73 provider coding compliance auditor jobs found

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 ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences including physicians and other staff. The ideal candidate will have at least five years of progressive experience in an acute care hospital...

Job Details Location: Huntington Beach Office, Huntington Beach, CA 92647. Position Type: Full Time. Salary Range: $72,800.00 – $80,000.00. This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting retrospective and prospective coding audits, diagnosis validation reviews, provider documentation assessments, and compliance monitoring activities to support accurate Medicare Advantage risk adjustment reporting and CMS audit readiness. This role reviews medical record documentation and ICD-10-CM diagnosis coding to ensure compliance with CMS Risk Adjustment program requirements, Official Coding Guidelines, AHA Coding Clinic guidance, and organizational policies. Functions & Responsibilities Conduct retrospective, prospective, and targeted coding audits to assess the accuracy, completeness, and compliance of ICD-10-CM diagnosis coding and HCC capture....

JOB DESCRIPTION SUMMARYPosition reports to the Supervisor Benefit Distribution & Installation and performs in-depth pharmacy and medical plan coding of new and existing business accounts. This position will ensure that all new and existing health (medical/dental/pharmacy) insurance plans underwritten by Western Growers Assurance Trust (WGAT) and those of Pinnacle Claims Management, Inc. (PCMI) are in compliance with the respective employers’ summary plan descriptions.DUTIES AND RESPONSIBILITIESPlan CodingPlan code new business and plan changes.Verify new and existing plans loaded on the company’s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.Respond to work orders received from examiners to investigate plan issues and irregularities.Evaluate testing requests for all new plans prior to loading them into the production system.AdministrativeKeep a detailed log of open and completed...

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values. Why Join Us? We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for...

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. Why Join Us? We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for conducting...

Join to apply for the Compliance Coding Auditor , ATM role at Advanced Medical Management, Inc. Your actual pay will be based on your skills and experience. Talk with your recruiter to learn more. Base pay range: $75,000 to $80,000 per year. Role Overview As a member of AMM’s Compliance and Ethics team, the Compliance Coding Auditor is an important driver of our mission. They are responsible for supporting the Company’s Compliance & Ethics Program (the Program) auditing, tracking, and monitoring initiatives. Robust auditing, testing, and monitoring capabilities are essential to fulfilling the expectations of AMM’s key stakeholders, including patients, families, and government agencies. The Program is led by AMM’s Chief Compliance & Ethics Officer, who reports to the CEO and the Board, and oversees the AMM Compliance Committee. This role requires sound, risk‑aware judgment, productive collaboration across the Company, and demonstrated success in performing audits to...

A healthcare provider in San Diego is seeking a Coding Auditor to conduct audits and ensure compliance with coding standards. The role requires strong knowledge of CPT and ICD-10 codes, exceptional communication skills, and the ability to train clinical staff. The ideal candidate has 3 years of experience in a healthcare setting and holds a CPC or CCS-P certification. Competitive hourly rate offered. #J-18808-Ljbffr

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 DescriptionJob DescriptionDescription :Facility Outpatient Coding AuditorJob Type :Full-Time or Part-Time Remote Medical Coding Audit Outpatient Coding Facility CodingGrow Your Career with a National Leader in Outpatient Medical Coding & Auditing - Work from Home!Are you a certified outpatient medical coding auditor with experience in surgical coding, emergency department (ED) coding, interventional radiology , or facility outpatient services ? Join GeBBS Healthcare Solutions , an award-winning provider of HIM (Health Information Management) and RCM (Revenue Cycle Management) services.We are expanding and seeking experienced Remote Outpatient Facility Coding Auditors to support our national client base.Position Summary :As a Remote Outpatient Coding Auditor , you'll conduct quality assurance audits on coded outpatient medical records.Your audits will focus on multiple service areas including :Outpatient SurgeriesObservationsInterventional RadiologyCardiac...

Professional Surgical Coder At NorthBay, the Professional Surgical Coder will play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes in an accurate and timely manner for professional surgery charges in the outpatient and inpatient settings. The coder is dedicated, knowledgeable individual with a strong understanding of medical terminology, coding guidelines, regulations, and proficiency in utilizing an EHR/encoder system. Can effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements. Work is performed using the approved classification Coding systems to include the modifiers. All work carried out in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and NorthBay Healthcare coding guidelines. Primary Job Responsibilities The coder...

Risk Adjustment Coding Specialist II Department: Quality - Risk Adjustment Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Yuvone Washington-Oshon Compensation: $70,000 - $85,000 / year Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects. What You'll Do Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company Review medical record information on both a retroactive and prospective basis to identify,...

Job Description Job Description The Certified Cardiology Coder plays a critical role in accurately translating cardiology medical records into standardized codes used for billing and documentation. This position requires expertise in cardiology procedures and coding standards to ensure compliance and data integrity. The coder works closely with clinicians and utilizes specific coding software alongside manual coding processes to support effective claims processing and reporting.   Responsibilities Assign accurate codes based on cardiology medical records Review and audit medical records for coding compliance Ensure data accuracy and adherence to coding guidelines Generate reports related to coding and billing activities Analyze patient data for completeness and coding accuracy Conduct coding audits to identify discrepancies and improve processes Collaborate with clinicians to clarify documentation and coding queries Process claims efficiently to support timely...

Overview Avanath is proud to be named one of the top property management companies to provide affordable housing for the workforce. Cultivating the American Dream is the purpose that binds the Avanath team. At Avanath, every day is an opportunity to make a difference in someone's life. Whether it is helping residents call one of our communities’ home, providing excellence in customer service, or championing our workforce, we are committed to creating an unforgettable experience as a great place to live, work, and be. The Role We are seeking a meticulous, detail-oriented Compliance Auditor to join our Compliance Team. The Compliance Auditor, specializing in hard-file review, will play a crucial role in ensuring our files comply with all relevant laws, Affordable Care Act regulations, and internal policies. This role involves carefully examining resident files, documentation, and records to identify non-compliance issues and recommend corrective actions. The incumbent in this...

Overview Avanath is proud to be named one of the top property management companies to provide affordable housing for the workforce. Cultivating the American Dream is the purpose that binds the Avanath team. At Avanath, every day is an opportunity to make a difference in someone's life. Whether it is helping residents call one of our communities’ home, providing excellence in customer service, or championing our workforce, we are committed to creating an unforgettable experience as a great place to live, work, and be. The Role We are seeking a meticulous, detail-oriented Compliance Auditor to join our Compliance Team. The Compliance Auditor, specializing in hard-file review, will play a crucial role in ensuring our files comply with all relevant laws, Affordable Care Act regulations, and internal policies. This role involves carefully examining resident files, documentation, and records to identify non-compliance issues and recommend corrective actions. The incumbent in this...

Job Posting Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Reviews inpatient records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Records types including inpatient encounter types. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work. Job Requirements: Education and Work Experience: High School Education/GED or equivalent: Required...

Job Title Job Title Job Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Reviews acute hospital outpatient emergency department (ED), medical oncology, adult outpatient rehab including cardiac rehab patient records including charge capture/entry to identify the diagnosis and procedure codes performed during the patient's stay are valid and in accordance with coding conventions and guidelines. Record types include ED including charge capture/entry, medical oncology cancer and adult outpatient rehab including cardiac rehab encounter...

Job Posting Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary Reviews SDS and OBV records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Records types including same day surgery and observation encounter types. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work. Job Requirements Education and Work Experience: High School...

Coder III Coder III is responsible conducting clinically based concurrent and retrospective reviews of inpatient medical records. This review is to evaluate that the clinical documentation is reflective of quality of care outcomes and reimbursement compliance for acute care services provided. The CDS will work closely with the medical staff to facilitate appropriate clinical documentation of patient care. The CDS/Coder III abstracts and codes the diagnostic and procedural information for Inpatient Services and Surgery medical records utilizing the current version of International Classifications of Diseases in accordance with regulatory agencies and hospital specific guidelines. The CDS/Coder III enters the coded data and other abstracted data from the medical record into the electronic information system. This position assumes primary responsibility for clarifying ambiguous documentation, DRG optimization with the primary role in assisting medical staff members with improving...

Food & Beverage Supervisor 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 November 13, 2026 Responsibilities Assist Operations Managers and Concessions Managers on duty in preparation for...

Job Description Job Description All for Health, Health for All, Inc. (AFH) is a nonprofit Federally Qualified Health Center (FQHC) and a certified Patient-Centered Medical Home. For over 40 years, we have provided high-quality, accessible healthcare services to medically underserved and diverse populations across Los Angeles County, Orange County, and the state of Nevada. Our integrated, team-based model includes general family practice, pediatrics, behavioral health, mental health services, and adult day health care. In the past year alone, we served over 30,000 patients across more than 90,000 visits at a dozen clinic locations. AFH is currently seeking dedicated and compassionate individuals to join our mission-driven team. We are hiring Full-Time medical biller/collector. SUMMARY An individual must be able to perform each essential duty satisfactorily which includes billing, posting payments, answering patient questions and concerns by phone or personally in fast-paced,...

Job Description The Health Information Coder III PD is a senior-level inpatient coder with advanced knowledge and skill set to utilize the ICD-10-CM, ICD-10-PCS, CPT, HCPCS classification systems. The skill set extends to advanced knowledge and comprehension of code sequences into Diagnoses-Related Groups. 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. This is a per diem position with no set schedule. OTHER FUNCTIONS AND RESPONSIBILITIES Demonstrate understanding of DRG coding mission within UCSF Health. Demonstrate understanding of DRG coding, AR, and data submission information flow. Ability to solve problems and troubleshoot computer issues. Perform data searches. Maintain patient confidentiality and IT security....

Job Description Job Description Overview Avanath is proud to be named one of the top property management companies to provide affordable housing for the workforce. Cultivating the American Dream is the purpose that binds the Avanath team. At Avanath, every day is an opportunity to make a difference in someone's life. Whether it is helping residents call one of our communities' home, providing excellence in customer service, or championing our workforce, we are committed to creating an unforgettable experience as a great place to live, work, and be. The Role: We are seeking a meticulous, detail-oriented Compliance Auditor to join our Compliance Team. The Compliance Auditor, specializing in hard-file review, will play a crucial role in ensuring our files comply with all relevant laws, Affordable Care Act regulations, and internal policies. This role involves carefully examining resident files, documentation, and records to identify non-compliance issues and recommend...

Medical Billing Specialist I/IIThe Department: As a vital department of Ventura County Health Care Agency (HCA), Ventura County Behavioral Health (VCBH) provides comprehensive mental health and substance use treatment services tailored to meet the needs of our community. From mobile crisis response to outpatient treatment, our array of programs ensures individuals receive the support they need at every stage of their journey.The Position: Under general supervision at the (I) level, or direction at the (II) level, the incumbent is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements.What We Offer: The County of Ventura offers an attractive compensation and benefits package. Aside from our base salary range, an employee within this position will also be eligible for the following:Educational Incentive - An educational incentive of 2.5% for completion...