Payment Integrity Nurse Coder RN III (Job ID: 12330)
Location: Los Angeles, 90017
Shift: Full Time
Pay Range: $102,183.00 (Min.) – $132,838.00 (Mid.) – $163,492.00 (Max.)
Job Description
The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise and judgment in the application of medical and reimbursement policies within the claim adjudication process. The role involves medical record review for Payment Integrity and Utilization Management projects, serving as a subject‑matter expert (SME), performing quality audits, validating coding accuracy and completeness, and guiding Payment Integrity initiatives, including concept and cost avoidance development. Additionally, the position trains and mentors Payment Integrity Nurse Coder, RN staff, acting as a resource and mentor for fellow employees.
Qualifications
At least 8 years of clinical RN experience.
At least 3 years of experience in utilization management or clinical coding, including investigation and/or auditing experience.
Skills Required
Knowledge of CPT, HCPCS, ICD‑9, ICD‑10, Medicare, and Medicaid rules and regulations.
Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines.
Working knowledge of claims coding and medical terminology.
Solid understanding of standard claims processing systems and claims data analysis.
About The Hospital
As the nation’s largest publicly‑operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs. Opportunity, amazing co‑workers, a supportive management team, great compensation and benefits, camaraderie, and a true sense of mission are just a few of the reasons to join us as we work toward a healthier L.A.
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