22 coding auditor senior jobs found

Compliance Auditor, MAPD 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...

OP Coder Auditor Trainee Facility Prime Healthcare Management Inc Location US-CA-Ontario ID 2026-245853 Category Business Professional Position Type Full Time Shift Days Job Type Non-Exempt Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities The Outpatient Coder Auditor Trainee reviews and analyzes documentation present in the medical record for outpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or...

Job Description Job Description Description: 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...

Senior Medical Billing Specialist Full Time Sunnyvale, CA, US 5 days ago Requisition ID: 1363 Salary Range: $70,000.00 To $100,000.00 Annually Work Location: Sunnyvale, CA - Onsite, 5 days per week Pay Range: $70,000 - $100,000 Our Company: Founded in 2010, iHealth is dedicated to empowering people to live healthier lives. The company is a leader in designing and manufacturing consumer-friendly, mobile personal healthcare products connected through the cloud that allows consumers to easily measure, track, and share vital health information with their doctors. With a focus on delivering high-quality and accessible products, iHealth is at the forefront of the digital health revolution. In 2018, iHealth established the Unified Care program to address the issue of managing chronic diseases. iHealth Care specialists support patients beyond the doctors office with chronic conditions via Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) to achieve better...

Job Summary and Responsibilities As a Senior Coder, you will act as the lead coder for your designated team. This position will train staff on department policies, procedures, systems and correct coding requirements. The Sr. Coder additionally will monitor staff workload, audit coders, fill in for out of office coders, and make recommendations to Physician Coding leadership to help improve the efficiency of the team. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. Train all new coders on department policies, procedures and correct coding principles Provide routine education,training and auditing to their designated coding teams Analyze coder's workload and make recommendations to assigned supervisor to ensure all...

Payment Integrity Nurse Coder RN III The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding...

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...

Senior Medical Billing Specialist Location: SF Bay Area, CA (Onsite - 5 days/week) Employment Type: Full-Time, Permanent Compensation: Competitive base salary + annual bonus + full benefits About the Opportunity We are partnering with an innovative medical technology and healthcare services organization that supports patients through technology-enabled care programs. This team plays a critical role in managing and optimizing reimbursement across professional medical billing, payer engagement, and revenue cycle operations for outpatient and digitally delivered healthcare services. This role is ideal for a hands-on, detail-oriented medical billing professional who thrives in end-to-end ownership, payer research, data analysis, and continuous process improvement. You will serve as a key contributor ensuring accurate, compliant, and efficient reimbursement while collaborating closely with cross-functional teams including operations, IT, and finance. Key Responsibilities Perform...

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...

Health Information Coder III The Health Information Coder III 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...

Health Information Coder 3 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...

Associate Director, Medical Safety Review Mirum Pharmaceuticals is a biopharmaceutical company dedicated to transforming the treatment of rare diseases. We are passionate about advancing scientific discoveries to become important medicines for rare disease patients. We are collaborative, creative, and experienced professionals and we're looking to augment our team with other individuals who embody our values: care, be real, get it done, and have fun, seriously. Position Summary Mirum Pharmaceutical is seeking an Associate Director of Medical Safety Review. The ideal candidate will have experience performing activities related to ICSR medical review, evaluation of safety data, signal detection and preparation of aggregate reports. This role will report to the Director of Medical Safety Science. Job Functions/Responsibilities Conduct medical review of ICSRs from any source including, but not limited to, clinical trials, literature, and post marketing reports Confirm that...

Senior Medical Billing Specialist Location: SF Bay Area, CA (Onsite - 5 days/week) Employment Type: Full-Time, Permanent Compensation: Competitive base salary + annual bonus + full benefits About the Opportunity We are partnering with an innovative medical technology and healthcare services organization that supports patients through technology-enabled care programs. This team plays a critical role in managing and optimizing reimbursement across professional medical billing, payer engagement, and revenue cycle operations for outpatient and digitally delivered healthcare services. This role is ideal for a hands-on, detail-oriented medical billing professional who thrives in end-to-end ownership, payer research, data analysis, and continuous process improvement. You will serve as a key contributor ensuring accurate, compliant, and efficient reimbursement while collaborating closely with cross-functional teams including operations, IT, and finance. Key Responsibilities Perform...

Health Information Coder 3, Per Diem HIMS Per Diem 87476BR Job Summary The Health Information Coder III 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. DUTIES AND ESSENTIAL JOB FUNCTIONS Retrieve and analyze comprehensive medical records and information systems for appropriate documentation and follow-up as appropriate. Evaluate full episode of care of...

Senior Medical Billing Specialist Location: SF Bay Area, CA (Onsite - 5 days/week) Employment Type: Full-Time, Permanent Compensation: Competitive base salary + annual bonus + full benefits About the Opportunity We are partnering with an innovative medical technology and healthcare services organization that supports patients through technology-enabled care programs. This team plays a critical role in managing and optimizing reimbursement across professional medical billing, payer engagement, and revenue cycle operations for outpatient and digitally delivered healthcare services. This role is ideal for a hands-on, detail-oriented medical billing professional who thrives in end-to-end ownership, payer research, data analysis, and continuous process improvement. You will serve as a key contributor ensuring accurate, compliant, and efficient reimbursement while collaborating closely with cross-functional teams including operations, IT, and finance. Key Responsibilities Perform...

Senior Medical Billing Specialist Location: SF Bay Area, CA (Onsite - 5 days/week) Employment Type: Full-Time, Permanent Compensation: Competitive base salary + annual bonus + full benefits About the Opportunity We are partnering with an innovative medical technology and healthcare services organization that supports patients through technology-enabled care programs. This team plays a critical role in managing and optimizing reimbursement across professional medical billing, payer engagement, and revenue cycle operations for outpatient and digitally delivered healthcare services. This role is ideal for a hands-on, detail-oriented medical billing professional who thrives in end-to-end ownership, payer research, data analysis, and continuous process improvement. You will serve as a key contributor ensuring accurate, compliant, and efficient reimbursement while collaborating closely with cross-functional teams including operations, IT, and finance. Key Responsibilities Perform...

Join Datavant, a leading data platform company revolutionizing health data exchange. Our mission ensures that every healthcare decision is guided by the right data at the right time and in the right format. As the world's foremost health data network, our platform enables secure, accessible, and actionable data, empowering healthcare stakeholders including life sciences firms, government agencies, and care providers. By becoming part of Datavant's high-performing, values-driven team, you'll contribute to innovative technology solutions that address some of healthcare's most challenging issues. Our diverse team brings various professional, educational, and life experiences together to achieve our ambitious goals for the healthcare sector. What You'll Be Doing: Conduct audits of coded medical charts according to the client's guidelines as assigned by the quality supervisor. Navigate multiple client guidelines with ease. Maintain a 95% quality average at the...

Details Department: Primary Care and Specialtiy Care Schedule: Monday - Friday 8am- 4:30pm or 8:30am - 5pm Facility: Joshua Max Simon Primary Care Center Location: Indianapolis, IN Salary: $21.85 - $29.56 per hour This position is currently full remote but there is a plan to transition to a hybrid role in the future that will require the associate to come into the office 3-4 times a month. Working at the Primary Care Center, you become a part of something very special. Providing care to all individuals, regardless of wealth, vulnerability, immigration or refugee status, is immensely gratifying. In this work, you will be joining others with a similar mission and vision, including the opportunity to volunteer in the community. Benefits Paid time off (PTO) Various health insurance options & wellness plan Retirement benefits including employer match plan Long-term & short-term disability Employee assistance programs (EAP) Parental...

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....

Company Description : Axis Community Health, a nonprofit established in 1972, provides comprehensive healthcare services to over 15,000 individuals across all age groups in the Tri-Valley area. The mission of Axis Community Health is to provide quality, affordable, accessible and compassionate health care services that promote the well-being of all members of the community. Our mission is rooted in delivering high-quality patient care, encompassing primary healthcare, mental health support, and dental services. We are committed to ensuring access to essential healthcare services for every member of our community, irrespective of financial status, living situation, or insurance coverage. Job Summary: The Medical Coder is responsible for reviewing, coding, and processing medical, dental, and behavioral health encounters to ensure accurate and compliant documentation, coding, and billing specific to a Federally Qualified Health Center (FQHC). This role assigns appropriate...

Sr Coder Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings. The posted compensation range of $32.38 - $48.17 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law. As a Senior Coder, you will act as the lead coder for your designated team. This position will train staff on department policies, procedures, systems and correct coding...