18 policy coding auditor jobs found

Fully Remote | Professional Fee Coding Auditor | 3-Month Contract with Strong Extension Potential Openings: 6 The Patient Records Abstractor 4 fulfills a role as a Medical Coder for UCSF's physician practices. This position reviews patient records, discharge summaries, operative reports, and other clinical documentation to assign standardized codes for diagnoses, procedures, and services. The role applies national and international coding classifications to ensure records accurately reflect the care delivered, supporting compliant reimbursement and reliable clinical data. This position also serves as a Coding Educator responsible for providing education and training for physicians, staff, and other providers on professional fee coding and clinical documentation standards. Responsibilities include conducting coding quality reviews, analyzing findings, and providing follow-up education to coding staff and providers. The incumbent outlines and annotates applicable laws and...

Salary : $105,597.80 - $145,114.92 Annually Location : Riverside Job Type: Regular Job Number: 26-74191-01 AL Department: RUHS-Medical Center Opening Date: 03/03/2026 Closing Date: Continuous For questions regarding this position, please contact the Recruiter listed in the Supplemental Information section. ABOUT THE POSITION Riverside University Health System (RUHS)is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to...

Become a part of our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

The University of California, Irvine is seeking an Outpatient Coding Auditor responsible for conducting audits and ensuring compliance with Federal and State regulations. The role requires a minimum of three years’ experience in outpatient coding/auditing, CCS certification, and strong analytical and communication skills. Responsibilities include reviewing records, providing feedback to coding staff, and assisting in policy development. The position offers various benefits, including medical insurance and retirement savings plans. #J-18808-Ljbffr

Job Description JOB DESCRIPTION Insight Global is seeking a fully remote Medical Coding Specialist (Inpatient) to support a Healthcare AI client. This is a part-time, fully remote opportunity where candidates will leverage their inpatient coding expertise to evaluate and improve AI-driven coding recommendations. This role is highly analytical and requires a deep understanding of diagnosis/procedure coding, DRG assignment logic, and clinical reasoning within acute care settings. Laptop and equipment will be provided. Responsibilities: • Review inpatient encounters and evaluate AI-generated coding recommendations across diagnosis and procedure coding • Assess the accuracy and reasoning behind ICD-10-CM/PCS code assignments, sequencing, and DRG selection (MS-DRG/APR-DRG) • Identify discrepancies where AI-generated outputs diverge from correct inpatient coding practices and explain the rationale • Provide insight into complex coding decisions, including cases requiring...

Job Summary: Supervises team to review and request primary source information and verifications. Proactively identifies, suggests improvements to, and provides resolution for complex gaps in vendor relationships. Serves as an escalation point of contact for external queries regarding practitioner status. Evaluates applications and supporting highly complex documents. Guides team to conduct improvements to credentialing and privileging processes. Guides and supervises team to evaluate complex practitioner sanctions. Participates in surveys and audits of credentialing entities. Facilitates and implements strategic initiatives cost-effective due process. Identifies and provides leadership to resolve adverse actions/issues. Leads and evaluates audits of data between different departments. Conducts and supervises the facilitation and orientation and training to newly appointed physician leaders. Develops highly complex informational documents. Maintains working relationships with key...

Food and Beverage Supervisor | Part-Time | Pasadena Convention Center & Auditorium The Food & Beverage Supervisor is responsible for the effective management and running of banquet and concessions operations. The F&B supervisor must provide a high level of event oversight, technical proficiency, and operational/personnel support to ensure the smooth running of any assigned event. This role involves leading and directing serving staff, coordinating with various departments, and ensuring a high level of customer service. The F&B Supervisor is also responsible for setting up, executing, and breaking down events, providing leadership and guidance to staff, and ensuring all banquet and/or retail event services align with the event's requirements. This role will pay an hourly rate of $28.00-$30.00. Benefits for part-time roles: 401(k) savings plan and 401(k) matching. This position will remain open until July 31, 2026. The Pasadena Convention Center is a...

Calaim Medical Billing Specialist The CalAIM Medical Billing Specialist is responsible for managing the day-to-day administrative and billing operations related to Enhanced Care Management (ECM) and Community Supports (CS) services. This position supports the organization's CalAIM programming by ensuring accurate claims submission, authorization management, billing compliance, encounter tracking, and reimbursement optimization in accordance with DHCS, Managed Care Plan (MCP), Medi-Cal, and organizational requirements. The Billing Specialist works closely with care managers, housing support staff, leadership, and Managed Care Plans to ensure timely and compliant billing processes while maintaining accurate records within electronic medical records (EMR/EHR) and billing systems. Qualifications: High school diploma or equivalent required; Associate's degree in Medical Billing and Coding, Healthcare Administration, Business Administration, or related field preferred Minimum...

Medical Billing Specialist $25 - $29 per hour | Los Angeles, CA | On‑Site | Permanent Billing Specialist - Leading A bit about us: We are a long‑standing nonprofit treatment provider with over five decades of service in the recovery community. For over 40 years, we’ve helped more than 50,000 individuals overcome health challenges through compassionate, evidence‑based care. With 300+ residential beds and a dedicated team of 150+ staff, interns, and volunteers, we offer comprehensive services that promote long‑term sobriety and personal growth. Why join us? Medical Dental Vision 401K Growth Options Job Details The billing specialist ensures accurate and timely billing for services provided. This role is responsible for preparing, reviewing, and submitting claims, resolving denied or unpaid claims, and maintaining compliance with local, state, and federal billing regulations. The ideal candidate is detail‑oriented, tech‑savvy, and experienced in medical billing systems and...

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 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. Skilled in the Medi-Cal Provider Manual and TAR process, they ensure timely, compliant submissions that support access to behavioral health services. They communicate effectively with peers, patients, and payers, resolve billing discrepancies, and...

Medical Billing Specialist III/IV 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. The ideal candidate has specialized expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal. Skilled in the Medi-Cal Provider Manual and TAR process, they ensure timely, compliant submissions that support access to behavioral health services. They communicate effectively with peers, patients, and payers, resolve billing discrepancies, and address compliance issues in collaboration with the compliance office. Experienced in leading and training staff on Managed Care, Medicaid, Medi-Cal, Medicare, and Commercial Insurance, they ensure accuracy, efficiency, and regulatory adherence in all mental health billing operations. Medical Billing Specialist III ($25.99 -...

MISSION, VISION, AND VALUES Our mission is to provide quality, comprehensive healthcare and supportive services to our community. Our vision is "Improving the Health and Well-Being of Our Community." Our core values are Integrity, Compassion, and Excellence. Employees are expected to demonstrate 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 activities for the clinic's primary care, pediatric, behavioral health, and dental services. This position works closely with providers, Front Office staff, and the Quality Improvement Department. ESSENTIAL DUTIES & RESPONSIBILITIES Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. An individual must be able to perform each essential duty satisfactorily to be successful in this...

Certified Coder Stony Point Admin - Santa Rosa, CA 95401 Overview Salary Range $70,304.00 - $77,900.00 Salary/year Position Type Full Time Description Job Summary: The Certified Professional Coder is accountable for ensuring coding compliance for services performed by physicians and non-physician providers (e.g., nurse practitioners and physician assistants) and adhering to government regulations and coding guidelines. This position requires current, in-depth knowledge of coding governmental and commercial rules and regulations, including regulatory compliance requirements. Specific Tasks/Duties Include: Perform physician/non-physician provider documentation audits for compliance and regulatory requirements. Perform coding data audits to validate documentation supports services rendered for reimbursement and reporting purposes. Perform medical record review to abstract information required to support accurate coding for professional provider encounters....

Oak View Group Oak View Group (OVG) is the global leader in premium live entertainment infrastructure and services, with a platform spanning venue development and end-to-end capabilities across venue management, hospitality, and sponsorship sales. Founded in 2015, the company serves a collection of seven world-class owned venues and a client roster of the most iconic arenas, stadiums, convention centers, music festivals, performing arts centers, and cultural institutions, spanning four continents. Position Summary The Food & Beverage Supervisor is responsible for the effective management and running of banquet and concessions operations. The F&B supervisor must provide a high level of event oversight, technical proficiency, and operational/personnel support to ensure the smooth running of any assigned event. This role involves leading and directing serving staff, coordinating with various departments, and ensuring a high level of customer service. The F&B...

In order to be considered for this role, after clicking "Apply Now" above and being redirected, you must fully complete the application process on the follow-up screen. Overview The Food & Beverage Supervisor is responsible for the effective management and running of banquet and concessions operations. The F&B supervisor must provide a high level of event oversight, technical proficiency, and operational/personnel support to ensure the smooth running of any assigned event. This role involves leading and directing serving staff, coordinating with various departments, and ensuring a high level of customer service. The F&B Supervisor is also responsible for setting up, executing, and breaking down events, providing leadership and guidance to staff, and ensuring all banquet and/or retail event services align with the event's requirements. This role will pay an hourly rate of $28.00-$30.00. Benefits for part-time roles: 401(k) savings plan and 401(k) matching....

A bit about us: We are a long-standing nonprofit treatment provider with over five decades of service in the recovery community. For over 40 years, we've helped more than 50,000 individuals overcome health challenges through compassionate, evidence-based care. With 300+ residential beds and a dedicated team of 150+ staff, interns, and volunteers, we offer comprehensive services that promote long-term sobriety and personal growth. Why join us? Medical Dental Vision 401K Growth Options Job Details The billing specialist ensures accurate and timely billing for services provided. This role is responsible for preparing, reviewing, and submitting claims, resolving denied or unpaid claims, and maintaining compliance with local, state, and federal billing regulations. The ideal candidate is detail-oriented, tech-savvy, and experienced in medical billing systems and procedures. Key Responsibilities Daily Billing Operations Reconcile billing records for accuracy,...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

Job DescriptionJob DescriptionSUMMARYThe Certified Risk Adjustment Coder is responsible for accurately abstracting provider services into ICD-10 codes from medical documentation.This role adheres to the coding ethics of organizations such as the American Academy of Procedural Coders (AAPC), American Health Information Management Association (AHIMA), and the National Alliance of Medical Auditing Specialists (NAMAS), as well as payer guidelines.The coder conducts concurrent, prospective, and retrospective reviews of medical record documentation to ensure the accurate and complete capture of the clinical picture, severity of illness, and complexity of patients.Additional duties include provider communication and education to support the closure of both risk adjustment and quality care gaps, as well as providing ongoing feedback to physicians regarding coding guidelines and requirements.ESSENTIAL JOB FUNCTIONSPerform coding quality audits of medical records to ensure ICD-10 codes are...