+500+501+502+503+504+505+506+507+508+509+51+52+53+54+55+56+57+58+590+591+593+594+595+596+597+598+599+60+61+62+63+64+65+66+670+672+673+674+675+676+677+678+679+680+681+682+683+685+686+687+688+689+690+692+7+77+81+82+84+850+852+853+855+856+86+872+880+886+90+91+92+93+94+95+960+961+962+963+964+965+966+967+968+970+971+972+973+974+975+976+977+98+992+993+994+995+996+998Phone Number. Req ID 16243 Working Title Sr Financial Analyst (reporting) - Hybrid Department MNS Accounting Business Entity Cedars-Sinai Medical Center Job Category Patient Financial Services Job Specialty Revenue Integrity Overtime Status EXEMPT Primary Shift Day Shift Duration 8 hour Base Pay $40.16 - $62.25. p>The Senior Health Informatics Analyst will create and develop essential department reports and deliverables to ensure timely dissemination of accurate information to organizational decision-makers; provide data analysis, interpretation, and consultation to maximize the use of organizational data (claims, authorizations, capitation, enrollment, pharmacy, financial, EMR, clarity, program engagement, abstraction data) in order to support needs of senior management, operational management, finance lead and healthcare leadership. Marquez%40pihhealth.org%7C1234f44474844f48e14a08d9ebe9053e%7Ca58ef208b7dc40aa8f166eb35263cb1c%7C0%7C0%7C637800208320708287%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=itjUBuUESomy5k8fnqLUf2EuyxVcl4xXjgaKar5hjhA%3D&reserved=0" rel="nofollow">PIHHealth.org or follow us on p>The Payment Compliance & Contract Management (PCCM) Analyst is responsible for maximizing reimbursement by identifying variances between posted and expected revenue for managed care, government contracts, and other payers. - Analyzes contract reimbursement, identifying variances, trends in underpayments/overpayments, denials, and revenue leakage to support maximization of reimbursement.
The Senior Regulatory Compliance & Revenue Cycle Analyst is responsible for advancing compliance across payer relationships, reimbursement practices, and healthcare regulatory frameworks, while supporting enterprise-wide GRC privacy and compliance initiatives. This is a high-impact, cross-functional role ideal for a compliance professional who understands how regulatory requirements translate into real-world healthcare operations, financial sustainability, and patient outcomes. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create digital marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. You will: Use knowledge of reimbursement methodologies to analyze, define and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Experian Health''s Contract Manager software. Initiate, draft, redline, and negotiate moderately complex payment and budget terms for invoiceable budget line items and trial costs to support the internal Site Payment teams as well as the trial Team on trial costs and payments. As the Clinical Budgets Analyst, you will negotiate and develop site budgets for clinical trials, ensure all budgets align with regulatory and fair market value guidelines, and manage the full budget lifecycle from study start-up through close-out. Analyst Paramount Skydance CorpAnalystCA30+ days ago The Analyst, Marketing Data Operations will provide day-to-day operational support for the marketing data ecosystem, with a primary focus on monitoring, maintaining, and troubleshooting data pipelines that ingest and transform performance data from paid media platforms such as Meta, Google, and TikTok. Actively incorporate and help develop AI-assisted workflows leveraging tools like Claude to support day-to-day tasks: writing and debugging code, drafting documentation, and accelerating data investigations. Los Angeles, CA30+ days ago This is an opportunity to work collaboratively with clinical, financial, and operational teams while serving as a subject matter expert in revenue cycle compliance and charge capture processes. - Proficiency in Epic (including SlicerDicer), Microsoft Office, and revenue cycle tools such as Optum 360 Charge Assist and Revenue Cycle Pro.
Woodland Hills, California30+ days ago ul>- Bachelor's degree required (Finance or Accounting preferred; related healthcare degrees acceptable). These roles support senior leadership and require strong healthcare financial experience.
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