16 financial compliance auditor iii claims jobs found

Primary Job Title: Financial Compliance Auditor III, Claims Location : CA (Hybrid Shift/Work Schedule: Date Posted: 7/10/2025 Employment Type: 3-month Contract Salary Range: $50.53 - $55.53/Hr Job Summary The Financial Compliance Auditor III, Claims is responsible for various tasks within the Financial Compliance Unit, including the audit of claims processed by medical groups and health plans contracted with Client. This role works closely with the Supervisor and/or Lead Auditor on the identification and resolution of issues in a timely and efficient manner. For Claims Emphasis: This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the audit report. This position is responsible for a variety of complex areas of the Medi-Cal, Medicare, Covered California, and PASC-SEIU benefits and processes. This position focuses on audits of contractual and regulatory compliance with timeliness and...

Job Title : Financial Compliance Auditor III Location : Los Angeles, CA 90017(Remote) Duration : 21 weeks Job Description: The Specialty Health Plans Auditor III, Finance is responsible all aspects of planning, execution, reporting, and corrective action plans monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental, behavioral health, transportation, and telehealth services providers. Essential Duties and Responsibilities: Performs financial audits and/or financial analyses for Specialty Health Plans on the quarterly and annual basis. Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors. Experience Required: At least 4 years of experience in conducting financial audits. At least 5 years of related...

Bright Vision Technologies is a forward-thinking software development company dedicated to building innovative solutions that help businesses automate and optimize their operations. We leverage cutting-edge technologies to create scalable, secure, and user-friendly applications. As we continue to grow, we're looking for a skilled Financial Compliance Auditor III, Finance to join our dynamic team and contribute to our mission of transforming business processes through technology. This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential. Position: Financial Compliance Auditor III, Finance Location: Los Angeles, CA 90017 Duration: Contract Job Summary The Specialty Health Plans Auditor III, Finance is responsible all aspects of planning, execution, reporting and corrective action plans monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental,...

Position Summary The Surgical Coder is responsible for accurately reviewing, analyzing, and assigning the appropriate CPT, ICD-10-CM, and HCPCS codes for surgical and procedural documentation in patient medical records. This role ensures coding compliance with all applicable regulations and guidelines to optimize reimbursement and maintain the integrity of clinical and financial data. Job Type Full-time Job Details Job Title: Surgical Coder Department: Revenue Cycle Management Reports To: RCM Director Location: HQ West Palm Beach Key Responsibilities Review operative reports and clinical documentation to assign appropriate CPT, ICD-10-CM, and HCPCS Level II codes. Ensure accurate capture of modifiers and adherence to payer‑specific coding guidelines. Verify that all coded information supports medical necessity and aligns with regulatory requirements (e.g., CMS, AMA, and payer‑specific policies). Query physicians for clarification or additional documentation when...

Job Overview Department: 04020 WFBMG University Group Practice: WFBMC Main - Anesthesiology Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Mon.-Friday- 1st shift Pay Range: $28.05 - $42.10 Education & Experience Graduation from an accredited medical coding program and three years of medical coding experience in a similar environment. Licensure & Certification National coding certification (CPC or CCS). Essential Functions Responsible for timely and accurate coding of hospital based professional services (outpatient hospital or inpatient hospital; single services or complete inpatient stays) by reading medical record documentation to assign and sequence diagnoses and procedure codes according to coding guidelines, and enter into the electronic system: Appropriate diagnoses codes, professional service codes and modifiers and/or facility service codes. Assign and record appropriate modifiers (i.e., GC, NO...

Job Description Applicants must reside in Connecticut, Massachusetts, or New York, or willing to relocate. The purpose of this position is to apply the appropriate diagnostic and procedural codes to individual health information for data retrieval, analysis, and claims processing. The DRG coder creates consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in hospital inpatient services. Responsibilities The coder abstracts pertinent information from patient records and assigns ICD-9-CM/ICD-10-CM, ICD-10-PCS or CPT/HCPCS codes, creating APC or DRG group assignments. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. The coder keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to supervisor or department manager for resolution....

Coder III, HIM - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union) Join to apply for the Coder III, HIM - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union) role at Keck Medicine of USC. In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non‑Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiate appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understand PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim to assure claims...

Medical Coder II, Inpatient Hospital Full Time Remote Hartford, CT, United States (Hybrid) About Us Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children’s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members. At Connecticut Children’s, treating children isn’t just our job – it’s our passion. As a leading children’s health system experiencing steady growth, we’re excited to expand our team with exceptional...

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 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 Billin g Specialist III ( $ 25.10 - $31.86...

GoTo Telemed seeks an exceptional  Remote Medical Biller  to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This...

GoTo Telemed seeks an exceptional  Remote Medical Biller  to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This...

GoTo Telemed seeks an exceptional  Remote Medical Biller  to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This...

GoTo Telemed seeks an exceptional  Remote Medical Biller  to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This...

Supervisor, Food Services-Hackettstown Medical Center-Part Time Join to apply for the Supervisor, Food Services-Hackettstown Medical Center-Part Time role at Atlantic Health Supervisor, Food Services-Hackettstown Medical Center-Part Time 2 days ago Be among the first 25 applicants Join to apply for the Supervisor, Food Services-Hackettstown Medical Center-Part Time role at Atlantic Health Get AI-powered advice on this job and more exclusive features. This range is provided by Atlantic Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $24.05/hr - $39.71/hr Job Description Responsible for assisting the Production Manager in the overall management of operations to include quality, product safety, associate safety, making production metrics, staffing, budgeting, maintenance, and raw material planning. Provides advice and oversees standardization of recipes, menu preparation, portion, cost and waste...

Schedule - Shift - Hours Full Time (40 Hours) - Days The Medical Coder II is responsible for the revenue cycle activities of specific physician practices of Ellis Medical Group (EMG). This includes but is not limited to: Managing the charge entry and charge reconciliation process for the assigned practice(s). Managing the Encounter Billing Exception Worklist (EBEW) and related worklists to ensure complete, timely and accurate submission of claims. Facilitating the accuracy and completeness of the practice’s codes and charges in the Service Catalog (Charge Description Master) and related encounter forms. Ensuring compliance with CPT/HCPCS and ICD-9/ICD-10 coding guidelines and government regulations, responsible for reviewing and coding from discharge data abstracts. Ensuring the practice(s) is optimizing reimbursement from third party payors by following and utilizing reimbursement guidelines. Establishing relationships with medical/dental staff, following up with providers to...

This position can be local or remote!! The Medical Coder II is responsible for the revenue cycle activities of specific physician practices of Ellis Medical Group (EMG). This includes but is not limited to: Managing the charge entry and charge reconciliation process for the assigned practice(s). Managing the Encounter Billing Exception Worklist (EBEW) and related work lists to ensure complete, timely and accurate submission of claims. Facilitating the accuracy and completeness of the practice’s codes and charges in the Service Catalog (Charge Description Master) and related encounter forms. Ensuring compliance with CPT/HCPCS and ICD-10 coding guidelines and government regulations, responsible for reviewing and coding from discharge data abstracts. Ensuring the practice(s) is optimizing reimbursement from third party payors by following and utilizing reimbursement guidelines. Establishing relationships with medical/dental staff, following up with providers to ensure documentation...