77 coding auditor and provider educator jobs found

Description Are you Compassionate, Collaborative, Respectful and strive for Excellence? If so, you share our CORE Values and we invite you to join our team as a Business Office Representative. Certified Coder Job Description Reports to: Revenue Cycle Manager Billing Office Supervisor Organizational Peers: Billing Specialist Direct Reports: None Job Details: Full Time, 40 hours/week, Monday-Friday Non-Exempt Pay Range: $25.75-$33.99/hour Job Summary: A Certified Coder is a nonexempt position responsible for front office and general coding billing duties. Responsible for Coding Audits, Claim, Billing review and Compliance. Performance Requirements: Knowledge: 1. Knowledge of billing practices and clinic policies and procedures. 2. Knowledge of coding and clinic operating policies. 3. Knowledge of medical terminology 4. Knowledge of health care insurance claim practices and compliance. 5. Knowledge of computer...

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 departmental policies and processes....

Job Title: Medical Biller II Salary: $25hr-$28hr DOE Location: Tustin, CA Openings: 1 Position Purpose: The Medical Billing Specialist II supports the revenue cycle team by independently performing a broad range of billing functions with moderate complexity. This role is responsible for accurate insurance verification, charge entry, claim submission, payment posting, and resolution of routine denials to ensure compliance with payer requirements and timely reimbursement. Core Duties and responsibilities, include but are not limited to: Insurance & Eligibility Verification Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO). Research and resolve discrepancies in patient coverage or eligibility. Document eligibility outcomes in the EHR/PM system. Charge Entry & Coding Support Perform charge entry and apply CPT, ICD-10, and HCPCS codes. Review encounter forms for accuracy; flag missing or incorrect...

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance. ESSENTIAL JOB FUNCTIONS: HCC Coding and Risk Adjustment (RA) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines. Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance. Conduct...

Job Description Shared Services: Compliance- (Full-Time, Day Shift) - Job Summary: The Compliance Auditor-Physician monitors and audits established mechanisms and controls to ensure compliance with regulations. Audits the activities of various departments for compliance with plans, policies and procedures prescribed by management. Prepares and submits reports on the results of audits, recommending improvements in policies and procedures. Cooperates with outside auditors in any undertaking that may expedite their work. Performs other duties as needed. Conducts full range of physician-based audits/projects and develops partnerships with internal and external customers. Performs other duties as needed. Education and Experience: Bachelor's Degree required. Master's Degree preferred. Minimum three years of experience in auditing within healthcare, compliance, regulatory oversight agency, quality management, quality assurance or business analysis. Knowledge and Skills:...

Job Type Full-time Description About Us Simply put, our purpose at Accelerated Urgent Care is to get you quality care when you need it. We aim to foster a supportive environment where our team members can develop their careers. To promote this goal, we've built a diverse and driven team of employees who are all eager to learn from one another and reach Accelerated Urgent Care's mission of delivering exceptional healthcare to the patients and communities that we are privileged to serve. We are ... a fast-growing company that doubles in size year after year since 2012! Recognized as Kern County's Top Urgent Care center 6 years in a row! Dedicated to our employees' career growth; 65% of our Administration and Management team members have been internal candidates! 16 clinics strong across 5 regions in California and growing! Our Core Values: Friendliness, Competence, Respect, Teamwork, Compassion, Hard work, Integrity, Humility, Dedication! Job Summary The Certified...

Details Client Name WelbeHealth - Modesto Job Type Local Offering Non-Clinical Profession Professional Specialty IT Job ID 13826730 Job Title Coding Auditor Weekly Pay $1040.0 Shift Details Shift Days 5x8 Scheduled Hours 40 Job Order Details Start Date 11/27/2023 End Date 02/26/2024 Duration 13 Week(s) Job Description Duties and Responsibilities: -Assist with retrospective and concurrent coding for PACE (Programs of All-Inclusive Care for the Elderly) Dual participants. -Conducts pre-visit chart preparations and post visit chart reviews. -Conducts audits and participates in provider education programs to ensure compliance with CMS risk adjustment diagnosis coding guideline. -Works closely with direct manager in identifying opportunities for HCC coding education. -Complete all required documentation in a timely and accurate manner. -Protect privacy and maintain confidentiality of all company procedures and...

Medical Billing Specialist III/IV - Behavioral Health Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5037514) Apply  Medical Billing Specialist III/IV - Behavioral Health Salary $54,060.11 - $76,162.64 Annually Location Ventura and may require travel throughout Ventura County, CA Job Type Full-Time Regular Job Number 0840HCA-25AA (NW) Department Health Care Agency Division Behavioral/Mental Health Opening Date 08/27/2025 Closing Date Continuous Description Benefits Questions Description THE POSITION Under general direction (III, IV), performs and is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements. IDEAL CANDIDATE The ideal candidate has specialized expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal....

Certified Coder Oakland, CA Information Systems Health Information Servcies Full Time - Day $29.59 - $49.31/ hour Req #:41965-31091 FTE:1 Posted:November 18, 2025 Summary SUMMARY: Reads and interprets medical record documentation to assign diagnosis codes, assigns CPT codes, and applies knowledge of payer reimbursement guidelines to ensure proper reimbursement. Performs related duties as required. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE:The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. Adheres to the ICD-9-CM (International Classification of Diseases, 10th revision, Clinical Modification) coding conventions, official coding guidelines approved by the cooperating parties, the CPT (Current Procedural Terminology) rules...

Physician Leader Associate Director of Medical Operations Location US-CA-Fresno Job ID 344400 Pos. Category Medical - Physician Pos. Type Full Time Recruiter : Full Name: First Last Tracy Geiger Overview Associate Medical Director Opportunity! $100K Hiring Incentive! Plus Monthly and Quarterly Bonus Incentives! Fresno County is the heart of California! Fresno offers outdoor adventures, family-friendly activities, and farm to table dining. The sun shines for more than 300 days of the year, creating the perfect environment to enjoy Concentra's work life Balance. We look forward to speaking with you! Through our evidenced based medicine approach, Concentra's goal is to provide quality patient care while treating everyone with friendliness, skill, and respect. We strive daily to promote a diverse environment of acceptance and compassion for our colleagues and cultivate a welcoming atmosphere where our patients can heal. As we've grown, we've...

divh2Coding Specialist/h2pResponsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment./ppstrongMinimum Qualifications:/strong/pp1. Graduate of Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience./pp2. Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), COC (Certified Outpatient Coder), CCS...

Job Summary The Health Information Coder 3 is a senior level inpatient coder with the knowledge and skill set to utilize the ICD-10-CM and ICD-10-PCS classification systems to code acute academic, teaching inpatient cases. The skill set extends to knowledge and comprehension of code sequences into Diagnoses Related Groups on acute academic, teaching inpatient cases. Cases are coded to comply with the official guidelines for coding and reporting, practice standards and code of ethics for HIMS coder. Cases are abstracted according to UCSF Health policies and procedures. The focus of coding and abstracting is on a range of all primary hospital services. There is minimal review of coding for quality. The employee will work eight (8) hours per day, excluding meal periods, on five (5) consecutive days within a workweek. The workweek schedule is set between the employee and the manager and may be scheduled to start any day of the week based on manager approval. DUTIES AND ESSENTIAL...

Associate Director of Annual Giving, Medical Center Development Office of Development, Redwood City, California, United States New Development Post Date 1 day ago Requisition # 108142 Main Work Location: Stanford Redwood City Schedule: Hybrid (at least 2 days per week on site). We are also open to remote employees. To Apply: Please submit a cover letter and résumé along with your online application. Stanford University is one of the world's premier academic and research institutions, devoting tremendous intellectual and physical resources toward the betterment of humanity. As a major Bay Area employer, Stanford seeks people committed to excellence and to improving our world. In turn, the university is committed to supporting its employees as they develop their careers and enrich their lives. The Office of Development (OOD) advances Stanford's mission by raising philanthropic support from alumni, parents, families, friends, and institutional funders....

Overview At Vista Community Clinic (VCC) , we believe healthcare is more than medicine, it’s about hope, community, and impact. For over 50 years, we’ve been a leader in the community clinic movement, growing from a small volunteer-driven effort in Vista to a nationally recognized network of state-of-the-art clinics across San Diego, Orange, Los Angeles, and Riverside counties. Today VCC has 14 clinics serving over 70,000 patients annually, we continue our mission of delivering exceptional, patient-centered care where it’s needed most. As a private, non-profit, multi-specialty outpatient clinic, VCC provides more than healthcare, we provide opportunity. Here your skills are celebrated, your growth is supported and your work makes a difference. We know that our success is a direct result of the exceptional talents and dedication of our employees. ✨ For eligible employees, benefits include: ✅ Competitive compensation & benefits ✅ Medical, dental, vision✅ Company-paid...

Facility: Copley Drive City San Diego Department Job Status Regular Shift Day FTE 1 Shift Start Time Shift End Time Certified Professional Coder (CPC) - AAPC; Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA) Hours : Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Flex hours are 6:00-9:00 am to 14:30-17:30 pm Weekend Requirements: As Needed On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $34.170 - $44.090 - $49.370 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.? The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates,...

This is a casual position which is subject to renewal on 10/24/2025. JOB SUMMARY: Under the general direction of the Supervisor, Professional Billing & Coding and Director, Professional Billing & Coding, this position operates from within the Revenue Cycle Center to address coding issues related to professional billing claims. The incumbent is responsible for reviewing provider charges to ensure accuracy, reduce claim errors & denials while maintaining compliance with CCI & other payer specific coding Edits (McKesson). The incumbent is responsible for reviewing professional surgical coding performed by departmental Professional Services Coders to ensure accuracy. The incumbent will be responsible for identifying trends of incorrect coding & compiling examples. They will develop training guidelines & presentations of coding recommendations based on these identified trends & will meet with physician providers to train & educate. The incumbent...

Benefits: 401(k) Dental insurance Health insurance Paid time off Vision insurance Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opportunities Job Summary We are currently seeking a detail-oriented and dedicated Medical Biller to join our team. In this role, you will be responsible for managing the billing and collection of outstanding account balances for Medi-Cal and managed care payors. You will analyze and interpret complex payor contract language to calculate expected reimbursements accurately and ensure timely collection of all payments owed to the organization. Responsibilities Process medical billing and follow up on claims with Medi-Cal and managed care payors Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County documentation and billing requirements....

Facility: System Services City San Diego Department Job Status Regular Shift Day FTE 1 Shift Start Time Shift End Time Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate; Other; Certified Health Care Compliance (CHC) - Compliance Certification Board Hours : Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $49.700 - $64.130 - $71.820 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.? The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other...

Vista Community Clinic (VCC) At Vista Community Clinic (VCC), we believe healthcare is more than medicine, it's about hope, community, and impact. For over 50 years, we've been a leader in the community clinic movement, growing from a small volunteer-driven effort in Vista to a nationally recognized network of state-of-the-art clinics across San Diego, Orange, Los Angeles, and Riverside counties. Today VCC has 14 clinics serving over 70,000 patients annually, we continue our mission of delivering exceptional, patient-centered care where it's needed most. As a private, non-profit, multi-specialty outpatient clinic, VCC provides more than healthcare, we provide opportunity. Here your skills are celebrated, your growth is supported and your work makes a difference. We know that our success is a direct result of the exceptional talents and dedication of our employees. Benefits include: Competitive compensation & benefits Medical, dental, vision Company-paid life insurance...

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. Essential Duties and Responsibilities: • 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 • Report Coding discrepancies patterns identified within the chart review process to the Coding...

WHO WE ARE AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people’s 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? If so, AIDS Healthcare Foundation is the place for you! Founded 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. AHF’s core values are: Patient-Centered Value Employees Respect for Diversity Nimble Fight for What’s Right Please review our Advocacy page for the latest news on how AHF is Fighting for...

Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 12330 Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (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 Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding...

Job Description 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 associated with...

Job Description Primary Duties and Responsibilities The Specialist is responsible for resolving inquiries related to claims, eligibility, and authorization and working with multiple parties to ensure records are up to date. The Specialist will ensure first-call-resolution standards are followed and will refer and follow-up as per Hoag guidelines. Ensure accuracy, reports issues, and works to resolve. Ensure compliance and regulatory guidelines and health plan requirements are met. Documents actions taken following HIPAA guidelines. May assist in providing customer service, member services, and others in working with providers/billing offices when needed. Assist in identifying and reporting issues working with the management team to help minimize re-work and address front-end process issues. Performs other duties as assigned. Revenue Cycle May also maintains databases, audit information and works with patients to process patient payment. May follow up...