48 coder auditor jobs found in Ontario, CA

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one 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 Inpatient Coder Auditor reviews and analyzes documentation present in the medical record for Inpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software. The Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International...

Prime Healthcare, headquartered in Ontario, CA, seeks an Inpatient Coder Auditor to verify inpatient documentation and assign ICD-10/PCS, CPT, and HCPCS codes accurately. The senior role leads DRG validation and supports CDS and medical staff to enhance clinical documentation. Candidates should have CCS and at least 1 year of acute care experience, with encoder software proficiency. Full-time, day shift, with competitive compensation and benefits. #J-18808-Ljbffr

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0 million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one 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 Inpatient Coder Auditor reviews and analyzes documentation present in the medical record for Inpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software. The Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International...

Prime Healthcare is seeking an Inpatient Coder Auditor to review documentation for inpatient visits and ensure accurate ICD-10/PCS, CPT, and HCPCS coding. You will finalize coding and abstracts, supporting DRG validation and working with CDS and medical staff. This senior coding role requires CCS, 1 year acute care experience, and strong knowledge of anatomy, medical terminology, and encoding software. Excellent communication and critical thinking are essential. #J-18808-Ljbffr

Riverside Medical Clinic in California is seeking a dedicated coder to handle coding and compliance processes related to CPT, HCPCS, and ICD. Candidates should have a minimum of one year experience in medical coding and possess a relevant medical coding certificate. This position offers growth and development opportunities within Universal Health Services (UHS) along with a competitive compensation package, making it a fulfilling environment for those passionate about quality healthcare. #J-18808-Ljbffr

A healthcare firm supporting agriculture seeks a Claims Auditor for remote work, ensuring compliance with health benefits plans. The role involves coding new business, verifying plans, and maintaining efficiency in processes. Candidates should have a BS/BA degree and at least two years in claims auditing. The position offers a salary range of $46,669.19 - $65,668.50 and a benefits package including profit-sharing. #J-18808-Ljbffr

Pinnacle Claims Management Job Opportunity If you're looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we're looking for you. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees. As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn't a work life and a home...

Western Growers Health — a part of Western Growers Family of Companies — provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry. Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today! Compensation: $46,669.19 - $65,668.50 with a rich benefits package that includes profit‑sharing. This is a remote position and can reside...

Coder The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM, ICD-10-PCS, and CPT codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Verifies that all ICD-10-CM and CPT codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings. Performs other duties as assigned. Resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing productivity and quality standard of 95% accuracy rate or better....

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...

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...

Clever Care Health Plan is hiring a Risk Adjustment Coding Auditor to conduct retrospective and prospective coding audits, validate diagnoses, and monitor CMS RADV compliance. The role focuses on HCC coding, documentation improvement, and education for providers across a fast-growing Medicare Advantage program. Candidates should have 5+ years in MA risk adjustment or related audits, with strong knowledge of ICD-10-CM guidelines and MEAT criteria. #J-18808-Ljbffr

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. Review...

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...

Coding Auditor Under direction of the Coding Supervisor and Coding Manager, performs coding audits of patient care billing documentation to ensure adherence with CPT and ICD coding guidelines and federal, state, and commercial payor billing and payment policy for all services provided by Providence Medical Foundation. Providence caregivers are not simply valued they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them. Required qualifications: Upon hire: National Certification from American Academy of Professional Coders. Or Upon hire: National Certified Coding Associate - American Health Information Management Association. Or Upon hire: National Certified Coding Specialist - American Health Information Management Association. Or...

A leading technology company in Los Angeles is looking for a Creative Coder to drive audio experiences in innovative projects. The role requires over 7 years of experience in implementing sonic experiences and at least 5 years in development with languages like C++, Kotlin, and Python. You will collaborate with various teams to enhance audio functionality and create immersive audio systems. The position offers a competitive salary, equity, and benefits, emphasizing creativity and technical insights in sound technology. #J-18808-Ljbffr

Medasource is looking for two experienced Senior Medical Review Coders in Long Beach, CA. You will support high-priority government audit and medical record review initiatives. Responsibilities include medical record abstraction, coding validation, and provider outreach. The ideal candidate has over 10 years of experience, active coding certification, and a deep understanding of ICD-10-CM guidelines. The role offers a hybrid work model, requiring proximity to Long Beach due to onsite needs. #J-18808-Ljbffr

Astrana Health Management is seeking a Senior DRG Coder to review inpatient medical records and assign diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS. The role is critical to ensuring coding accuracy and compliance within hospital reimbursement frameworks. Candidates should possess an associate’s degree, at least five years of inpatient coding experience, and relevant certifications. The position offers a competitive hourly wage and requires remote work capabilities with occasional in-person meetings. #J-18808-Ljbffr

Astrana Health, Inc. is seeking a Senior DRG Coder to ensure coding accuracy and compliance. You will review inpatient medical records, assign appropriate codes, and collaborate with various teams for accurate reimbursement. This role requires at least 5 years of inpatient coding experience with a strong background in ICD-10-CM and ICD-10-PCS methodologies. The position is remote but requires occasional in-person meetings. #J-18808-Ljbffr

Job Description Job Description Job Summary Medical Biller The Medical Biller reports to the Billing Manager in person at out office in Ontario, CA and is responsible for the accurate, compliant, and timely billing of clinical laboratory services, including blood testing, microbiology/culture testing, and toxicology services. This role requires strong expertise in Medicare Part A vs Part B billing, skilled nursing facility (SNF) workflows, and commercial payer laboratory billing rules. The Medical Biller manages claims from Pending Review through payment resolution while ensuring full compliance with Medicare, Medicaid, and commercial payor regulations. No Remote Work Available Supervisory Responsibilities None Essential Duties and Responsibilities Laboratory Billing & Claims Management Review laboratory patient demographics, insurance, ordering provider, and facility information. Prepare, review, and submit insurance claims for laboratory...

Location: Ontario, CA, US, 91761 Position Summary: Assume role as Ventura Foods Company Auditor, responsible for auditing VF plants for compliance to HQ and plant policies, programs, and SOPs. Auditor will schedule and prepare for audits, conduct audits, prepare and issue reports, and monitor follow‑up RCA and CAPA. Role is expected to build and improve the Company Auditing program and standards. Auditor also responsible for all aspects of audit preparation and execution for audits conducted at the home plant, including GFSI, SQF, customer and VF Company audits. Support cross‑functional plant audit team as the audit leader and coordinator for RCA and CAPA follow‑up. Audit food safety, quality and HACCP programs for compliance. Coordinate daily/weekly/monthly facility audits on a pre‑determined schedule. Identify gaps and coordinate corrective action initiatives for findings and non‑conformances. Major Duties and Responsibilities: Responsible for auditing Ontario VF plant for...

Coding Compliance Auditors (Administrative Services Manager I) Riverside University Health System (RUHS) is seeking two skilled Coding Compliance Auditors 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...

DRG Coder The Senior DRG Coder is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-Related Group (DRG) assignment. This role ensures coding accuracy, reimbursement integrity, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent Practice Association (IPA) and Management Services Organization (MSO) environment, the Senior DRG Coder partners with utilization management, care management, finance, and provider network teams to support accurate payment, risk adjustment, quality reporting, and medical expense analysis. What You'll Do Review inpatient hospital records and assign accurate diagnosis and procedure codes Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation Conduct coding validation and auditing to ensure compliance with payer and regulatory...