6 jobs found in Costa Mesa

Job Description Job Description Are you the missing piece in protecting America’s safety net? We don’t just hire talent—we build purpose-driven teams. At ERN Enterprises, we stand in the gap for emergency safety net providers and the patients they serve. We hold health plans accountable. We speak up for those who can’t, and we’re looking for more than just a resume—we’re looking for you. ERN in the news: https://youtu.be/mw1TQhVFBKk The Mission Our Healthcare Claims Compliance Auditors are warriors for justice in Revenue Cycle Management. You’ll analyze unfair trends, initiate corrective actions, support prelitigation strategy, and make sure regulatory timelines are honored—not ignored. You’ll change lives and challenge systems. Do You Belong Here? We’re looking for people with: Competency – Do you have the skills or the hunger to learn them? Character – Are you ethical, reliable, and honest—even when no one’s watching? Chemistry – Can you collaborate, communicate, and carry the...

Job Description Primary Duties And Responsibilities The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM, ICD-10-PCS, and CPT codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Verifies that all ICD-10-CM and CPT codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings. Performs other duties as assigned. Medical Coding - Hoag Hospital Resolves billing related errors and assists with workflow changes and process improvement projects....

Job Title Coder (Hospital Billing) Job Description The Coder (Hospital Billing) reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM and ICD-10-PCS codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Responsibilities Verifies that all ICD-10-CM and ICD-10-PCS codes are correctly captured. Verifies that physician and other key information is correctly abstracted. Resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing productivity and quality accuracy rate of 95% or better. Coder III assigns codes for diagnoses, treatment, and procedures for inpatient surgeries. Determines the correct principal...

Job Description Primary Duties and Responsibilities The Specialist is responsible for resolving inquiries related to claims, eligibility, and authorization and working with multiple parties to ensure records are up to date. The Specialist will ensure first-call-resolution standards are followed and will refer and follow-up as per Hoag guidelines. Ensure accuracy, reports issues, and works to resolve. Ensure compliance and regulatory guidelines and health plan requirements are met. Documents actions taken following HIPAA guidelines. May assist in providing customer service, member services, and others in working with providers/billing offices when needed. Assist in identifying and reporting issues working with the management team to help minimize re-work and address front-end process issues. Performs other duties as assigned. Revenue Cycle May also maintains databases, audit information and works with patients to process patient payment. May follow up...

Claims Billing Specialist The Specialist is responsible for resolving inquiries related to claims, eligibility, and authorization and working with multiple parties to ensure records are up to date. The Specialist will ensure first-call-resolution standards are followed and will refer and follow-up as per Hoag guidelines. Ensure accuracy, reports issues, and works to resolve. Ensure compliance and regulatory guidelines and health plan requirements are met. Documents actions taken following HIPAA guidelines. May assist in providing customer service, member services, and others in working with providers/billing offices when needed. Assist in identifying and reporting issues working with the management team to help minimize re-work and address front-end process issues. Performs other duties as assigned. May also maintains databases, audit information and works with patients to process patient payment. May follow up with insurance companies on outstanding or unpaid claims,...

The medical biller position responsibilities are to submit accurate and timely claim billing and reports based on health plan, payor, or contract requirements. This also involves accounts receivable payment follow-up, appeals, and refunds if necessary. Essential Functions: Complete health plan billings based on requirements. Compile proper paperwork and conduct appropriate research to appeal claim denials, including requests for refunds/credits when applicable. Review and monitor reimbursements due from different payors to determine appropriate collection methods. Communicate effectively and professionally with external customers. Resolve payment issues with carriers, (e.g. denials, partial payments, etc.) Review, modify, and re-bill rejected/denied claims. Assist Cash department on payor backup as needed for payments received. Adhere to and comply with information systems security. Know and follow Information Systems security policies and procedures. Attend...