Location: Long Beach, CA/Surrounding areas (Remote, must be withing 50 miles of Long Beach or Woodland Hills, CA incase of any onsite needs)
Hours: 8-5 PST
Start Date: ASAP
Client Overview
A leading nonprofit health plan serving millions of members across commercial, Medicare, Medicaid, and individual market programs. The organization is committed to improving healthcare quality, affordability, and access through innovative care delivery models, population health initiatives, and regulatory compliance excellence. This role supports enterprise-wide risk adjustment, medical record review, and government audit activities that help ensure accurate documentation, coding integrity, and compliance with federal and state requirements.
Job Description
Seeking two experienced Senior Medical Review Coders to support high-priority government audit and medical record review initiatives. Responsibilities include retrospective and prospective medical record reviews, coding validation, abstraction, provider outreach, and audit support across Medicare Advantage (MA), ACA, and Medi-Cal programs.
Key Responsibilities
Review and abstract medical records for coding and audit projects
Support government audit initiatives including RADV and other regulatory reviews
Perform retrospective and prospective coding reviews
Validate diagnosis coding and documentation accuracy
Request and follow up on medical records from providers
Conduct provider outreach and resolve documentation issues
Utilize coding guidelines and regulatory requirements to ensure compliance
Collaborate with internal audit, coding, and quality teams
Skill Set Requirements
10+ years of medical coding/review experience
Active coding certification (CPC, CCS, CRC, RHIT, RHIA, or equivalent)
Extensive experience with:
Medi-Cal programs
Medical record abstraction and review
Strong knowledge of ICD-10-CM coding guidelines
Microsoft Office Suite
Medical record retrieval and documentation systems
Experience with Facets preferred (training available)
Experience using fax systems such as RightFax preferred
Nice to Haves
Prospective and retrospective review experience
Provider outreach and medical record retrieval
Health plan or managed care environment
Education/Certification(s)/License(s)
Active coding certification (CPC, CCS, CRC, RHIT, RHIA, or equivalent)
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