11 auditor supervisor jobs found in Los Angeles

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 Description Job Description Education and/or Experience :   Must have these requirements under the umbrella of the HCC industry: Requires knowledge in HCC Coding documentation guidelines. Requires technical expertise in ICD-9-CM or ICD-10-CM. Strong skills in medical record audit and review. Regulatory requirements for coded data. Medical record documentation requirements. Understanding of healthcare data systems. Proficiency in MS Outlook and Word. Strong proficiency with Excel--must have ability to prepare spreadsheets. Excellent written and verbal communication skills. Certification is a plus with HCC. AHA coding clinic is a plus. Certification required in CPC and/or CCS, and CRC is a plus. Hybrid Schedule Requirements Part A Monday - Wednesday onsite / Thursday - Friday Remote Part B Wednesday - Friday Onsite / Monday - Tuesday Remote   We are looking for HCC Risk Adjustment Auditors/Coders to join our team!   Position...

Primary Job Title: Financial Compliance Auditor III, Claims Location : CA (Hybrid Shift/Work Schedule: Date Posted: 7/10/2025 Employment Type: Contract Salary Range: $50.53 - $55.53/Hr Job Summary The Financial Compliance Auditor III, Claims is responsible for various tasks within the Financial Compliance Unit, including the audit of claims processed by medical groups and health plans contracted with Client. This role works closely with the Supervisor and/or Lead Auditor on the identification and resolution of issues in a timely and efficient manner. For Claims Emphasis: This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the audit report. This position is responsible for a variety of complex areas of the Medi-Cal, Medicare, Covered California, and PASC-SEIU benefits and processes. This position focuses on audits of contractual and regulatory compliance with timeliness and appropriateness...

Financial Compliance Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 12483 Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for audits of claims processed by Delegated Participating...

Supervisor, Medical Laboratory Job Summary: Leads the development of applicable policies and procedures for audit and process improvement projects. Identifies an appropriate plan for correcting deviations from expected quality control results. Promotes the use of strategies to ensure that tests are performed properly and results are verified before being shared. Monitors the management of specimens to ensure they are collected and processed according to established time and quality standards. Removes obstacles that prevent adherence to all requirements related to the recruitment, processing, testing, storage, and distribution of materials and samples. Researches, reports, and responds to technical and/or non-technical deficiencies in regulatory/accreditation inspection processes. Implements new testing methodologies, processes, and technology that have the potential to improve service, quality and/or efficiency. Leads the development and implementation of technical and/or...

Job Description Job Description South Los Angeles based FQHC looking for onsite Certified HCC coder . *This is not a remote position Conduct the necessary audits of medical record to verify the physicians have appropriately documented the diagnoses then code these diagnoses in ICD-10 for Medicare Risk Adjustments/Medicare Advantage. Evaluate medical information (Outpatient/Inpatient) documentation from a clinical standpoint for evidence of the possibility of additional medical conditions that may not have been documented in the past, and ensure accurate coding of the encounter data and recommend processes for accurate coding practices. This process involves a very strong understanding of medical coding. Ascertain that medical record documentations have accurate diagnoses and conditions to assure not to up-code, fraudulently or misrepresent the patient condition and ensure compliance to prepare for random CMS medical records audit HEDIS coding and record collection...

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...

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...

Job Description Job Description Position Purpose: Under the direct supervision of the Director of Quality Assurance, the Licensed Nurse is responsible for supporting the compliance functions of the Quality Assurance and Performance Improvement department of JWCH. The responsibilities include: Maintaining defined review schedule for JWCH agency by (1) doing preparatory work for the audit including developing a scope of work, (2) reviewing the documentation, (3) preparing reports, (4) doing any necessary follow-up reviews and (5) ensuring that appropriate collected data are securely kept and maintained. Serve as a resource to clients in answering compliance questions from Internal Audit and Audit Advisory Services and assisting as necessary in their audit process. Essential Duties and Responsibilities : Conduct Compliance Reviews Complete compliance reviews within established parameters and initiate and carry out all assigned reviews according to defined...

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 MISSION, VISION, AND VALUES Our mission is to provide quality, comprehensive healthcare and supportive services to those in our community. Our vision is "Improving the Health and Well Being of our Community." Our Core Values consist of Integrity, Compassion, and Excellence. Employees must possess a strong commitment to the mission, policies, goals and philosophy of Harbor Community Health Centers. JOB SUMMARY Reporting to the Revenue Cycle Manager (RCM), the Medical Biller II is responsible for the billing and collection of the overall clinic’s primary care, pediatric, behavioral health and dental services. This position works closely with providers, front office, and Quality Improvement Department. ESSENTIAL DUTIES & RESPONSIBILITIES To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability...