6 jobs found in Huntington Beach

Who We Are Advantage is redefining what it means to be a pharmacy for people with serious behavioral health conditions. We specialize in serving patients with schizophrenia, bipolar disorder, substance use disorder, and related challenges—patients who are often overlooked by traditional healthcare systems. We provide advanced pharmacy services and wraparound care that ensure patients can access and stay on complex medications. We offer in-home and community-based injection support, help patients navigate insurance and prior authorizations, and work closely with providers to overcome barriers to treatment. By strengthening connections between patients, care teams, and support systems, we make it possible for people living with behavioral health challenges to achieve stability and long-term success. Job Overview The Compliance & Billing Specialist supports the organization's pharmacy compliance, licensing, credentialing, and reimbursement functions by ensuring regulatory...

Clever Care Health Plan in Southern California is seeking a Pharmacy Part D Oversight Auditor to lead independent auditing of Part D clinical compliance, MTM elements, and delegated PBM controls, ensuring timely, accurate, audit-ready documentation. You will coordinate with UM/Part C on benefit coordination, prepare dashboards, and deliver Board-level reporting while adhering to CMS requirements. Requires PharmD or RPh preferred, BS in Pharmacy, and 3–5+ years of Part D auditing. #J-18808-Ljbffr

4 days ago Be among the first 25 applicants This range is provided by PrismHR. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $24.00/hr - $2,428.00/hr Direct message the job poster from PrismHR Huntington Valley Healthcare Center is a 140-bed facility centrally located in Huntington Beach, CA. We are seeking an experienced Medical Biller with a background in Skilled Nursing Facility (SNF) billing. About the Role Responsibilities Process and submit claims for Skilled Nursing Facility services Manage billing for Cal Optima, Medi-Cal, Medicare, and HMO plans Follow up on claims to ensure timely reimbursement Resolve billing discrepancies and denials Verify patient insurance eligibility and benefits Maintain compliance with industry regulations and payer guidelines Work closely with facility staff and insurance providers to ensure accurate billing Qualifications Must have experience in SNF billing (applications...

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. Why Join Us? We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting...

Clever Care Health Plan is hiring a Risk Adjustment Coding Auditor to conduct retrospective and prospective coding audits, validate diagnoses, and monitor CMS RADV compliance. The role focuses on HCC coding, documentation improvement, and education for providers across a fast-growing Medicare Advantage program. Candidates should have 5+ years in MA risk adjustment or related audits, with strong knowledge of ICD-10-CM guidelines and MEAT criteria. #J-18808-Ljbffr

Job Details Location: Huntington Beach Office, Huntington Beach, CA 92647. Position Type: Full Time. Salary Range: $72,800.00 – $80,000.00. This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting retrospective and prospective coding audits, diagnosis validation reviews, provider documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record documentation and ICD-10-CM diagnosis coding to ensure compliance with CMS Risk Adjustment program requirements, Official Coding Guidelines, AHA Coding Clinic guidance, and organizational policies. Functions & Responsibilities Conduct retrospective, prospective, and targeted coding audits to assess the accuracy, completeness, and compliance of ICD-10-CM diagnosis coding and HCC capture....