263 jobs found in Los Angeles, CA

Job Title : Financial Compliance Auditor III Location : Los Angeles, CA 90017(Remote) Duration : 21 weeks Job Description: The Specialty Health Plans Auditor III, Finance is responsible all aspects of planning, execution, reporting, and corrective action plans monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental, behavioral health, transportation, and telehealth services providers. Essential Duties and Responsibilities: Performs financial audits and/or financial analyses for Specialty Health Plans on the quarterly and annual basis. Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors. Experience Required: At least 4 years of experience in conducting financial audits. At least 5 years of related...

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 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...

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...

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 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 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 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 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...

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...

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 Bring your whole self to exceptional care. Cedars‑Sinai was tied for #1 in California in U.S. News & World Report's 'Best Hospitals 2024‑25' rankings, and it's all thanks to our team of 14,000+ remarkable employees! What you will be doing in this role: The Claims Edit Coder (Coder II) operates under the general direction of an audit supervisor and involves responsibilities across various work units, as well as duties specific to the reporting team. In this role, the Coder II reviews ICD‑10‑CM diagnosis coding and Current Procedural Terminology (CPT) procedure code for claim edit fall outs. The position entails conducting modifier review and assignment, handling complex coding edits that necessitate research and resolution, and validating key data elements like the billing physician and date of service. You are expected to abstract coded data accurately and promptly into the applicable system using relevant applications such as EPIC (CS‑Link), EPIC HB and PB...

Senior Outpatient Coder Come lead with us at Corporate. At Houston Methodist, the Senior Outpatient Coder position is responsible for ensuring diagnostic and procedure codes are assigned accurately to day surgery and observation encounters based on documentation within the electronic medical record while maintaining compliance with established rules and regulatory guidelines. FLSA STATUS Non-exempt Qualifications Education : Associate’s or higher degree in a Commission on Accreditation for Health Informatics and Information Management accredited program or additional two years of experience (in addition to the minimum experience requirements listed below) in lieu of degree Experience : Three years of relevant outpatient coding experience or successful completion of the Houston Methodist Senior Outpatient Coder Transition Program Licenses and Certifications (Required) : Must have one of the following: RHIT – Certified Health Information Technician (AHIMA) RHIA – Registered...

Coder III, HIM - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union) Join to apply for the Coder III, HIM - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union) role at Keck Medicine of USC. 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 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. Initiate appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understand PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim to assure claims...

A leading medical institution in Los Angeles is seeking a Coder III for their HIM Financial department. The role involves inpatient coding using ICD-10 and CPT/HCPCS, ensuring accuracy and compliance with federal regulations. Candidates should possess a high school diploma and a coding certification, alongside a minimum of three years of experience in coding inpatient medical records. The position offers a competitive hourly rate ranging from $46.00 to $76.07, with additional responsibilities including collaboration with clinical teams and Improving coding standards. #J-18808-Ljbffr

A mobile surgical physician wound care group is seeking a Lead Medical Biller in Playa Vista, CA. This in-person role requires overseeing the billing team and ensuring the financial health of the organization through accurate claim submissions. The ideal candidate has at least 2 years of experience and proficiency in medical billing systems such as Lytec or Medisoft. The position offers a competitive pay range of $25-28/hour based on experience, along with a generous benefits package including a 401K plan and paid time off. #J-18808-Ljbffr

Description The Departments of Obstetrics & Gynecology, Surgery, and Urology at UCLA seek to hire a Controls and Compliance Auditor. The Controls and Compliance Auditor is an important member of the departmental administrative team, reporting to the Director of Business Analytics & Quality Improvement. In this role you will be the subject-matter expert on UCLA's Distributed Administrative Computing Security System (DACSS) and associated systems. You will also provide oversight and support in the daily operations of internal controls for a variety of accounting cycles including financial reporting, travel and entertainment, and revenue. Pay Range: $78,500.00 - $163,600.00 annually. Please note, the department's target salary for this role is $80,000.00 Qualifications Required: At least 2 years-experience in accounting operations or administrative analysis. Strong analytical skills and the ability to synthesize complex and diverse information....

Bright Vision Technologies is a forward-thinking software development company dedicated to building innovative solutions that help businesses automate and optimize their operations. We leverage cutting-edge technologies to create scalable, secure, and user-friendly applications. As we continue to grow, we're looking for a skilled Financial Compliance Auditor III, Finance to join our dynamic team and contribute to our mission of transforming business processes through technology. This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential. Position: Financial Compliance Auditor III, Finance Location: Los Angeles, CA 90017 Duration: Contract Job Summary The Specialty Health Plans Auditor III, Finance is responsible all aspects of planning, execution, reporting and corrective action plans monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental,...

Job Posting Job Description: Contract ID#: 212482 Signup Starts: 7/8/2022 12:00 AM EST Time Left: 60 Days / 10 Hours / 34 Minutes Need Status: Interviewing

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...

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

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview Assigned codes to patient symptoms, diagnosis, operations, and treatments to process reimbursements; knowledge and expertise in reviewing and adjudicating coding services procedures and diagnoses on medical claims. Completes accuracy and timely entry of ICD-9-CM, HCPCS procedure codes and CPT codes into the NextGen system. Minimum Requirements...