Accounts Payable Specialist Vaco LLCAccounts Payable SpecialistAlhambra, CA$27–$30 / hourDetermining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: the individual’s skill sets, experience and training; licensure and certification requirements; office location and other geographic considerations; other business and organizational needs. Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs.
Medical Coding Specialist OneOncology IncMedical Coding SpecialistCARemoteOneOncology 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.
Medical Billing & Coding Specialist CrewBloomMedical Billing & Coding SpecialistLos Angeles, CARemoteYou will work closely with healthcare practitioners in private practices and medical clinics to accurately review, assign, and manage medical codes, ensuring compliant billing, timely reimbursements, and efficient revenue cycle operations. While industry certifications are a plus, what matters most is hands-on experience with medical billing and coding, particularly a strong understanding of Eye Care Practice (ECP) coding guidelines and regulations.
Risk Adjustment Coding Specialist II - Remote Astrana Health, Inc.Risk Adjustment Coding Specialist II - RemoteMonterey Park, CaliforniaRemote$70,000–$85,000 / yearPerform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines. Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
Risk Adjustment Coding Specialist II - Remote Astrana Health IncRisk Adjustment Coding Specialist II - RemoteMonterey Park, CARemoteIn this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. Additionally, you'll track and report on key performance metrics-such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
Clinical Coding Specialist SmarterDx IncClinical Coding SpecialistCARemote$75,000–$105,000 / yearThis role is fully remote within the US What You'll Do Review and analyze medical records to ensure coding accuracy in a timely fashion Identify opportunities for improvement in coding models Understand and apply coding guidelines to assign appropriate codes to diagnoses and procedures as supported by clinical documentation Participate in ongoing training and professional development to stay current on documentation and coding guidelines Contribute to process improvement efforts to enhance coding practices and support efficient and effective healthcare delivery What You Bring 5+ years of recent experience in performing inpatient coding and/or auditing Strong expertise in ICD-10 classification system Active RHIA, RHIT, and/or CCS credential(s) Experience reviewing complex medical records and applying coding conventions and guidelines accurately Familiarity with DRG and inpatient reimbursement methodologies Strong attention to detail and ability to identify subtle coding inaccuracies Experience with coding audits, QA, or validation workflows Strong written communication for documenting rationale and feedback Nice To Haves Experience working with AI coding tools or CAC (computer-assisted coding) systems Prior experience in auditing or coding quality assurance roles Familiarity with evaluation frameworks, labeling, or annotation workflows Certified Clinical Documentation Specialist (CCDS) or Clinical Documentation Improvement Practitioner (CDIP) credentials Compensation $75k - $105k salary + benefits, 100% US-based remote #LI-Remote #LI-DNP Benefits Medical, Dental & Vision - Comprehensive plans with leading insurance providers, covering 75% of your premiums, depending on the plan. Clinical Coding Specialist (Inpatient) Role As an Inpatient Coding Specialist at SmarterDx, you will be responsible for conducting comprehensive chart reviews and coding validation of AI diagnostic models to support coding improvement.
Profee Coding Consultant - PRN Datavant LLCProfee Coding Consultant - PRNCA$20–$28 / hourGuided 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. Collaborating closely with key stakeholders such as clients and healthcare leaders, you'll meet and exceed customer expectations through identifying and proposing solutions, and being a responsible and reliable teammate.
Profee Coding Consultant - Full Time Datavant LLCProfee Coding Consultant - Full TimeCA$20–$28 / hourGuided 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. Collaborating closely with key stakeholders such as clients and healthcare leaders, you'll meet and exceed customer expectations through identifying and proposing solutions, and being a responsible and reliable teammate.
Coding Technician III - FT Days Torrance Memorial Medical CenterCoding Technician III - FT DaysTorrance, CaliforniaReviews 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.
Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern CaliforniaCoding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)Los Angeles, CaliforniaIn accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments – and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. 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.
Coding Audit Supervisor Cedars-Sinai Medical CenterCoding Audit SupervisorLos Angeles, CAA 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.
Remote Physician Pro Fee Coding Specialist-Cardiology/Electrophysiology Community Health Systems IncRemote Physician Pro Fee Coding Specialist-Cardiology/ElectrophysiologyCARemoteEnsures compliance with governmental regulations, third-party payer policies, and corporate coding protocols, following National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs). The Physician Coder plays a key role in revenue cycle accuracy by identifying documentation gaps, ensuring coding integrity, and working collaboratively with internal teams to support physician coding compliance and reimbursement.
Coding and Compliance Specialist Hybrid Concentra Inc.Coding and Compliance Specialist HybridSanta Clarita, CA$28.81–$33.13 / hourSchedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside of normal working hours when the need arises. This function is critical to the overall revenue cycle in supporting charge entry, level of service selection, procedure and diagnosis coding, as well as one on one, and group, education and training to employed and contracted Clinicians.
NewCoding and Compliance Specialist- Hybrid ConcentraCoding and Compliance Specialist- HybridSanta Clarita, California$28.85–$33.13 / hourSchedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside of normal working hours when the need arises. This function is critical to the overall revenue cycle in supporting charge entry, level of service selection, procedure and diagnosis coding, as well as one on one, and group, education and training to employed and contracted Clinicians.
Claim Review Specialist - Coding Certification Required CorroHealth IncClaim Review Specialist - Coding Certification RequiredCARemoteJOB SUMMARY: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Become proficient in the use of the PARA Data Editor, our proprietary software; Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation.
NewCoding Data Quality Auditor CVS Health CorpCoding Data Quality AuditorCA$18.50–$38.82 / hourResponsible 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. Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
SPECIALIST II, CLINICAL CODING Pomona Valley Hospital Medical CenterSPECIALIST II, CLINICAL CODINGPomona, CA$39.89–$56.13 / hourPosition Summary:Responsible for the review and evaluation of the medical record in order to assign accurate diagnosis and procedural codes ensuring optimal reimbursement while remaining compliant with all regulatory agencies. As part of our ongoing effort to remain an employer of choice, eligible employees who work qualifying weekend shifts receive a competitive weekend rate.
HIM Coding Manager - HIM Financial - Full Time 8 Hour Days (Exempt) (Non-Union) University of Southern CaliforniaHIM Coding Manager - HIM Financial - Full Time 8 Hour Days (Exempt) (Non-Union)Los Angeles, CA$110,240–$181,896 / yearReq 2 years Leadership Experience.\n Req Experience in using a computerized coding & abstracting database software and encoding/code-finder systems [e.g., 3M 360 Encompass/CAC and 3M Coding and Reimbursement System (CRS)].\n \nPreferred Qualifications:\n \nRequired Licenses/Certifications: \n\n Req Advanced knowledge of: \u2022 ICD-10-CM \u2022 ICD-10-PCS \u2022 CPT \u2022 HCPCS \u2022 MS-DRG \u2022 APR-DRG\n Req Knowledge of coding compliance and regulatory requirements\n Req Knowledge of CMS coding and billing rules\n Req Strong analytical and problem-solving skills\n Req Excellent organizational and time management skills\n Req Strong written and verbal communication skills\n Req Ability to work independently and collaboratively\n Req Ability to interpret and apply official coding guidelines\n Req Strong presentation and training skills\n Req Certified Coding Specialist - CCS (AHIMA) AHIMA Certified Coding Specialist (CCS) only; or AAPC Certified Inpatient Coder (CIC) only; or either the CCS or CIC in conjunction with any one of the following national HIM credentials: 1. \u2022 Ensure effective use of coding and electronic health record systems including: \u25e6 Cerner/PowerChart and Coding mPage \u25e6 Solventum/3M 360 Encompass (CAC/CRS) \u25e6 Solventum/3M HDM, HRM, and ARMS \u25e6 Soarian Financials and CHC Assurance PFS systems \u2022 Promote effective use of system tools to support coding accuracy, audit activities, and denial prevention\n Perform other duties as assigned.\n
HIM Coding Manager Auditing and Education - HIM Financial - Full Time 8 Hour Days (Exempt) (Non-Union) University of Southern CaliforniaHIM Coding Manager Auditing and Education - HIM Financial - Full Time 8 Hour Days (Exempt) (Non-Union)Los Angeles, CA$110,240–$181,896 / yearPreferred Qualifications: Required Licenses/Certifications: Req Advanced knowledge of: • ICD-10-CM • ICD-10-PCS • CPT • HCPCS • MS-DRG • APR-DRG Req Knowledge of coding compliance and regulatory requirements Req Knowledge of CMS coding and billing rules Req Strong analytical and problem-solving skills Req Excellent organizational and time management skills Req Strong written and verbal communication skills Req Ability to work independently and collaboratively Req Ability to interpret and apply official coding guidelines Req Strong presentation and training skills Req Certified Coding Specialist - CCS (AHIMA) AHIMA Certified Coding Specialist (CCS) only; or AAPC Certified Inpatient Coder (CIC) only; or either the CCS or CIC in conjunction with any one of the following national HIM credentials: 1. • Ensure effective use of coding and electronic health record systems including: ◦ Cerner/PowerChart and Coding mPage ◦ Solventum/3M 360 Encompass (CAC/CRS) ◦ Solventum/3M HDM, HRM, and ARMS ◦ Soarian Financials and CHC Assurance PFS systems • Promote effective use of system tools to support coding accuracy, audit activities, and denial prevention Perform other duties as assigned.
Coding Policy Analyst - Remote Providence Health & ServicesCoding Policy Analyst - RemoteCalifornia, CARemoteRequsition ID: 432922 Company: Providence Jobs Job Category: Coding Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Multiple shifts available Career Track: Business Professional Department: 5018 HCS MEDICAL MANAGEMENT OR REGION Address: WA Liberty Lake 24021 E Mission Ave Work Location: Liberty Lake 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. The analyst is responsible for monitoring changes to codes, coding guidelines and regulations, and coding edits from external agencies such as AMA, CMS, Medicaid, and specialty societies, and assists with implementation of such changes to the claims adjudication and editing software.
Medical Billing Specialist- Certified Coder Men's Health Foundation USAMedical Billing Specialist- Certified CoderLos Angeles, CAPerforms billing functions for the various service components of the Clinics, assists other claims processors as needed; serves as back up for the Billing Manager and runs various financial reports as needed by the CFO. Must take yearly flu shot or wear flu mask during flu season for patient-facing positions and test for tuberculosis as required by the Centers for Disease Control and Prevention.
Payer Coding Ops Hourly Datavant LLCPayer Coding Ops HourlyCA$25–$26 / hourGuided 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.
Coder - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern CaliforniaCoder - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)Los Angeles, CA$33–$54.02 / hourRequired Qualifications: Req High school or equivalent Req Specialized/technical training; Combined experience/education as substitute for minimum education Graduation from a formal coder training program or completion of academic class in medical coding Combined experience/education as substitute for minimum education Req 2 years; Combined education/experience as substitute for minimum experience 2 years' coding experience. Required Licenses/Certifications: Req Certified Professional Coder - CPC (AAPC) OR AHIMA Certified Coding Specialist-Physician (CCS-P); ◦ *Certified Coding Specialist (CCS) in lieu of (CCS-P) acceptable for employees hired prior to April 30, 2020.
NewCoding Analyst, Care Delivery Organization - Fully remote Alignment Healthcare IncCoding Analyst, Care Delivery Organization - Fully remoteCARemote$58,531–$87,797 / yearWorking closely with clinical documentation teams, and CDO provider partners - including PCPs, specialists, and clinical support staff - this role delivers accurate HCC code assignments, conducts structured provider coding audits, and provides targeted education that improves documentation quality and risk capture at the point of care. The Coding Analyst''s work directly drives RAF score accuracy, revenue integrity, and the quality of clinical documentation across the CDO''s provider network, making this role both a production function and a trusted clinical partner in Alignment''s Medicare Advantage operations.
Senior Coding Auditor Montefiore Medical CenterSenior Coding AuditorLos Angeles, CA$76,632.04–$95,790.05 / yearThe 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.
Medical Data Specialist II — Medical Device (Hybrid — Valencia, CA) Contract Pharmavise CorporationMedical Data Specialist II — Medical Device (Hybrid — Valencia, CA) ContractValencia, CaliforniaData Modeling: Strong knowledge of relational (PostgreSQL, MySQL) and NoSQL (MongoDB, DynamoDB) data models, especially clinical or device data schemas (FHIR, HL7, OMOP). • Builds data APIs and data delivery services that support critical operational and analytical applications for our internal business operations, customers and partners.
Client Coding Project Manger CCPM Datavant LLCClient Coding Project Manger CCPMCA$75,000–$90,000 / yearGuided 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. At Datavant our total rewards strategy powers a high-growth, high-performance, health technology company that rewards our employees for transforming health care through creating industry-defining data logistics products and services.
Coding & Compliance Auditor American Oncology Network IncCoding & Compliance AuditorCARemote$20.78–$36.53 / hourAbility to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations. Core Capabilities: Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills.
Supervisor, Reimbursement - Corporate Reimbursement/Coding - Full Time Guthrie ClinicSupervisor, Reimbursement - Corporate Reimbursement/Coding - Full TimeCAGuthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities.
Medical Assistant/ Insurance verifier , authorization specialist Apex Practice Management GroupMedical Assistant/ Insurance verifier , authorization specialistNorthridge, CAThe ideal candidate will be responsible for obtaining insurance authorizations and check eligibility for medical procedures and services, ensuring timely approvals to facilitate patient care. - Communicate with healthcare providers, insurance companies, and patients to gather necessary information.
NewOnline Adjunct Instructor - ICD-CM Coding Rasmussen College LLCOnline Adjunct Instructor - ICD-CM CodingCARemoteAbout Us: Rasmussen University, a university accredited by the Higher Learning Commission, an institutional accreditation agency recognized by the U.S. Department of Education (www.hlcommission.org), is dedicated to changing lives and the communities it serves through innovative educational programs. Student support and outreach that supports the success of students is accomplished through faculty availability to students in all courses through synchronous or asynchronous communication and meetings to help students achieve the learning objectives for their course(s).
Senior Medical Billing Specialist – Multi-Specialty (PM&R Focus) Health Atlast West LaSenior Medical Billing Specialist – Multi-Specialty (PM&R Focus)Los Angeles, CaliforniaAfter seeing many patients placed on multiple medications by numerous providers without much coordination, HEALTH ATLAST founders Stephanie and Wayne Higashi, both doctors of chiropractic, found a need to create a multi-disciplinary approach to healing where doctors work together as one to optimize a patient's health. We are hiring a seasoned Medical Billing Specialist with direct, hands-on experience billing PM&R-based services in an outpatient, multi-provider environment.
Senior Medical Billing Specialist – Multi-Specialty (PM&R Focus) HEALTH ATLAST WEST LASenior Medical Billing Specialist – Multi-Specialty (PM&R Focus)Los Angeles, CA$20–$28 / hourWe are hiring a seasoned Medical Billing Specialist with direct, hands-on experience billing PM&R-based services in an outpatient, multi-provider environment. Health Atlast is a high-volume, integrated, multi-disciplinary healthcare organization in West Los Angeles.
Sr. Claims Specialist, Medical Malpractice | Long Term Care | California Sedgwick Claims Management Services, Inc.Sr. Claims Specialist, Medical Malpractice | Long Term Care | CaliforniaCA$100,000–$120,000 / yearIdeal candidates demonstrate strong analytical and negotiation skills, exercise sound judgment, and are committed to delivering timely, cost-effective claim resolutions while maintaining a high level of customer service. ESSENTIAL RESPONSIBLITIES MAY INCLUDE: Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
NewSenior Manager, Coding. CDI & Data Quality City of HopeSenior Manager, Coding. CDI & Data QualityCAPartnering closely with HIMS leadership, clinical teams, finance, and revenue cycle stakeholders, the Senior Manager will ensure accurate clinical data capture, compliance with regulatory requirements, optimized reimbursement, and strong performance across key operational metrics. City of Hope's 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.
Medical Assistant/Cast Specialist - Manhattan Beach-BCO Ortho Clinic- Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern CaliforniaMedical Assistant/Cast Specialist - Manhattan Beach-BCO Ortho Clinic- Full Time 8 Hour Days (Non-Exempt) (Non-Union)Manhattan Beach, CA$29–$45.20 / hourOrthopaedic Technologist Certified (OTC) - Registered Orthopaedic Technologist (ROT) from American Society of Orthopedic Professional (ASOP), Registered Orthopaedic Technologist (ROT) from National Board for Certification in the Orthopedic Specialties (NBCOS), or Orthopaedic Technologist Certification (OTC) from the National Board for Certification of Orthopaedic Technologists (NBCOT). Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu.
Medical Assistant/ Cast Specialist - Arcadia Ortho Clinic - Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern CaliforniaMedical Assistant/ Cast Specialist - Arcadia Ortho Clinic - Full Time 8 Hour Days (Non-Exempt) (Non-Union)Los Angeles, CaliforniaWhen 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. Escorts patients to x-ray and exam rooms, monitors patient flow, assists physicians with minor clinical procedures including staple removal, suture removal, and wound care.
Medical Assistant/Cast Specialist - PMOB Ortho Clinic - Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern CaliforniaMedical Assistant/Cast Specialist - PMOB Ortho Clinic - Full Time 8 Hour Days (Non-Exempt) (Non-Union)Los Angeles, CaliforniaWhen 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. Escorts patients to x-ray and exam rooms, monitors patient flow, assists physicians with minor clinical procedures including staple removal, suture removal, and wound care.
Medical Coder (FQHC) Healthcare ISMedical Coder (FQHC)CAWe are seeking an experienced medical coder to join the revenue cycle team at a federally qualified health center (FQHC). Responsibilities: Review clinical documentation from patient medical records and assign appropriate ICD-10, CPT, and HCPCS codes.
Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid) University of CaliforniaClinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)Los Angeles, CA$95,400–$208,300 / yearAs the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. 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.
Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment Hybrid UCLA Health SystemClinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment HybridLos Angeles, CA$95,400–$208,300 / yearAs the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. 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.
(RN) Appeals Medical Review Nurse - REMOTE Molina Healthcare Inc(RN) Appeals Medical Review Nurse - REMOTECARemoteREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union)Los Angeles, CA$99,507–$164,559 / yearThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
NewSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)Los Angeles, CaliforniaRemoteThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Clinical Documentation Improvement Specialist Full Time Days Hollywood Presbyterian Medical CenterClinical Documentation Improvement Specialist Full Time DaysLos Angeles, CAHPMC is part of a global healthcare enterprise which owns and operates general hospitals throughout Korea, numerous fertility and research centers in the U.S. and Korea including CHA Fertility Center, a medical university, and CHAUM (a premier anti-aging life center). Preferred Education/Certification: • CDI certification (CCDS, CCDS-O, CDIP) • Coding certification (CCS, CPC, RHIA, RHIT) • Prior experience in acute care, outpatient CDI, or risk adjustment • Familiarity with ACDIS and AHIMA CDI guidelines.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistCA$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Clinical Documentation Specialist City of HopeClinical Documentation SpecialistCACity of Hope's 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. As an essential member of the Coding and Data Quality team, the Clinical Documentation Specialist is responsible for improving the quality, accuracy, and completeness of clinical documentation to accurately reflect patient severity of illness and risk of mortality.
ProFee Audit Specialist- FT Datavant LLCProFee Audit Specialist- FTCARemote$35–$45 / hourWhat We're Looking For: As a Profee Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. 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.
Medical Claims Examiner Ultimate Staffing ServicesMedical Claims ExaminerPasadena, California$26–$29 / hourWe are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. Identify coding discrepancies, overpayments, and potential fraud or abuse.
Senior Clinical Documentation Integrity Specialist Blue Cross and Blue Shield AssociationSenior Clinical Documentation Integrity SpecialistLos Angeles, CAPursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. The Senior Clinical Documentation Integrity Specialist ensures accurate, complete, and compliant clinical documentation that appropriately reflects severity of illness, risk of mortality, and supports correct reimbursement.