Coder auditor jobs in Ontario, CA

Coder Auditor

Prime Healthcare Management Inc 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...

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Inpatient Coder Auditor - DRG & Documentation Quality

Prime Healthcare Ontario, CA

Prime Healthcare is seeking an Inpatient Coder Auditor to review documentation for inpatient visits and ensure accurate ICD-10-CM, CPT, and HCPCS coding. The senior role emphasizes DRG validation and primary responsibility in assisting CDS and medical staff to improve the quality of clinical documentation. You will participate in chart review projects as assigned and other duties as needed, requiring a strong grasp of DRGs, anatomy, and medical terminology, along with encoder software experience #J-18808-Ljbffr

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OP Coder Auditor Trainee

Prime Healthcare Management Inc 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 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 Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software. The Outpatient Coder Auditor Trainee finalizes the coding and abstracting of the medical record upon ensuring the assignment of...

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Remote Medicare MRA Coding Auditor (CMS-HCC V28)

Alignment Healthcare USA, LLC Orange, CA

Alignment Health is seeking an experienced MRA Coding Auditor to support QA audits of the internal Coding Analyst Team and vendors, ensuring high-quality data submitted to CMS. The role involves risk adjustment data validation, chart reviews, and process improvements. Required: 3+ years Medicare Risk Adjustment coding, certified coder (CCS/CCS-P/CPC/CRC/RHIT/RHIA), and proficiency with MS Office and leading EHR systems. This is a remote position with competitive pay and benefits. #J-18808-Ljbffr

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Plan Coder

Western Growers Assurance Trust Irvine, CA

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...

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DRG Coding Auditor - MS-DRG and APR-DRG

Elevance Health Costa Mesa, CA

Anticipated End Date: 2026-08-31 Position Title: DRG Coding Auditor - MS-DRG and APR-DRG Job Description: DRG Coding Auditor - MS-DRG and APR-DRG Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development . Alternate locations may be considered if candidates reside within a commuting distance from an office Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its...

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Inpatient Coding Auditor

Huron Consulting Group Los Angeles, CA

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare...

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Risk Adjustment Coding Auditor

Clever Care Health Plan Huntington Beach, CA

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...

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Risk Adjustment Coding Auditor

Clever Care Health Plan Huntington Beach, CA

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...

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Hybrid Risk Adjustment Coding Auditor (HCC/RADV)

Clever Care Health Plan Huntington Beach, CA

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

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Compliance Coding Auditor , ATM

Advanced Medical Management, Inc. Long Beach, CA

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...

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Lead Creative Coder: Immersive Audio Prototyping

META Los Angeles, CA

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

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Senior DRG Coder (Remote) - Audit & Reimbursement

Astrana Health, Inc. Orange, CA

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

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Senior DRG Coder (Remote) - Audit & Reimbursement

Astrana Health Management Orange, CA

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

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Senior Risk Adjustment Coder II - Travel & Field Audits

Astrana Health, Inc. Monterey Park, CA

Astrana Health, Inc. in Monterey Park, CA is seeking a Risk Adjustment Coding Specialist II to verify provider documentation, educate providers, and support CMS risk adjustment initiatives. The role requires travel to provider sites (about 75%) and reports to the Supervisor - Risk Adjustment. Requires CCS/CPC or similar certification and 3+ years of risk adjustment coding, with strong ICD-10-CM/HCC knowledge and EHR proficiency. Competitive salary is $75,000–$85,000 per year. #J-18808-Ljbffr

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Senior Risk Adjustment Coder II – HCC & Audits

Astrana Health Management Monterey Park, CA

Astrana Health seeks a Risk Adjustment Coding Specialist II to join our Strategy and Operations team in Monterey Park, CA. The role requires converting provider documentation into compliant HCC coding and educating providers on CMS requirements while traveling to provider sites as needed. Qualified candidates hold CCS/CPC certification with 3+ years of risk adjustment coding experience, strong EHR skills, and the ability to work in a hybrid setting, including on-site visits and remote #J-18808-Ljbffr

Full Time

Coding Manager

CHLA Medical Group Hybrid (Los Angeles, CA)

Primary Purpose of the Position: The Revenue Cycle Coding Manager provides strategic and operational leadership for professional coding and charge capture. The Manager is accountable for coding quality, productivity, inventory, compliance remediation, workforce planning, vendor performance, physician and division engagement, and coding-related revenue integrity. The position establishes clear standards, analyzes trends, and develops corrective action plans to support accurate, timely, and compliant claim submission. Essential Duties of the Position May Include the Following: Leads day-to-day and long-range coding operations, including staffing, workload allocation, coverage planning, production priorities, and escalation management. Owns the coding operating model and clearly defines responsibilities among the Coding Manager, Coding Supervisor, internal coders, and external coding vendors. Establishes, monitors, and reports key performance indicators for...

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CPC - Orthopedics outpatient coder - Full Time - Days - 8hr

Emanate Health Covina, CA

EH Corporate Badillo St. - Covina Full time R0014354 Current Emanate Health Employees - Please log into your Workday account to apply Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals. On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country. J ob Summary Reporting to the Manager Physician Coding Services, the Certified Coder Professional will be responsible for reviewing an evaluating clinical documentation within medical records to ensure high quality and compliant coding. The Certified Coder Professional will provide training, consultation, and feedback to clinicians on their documentation and coding to...

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CPC - Orthopedics outpatient coder - Full Time - Days - 8hr

Emanate Health Covina, CA

Certified Coder ProfessionalReporting to the Manager Physician Coding Services, the Certified Coder Professional will be responsible for reviewing and evaluating clinical documentation within medical records to ensure high quality and compliant coding. The Certified Coder Professional will provide training, consultation, and feedback to clinicians on their documentation and coding to ensure Emanate Health Medical Group receives appropriate reimbursement and conforms to applicable guidelines and regulations. Collaborates with Emanate Health's Compliance team and with all third party billing and reimbursement requirements including, but not limited to, the requirements of Medicare and Medicaid programs. Serves as the coding subject matter expert for the physicians.Minimum Education Requirement:Associate degree preferred; college degree preferred, knowledge of Medical Terminology, Anatomy & Physiology and Computer experience.Minimum Experience Requirement:Minimum of 2+ years of...

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DRG Coder

Astrana Health, Inc. Orange, CA

Job Description Job Description Description The 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 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...

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Medical Billing Specialist

Stallant Health Crescent City Highland, CA

Certified Coder and Biller We are looking for a certified coder and biller for our Highland clinic. The role is in‑person and involves coding, billing, claims, payer follow‑up, refunds, and billing queues. Coding visits and entering charges should occur within 48 hours of encounter completion. You will work Athena queues, handling missing slips, holds, messages, unpostables, denials, collections items, and related follow‑up. Other responsibilities may include insurance refunds, Medi‑Cal and normal overpayment cases, credentialing support, payer enrollment, and contract submissions. You will help keep billing spreadsheets updated for revenue, payments, fee‑for‑service, refunds, and reporting. The position may also answer billing questions from patients and staff, and assist with billing and chart audits. Qualifications CPC or equivalent coding certification Experience with medical coding, billing, charge entry, claims submission, and payer follow‑up Comfort working with...

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Medical Coding and Billing Specialist

Stallant Health Crescent City Highland, CA

Job Description Job Description Hi! We are looking for a certified coder and biller for our Highland clinic. This is an in-person position for coding, billing, claims, payer follow-up, refunds, and billing queues. The job includes coding visits and entering charges within 48 hours of encounter completion. This person will also work Athena queues; missing slips, holds, messages, unpostables, denials, collections items, and related follow-up. We need someone who knows their stuff! Other work may include: insurance refunds, Medi-Cal and normal overpayment cases, credentialing support, payer enrollment, and contract submissions and related items. This position will also help keep billing spreadsheets updated for revenue, payments, fee-for-service, refunds, and reporting. If you have experience with these fields, please, apply! The person in this role may also answer billing questions from patients and staff, and assist with billing and chart audits. --- We are looking...

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Medical Biller - Per Diem - 1st Shift

Memorial Hospital of Gardena Cerritos, CA

Pharmacy Biller/Collector Responsible for timely billing and follow up for all Part "D", Sub-Acute/SNF patients. Works all denials and or rejections in a timely manner. Works incoming correspondence. Works closely with the Pharmacy departments relating to the drugs and formulas. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication. Essential Functions: Knows how to download CMS/Epremise system daily or as needed. Monitors & processes credit balances for refunds and transfers in accordance with department procedures. Processes daily bills via CMS/Epremise system. Process claims and bills to payors through bill editor in accordance with department procedures. Knowledge in printing the Remittance Advices. Works on denial accounts daily or...

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Remote Medical Biller & Coder: Claims Specialist

Beyond Wealth Management Irvine, CA

Beyond Wealth Management is seeking a detail-oriented medical billing and coding specialist for a remote role. You will ensure patient and payer records are accurate and claims are processed efficiently. In this remote position, you will review records, prepare and submit claims, resolve denials, and maintain audit-ready billing files while collaborating with internal teams. The ideal candidate has 2–5 years of relevant experience and is comfortable working independently with minimal #J-18808-Ljbffr

39 coder auditor jobs found in Ontario, CA