106 jobs found in Los Angeles

Description Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization. Reporting to the Compliance Manager, MAPD Audit, you will contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide regulatory readiness and operational improvement. This position calls for a strong foundation in CMS guidelines, managed care compliance, and effective collaboration with both internal teams and external partners. In this role, you will: * Conduct compliance audits related to operational functions, vendor performance, data validation, RADV, Triennial Review, pre-delegation reviews, and...

Coding Compliance Auditor In 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. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant. The Coding Compliance Auditor will also provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics Re: coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems...

Job Title Work Location: Los Angeles, CA, USA Onsite or Remote Flexible Hybrid Work Schedule: Monday - Friday, 8:00am - 5:00pm PST Salary Range: $40.04 - 52.83 Hourly Employment Type: 2 - Staff: Career Duration: Indefinite

Job Summary How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Day (United States of America) Core Responsibilities and Essential Functions Accurately and completely assigns appropriate ICD-10-CM diagnostic and CPT-4/HCPCS procedural codes to the greatest specificity, assigning the most accurate DRG/APC, when appropriate and in accordance with Official Guidelines for Coding and Reporting and Facility Coding Guidelines, as applicable Accurately and completely abstracts all required patient demographic data into the EMR Accurately assigns correct...

UCLA Health Coding Specialist Play a key role with a world-class health organization. Help ensure the operational efficiency of a complex health system. Take your professional expertise to the next level. You can do all this and more at UCLA Health. You will be responsible for coding diagnoses and procedures for assigned cases. This will involve using your knowledge of UCLA, AHA - Coding Clinic, and AMA - CPT Assistant guidelines, medical terminology, anatomy and physiology, and pathological basis of disease, documented treatment, and procedures. You will assign ICD-10-CM/PCS and CPT/HCPCS codes for patients receiving our services while correctly assigning DRGs for all patients to assure accurate reimbursement and the highest quality data possible. You will abstract all coded data in a timely and accurate manner into the abstracting system. Salary Range: $59.80/hourly - $74.35/hourly Qualifications We're seeking an independent, detail-oriented, self-directed individual with:...

Inpatient Coding Specialist In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non-Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Perform other coding...

Contract Assignment Healthcare System (Epic Ehr) This is a remote position. We're seeking a Certified Professional Coder (CPC) with hands-on front-end Epic operational experience to support a health system's day-to-day coding workflows. This contractor will perform professional coding activities directly within Epic's end-user workflows (e.g., encounter completion, charge entry, charge review workqueues) to ensure accurate, timely, and compliant coding and charge capture. Responsibilities: Review clinical documentation and assign CPT/HCPCS, ICD-10-CM codes within Epic at the point of coding (front end), ensuring compliance with payer guidelines and health system policies. Work in Epic workqueues (e.g., Charge Review, Claim Edit, Coding WQs) to resolve edits, denials, and holds; clear daily queues to meet turnaround goals. Validate medical necessity and modifier usage; correct charge router/charge session issues before billing. Collaborate with revenue cycle, clinic...

Physician Coding Compliance Auditor Align with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. We provide an outstanding benefit package that includes paid vacation, wellness initiatives and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals. What you be doing in this role: The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks...

divh2AIDS Healthcare Foundation/h2pstrongAMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!/strong/ppDoes the idea of doing something that really makes a difference in peoples lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?/ppstrongIf so, AIDS Healthcare Foundation is the place for you!/strong/ppFounded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them./ppAHFs core values are to be:/pulliPatient-Centered/liliValue Employees/liliRespect for Diversity/liliNimble/liliFight for Whats Right/li/ulpPlease review our Advocacy page for...

E/M Multi-Specialty Coder - Coder II (Remote) Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company's Workplace of the Year. Discover why U.S. News & World Report has named us one of America's Best Hospitals! What will you be doing in this role? In this remote role, under the general direction of the Coding Supervisor, (using knowledge of CSMC and official coding guidelines, medical terminology, anatomy and physiology, and pathological basis of disease, documented treatment and procedures performed at CSMC and Cedars-Sinai Affiliates and their locations) assigns ICD-10-CM and CPT codes for patients receiving services at CSMC. Accurately assigns all applicable modifiers for all patients to assure optimal reimbursement and the highest quality data possible....

Health Information Coder Take on a significant role within a world-class health organization. Elevate the operational effectiveness of a complex health system. Take your professional expertise to the next level. You can do all this and more at UCLA Health. As a Health Information Coder for our Medical Group, you will handle a variety of vital responsibilities, including: reviewing physicians' notes to determine if documentation requirements are met, extrapolating and applying surgical codes as applicable across anatomical subsections for general coding in work queues, analyzing medical documentation to assess accuracy, entering charges in EPIC, identifying and reporting any potential compliance risks. Salary Range: $40.04 - $52.83 Hourly Qualifications: We're seeking a self-directed, detail-oriented professional with: current Certified Professional Coder (CPC) certification, must have been certified a minimum of 2 years required, additional specialty certification a plus,...

Virtua Health Coding Specialist Codes and abstracts hospital medical records (including Inpatients, Observation, Outpatient Surgery, Invasive Outpatients, and Emergency Department) for diagnostic and procedural coding. Utilizes federal, state procedures/guidelines to assure accuracy of coding and abstracting and productivity standards. Collaborates with medical staff and clinical documentation improvement (CDI) staff to clarify documentation. Maintains performance in accordance with corporate compliance requirements as it pertains to the coding and abstracting of medical records, as well as Diagnosis Related Group (DRG) assignment. Accurately reviews each record and knowledgeably utilizes ICD-10-CM, ICD-10-PCS, CPT-4, and encoder to accurately code all significant diagnoses and procedures according to American Hospital Association (AHA), American Health Information Management Association (AHIMA), Uniform Hospital Discharge Data Set (UHDDS) hospital specific guidelines and...

DRG Coding Auditor Principal This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case...

Abstractor/Coder The University of Chicago Physicians Group (UCPG) team is responsible for the overall management of clinical revenue for physician billing. This includes frontend revenue capture, working of edits and conducting audits for physician education. Ensuring the workflow of charge capture through invoice creation. UCPG is seeking an Abstractor/Coder to work with providers and staff on professional billing and compliance activities. Strong knowledge of evaluation and management coding guidelines and requirements is strongly preferred. This position is eligible for a flexible work arrangement. Responsibilities: Obtain appropriate reimbursement levels for professional services by reviewing and coding medical procedures, diagnoses, and physician visits. Analyze denial and rejection reports, and appeal wherever appropriate. Submit charges in a timely manner. Work in collaboration with the Clinical Revenue Supervisor and others, provide guidance to faculty and staff on...

Coding Specialist In accordance with federal coding compliance regulations and guidelines, use current ICD-10-CM, CPT-4, and HCPCS code sets, OCE/NCCI, CMS Transmittals, and other federal billing/coding regulations, manuals, rules, and guidelines to analyze, troubleshoot, and resolve all coding related edits generated within the coding, billing, and Clearinghouse systems: PBAR, nThrive (formerly MedAssets), and Aeos. Analyze, troubleshoot, and resolve all outpatient denial management coding related edits, items, and issues returned from Patient Financial Services (PFS) and assorted claims payers. Accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary/Clinic Visits, and assorted outpatient surgery: GI Lab, Heart...

divh2AIDS Healthcare Foundation/h2pstrongAmazing Individuals Working for Positive People at AIDS Healthcare Foundation!/strong/ppDoes the idea of doing something that really makes a difference in peoples lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?/ppstrongIf so, AIDS Healthcare Foundation is the place for you!/strong/ppFounded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them./ppstrongAHFs core values are:/strong/pulliPatient-Centered/liliValue Employees/liliRespect for Diversity/liliNimble/liliFight for Whats Right/li/ulpPlease review our Advocacy...

Medical Coder Trajectory RCS joined the MedHQ family in 2024 after enjoying 10 years as a well-established revenue cycle company with an annual growth rate of 40% to 50% and 150 employees. Together they now serve small hospitals, physician groups, ambulatory surgery, and outpatient centers nationwide by optimizing healthcare cash flow through integration of both business office processes and clinical documentation. MedHQ, LLC, is a fast growing, leading provider of consulting and technology enabled expert services for outpatient healthcare. With a 97% long-term, client retention rate spanning over 20 years, MedHQ serves Ambulatory Surgery Centers (ASCs), Surgical Hospitals, Physician Practices, and Hospital and Healthcare Outpatient Facilities nationwide. The MedHQ RITE Values: Respect, Innovation, Trust, and Energy, permeate all service line offerings with a unique personalized approach balancing exceptional transactional and emotional intelligence, and above all excellent...

Job Posting In accordance with federal coding compliance regulations and guidelines, use current ICD-10-CM, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary/Clinic Visits, and an assorted outpatient surgeries: GI Lab, Heart Cath Lab, Pain Management surgery, and Invasive Radiology, etc.). Address OCE/NCCI edits within 3M-CRS and those returned from the Business Office. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Performs other coding department related duties as assigned by HIM management staff. Essential Duties Ambulatory Surgery coding of all...

Job Description Job Description Position Purpose: The Certified Medical Coder plays a crucial role in the Billing Department by ensuring precise and compliant coding of medical services. Under the guidance of the Billing Department Supervisor, the Coder will assign appropriate diagnosis and procedural codes for services provided by JWCH physicians, adhering to industry standards and legal requirements. This position involves validating and auditing coding practices to guarantee accuracy in billing, supporting optimal reimbursement, and maintaining adherence to regulatory guidelines. Duties and Responsibilities: Serve as the primary liaison between providers and the Billing Department, effectively communicating to clarify diagnoses, procedures, coding, and documentation requirements. Recommend appropriate ICD-10-CM, CDT diagnosis codes, CPT codes, and HCPCS codes. Regularly review diagnosis and procedure coding within NextGen to ensure optimal billing accuracy....

Job Description Job Description Description: Functions and responsibilities of the role: Answer telephones with pleasant greeting Computerize tasks such as exam forms and patient charts Obtain insurance authorizations and verify eligibility Filing Appointment scheduling and confirming Prepare insurance billing Email recall notices/cards Replenish office supplies Report areas to improve and innovations Report insurance updates Maintain inventory control Provide coverage and perform duties at Reception desk, when needed Requirements: Level of education needs to be specified High school graduate required College or vocational courses preferred Previous experience, certifications and technical skills should be outlined Microsoft Office

Job Description Job Description WelbeHealth PACE (All-Inclusive Care for the Elderly) program provides seniors with the opportunity to continue living in their homes and in their communities. Our innovative and comprehensive range of medical services to participants is what ignites our passion to treat the whole person and not the symptoms! We employ a collaborative interdisciplinary team (IDT) approach to evaluate and guide participant care, which is key to WelbeHealth values, team culture, and mission. At the direction of the Coding Supervisor, the Coding Auditor and Educator focuses on ensuring coding is accurate and properly supported by clinical documentation within the health records, as well as educating our teams on best practices to promote compliance. Essential Job Duties: Assist with retrospective and concurrent coding for PACE (All-inclusive Care for the Elderly) Dual participants Conduct pre-visit chart preparations and post-visit chart reviews Oversee audits...

Job Description Job Description Los Palos Post-Acute Care Center, located in San Pedro, CA, is looking to hire an experienced Medicare Biller / Collector with a strong background in billing/collections in a skilled nursing environment. This position will help to support 3 nursing facilities in a centralized billing environment. The Medicare Biller / Collector will be responsible for the coordination of collecting money from Medicare and the Medicare part A and part B coinsurance. They will support the function of Medicare and Medicare coinsurance collections to give it more focus and establish efficient methods of collecting. What You Will Do: Responsible to bill Medicare, Managed Care, Medical, Co-Insurance, and various share of costs. Setup new admissions medical records system to bill accurately Review billing documentation to ensure completeness, including accuracy of Medicare claims Manage submission of claims to Medicare and Medicare coinsurance to...

Job Description Job Description Mission Statement: The Mission of JWCH Institute is to improve the health status and well-being of under-served segments of the population of Los Angeles area through the direct provision or coordination of health care, health education, services, and research. Position Purpose: The Medical Biller is responsible for reviewing patient encounters, ensuring billing accuracy, and processing claims for various payer sources. This position plays a critical role in maximizing revenue by adhering to payer guidelines, investigating discrepancies, and ensuring timely payment processing. The Medical Biller will also work closely with the Billing Supervisor to provide updates on billing discrepancies, manage rebills, adjustments, write-offs, and ensure payment posting is up to date. Principal Responsibilities: Review all patient encounters for discrepancies in a timely manner to prevent submission errors to insurance providers. Monitor and update...

Job Description Job Description Benefits: 401(k) 401(k) matching Competitive salary Dental insurance Health insurance Opportunity for advancement We are seeking a motivated, punctual, and outgoing Orthodontic Dental Biller and Coder to join our team! In this role, you will be responsible for customer focused, compassionate, and dedicated to facilitating solutions to patients dental health needs. The Orthodontic Dental Billing Specialist will work in a growing practice with a great team that makes coming to work engaging and supportive. We offer training to those who are looking for a career with growth potential and the opportunity to fulfill our mission to provide quality affordable dental care to our patients. In working with new & existing team members with an open heart & mind; additional responsibilities including the below: SPECIFIC DUTIES Accurately prepare and submit insurance claims, including working with state-sponsored insurance programs...