Senior Payment Integrity Program Development Specialist Inland Empire Health PlanSenior Payment Integrity Program Development SpecialistRancho Cucamonga, California$80,059.20–$106,059.20 / yearFull timeReporting to the Manager of Payment Integrity Program Development, the Senior Payment Integrity Program Development Specialist services as a subject matter expert driving the research, analysis, and development of Payment Integrity initiatives that strengthen payment accuracy, reduce overpayments, and ensure regulatory and contractual compliance. This Senior Payment Integrity Program Development Specialist also assesses existing pre and post payment audit programs to enhance fraud, waste, and abuse (FWA) detection, while guiding cost avoidance improvements across Payment Integrity operations.
Certified Coder, Acute Hospital ED, Cancer & Edits (Remote) Adventist Health SystemCertified Coder, Acute Hospital ED, Cancer & Edits (Remote)CARemoteJob 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. Attends meetings for coder education, audit reviews, staff meetings, coder roundtable and other specialty meetings as needed including emergency department charging, cancer, infusions and injections, cardiac rehab and returned for coding.
Healthcare Claims Examiner Ultimate Staffing ServicesHealthcare Claims ExaminerEl Monte, California$25–$28 / hourResearch and resolve claim discrepancies, including making payment corrections, recovering overpayments, and reprocessing claims as needed. Evaluate claims for potential fraud, waste, abuse, Workers' Compensation, hospital-acquired conditions, and third-party liability; escalate issues appropriately.
Health Claims Examiner Ultimate Staffing ServicesHealth Claims ExaminerPasadena, California$23–$27 / hourCommunicate professionally with members and providers to address inquiries, follow up on pended claims, and complete necessary corrections or adjustments. Strong working knowledge of medical terminology, billing practices, and coding systems, including CPT, ICD-9/ICD-10, HCPCS, DRG, and revenue codes.
DRG Coder Astrana Health, Inc.DRG CoderCA, CaliforniaRemote$28–$32 / hourIn 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. 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.
Jr. Quality Improvement Coder Astiva Health, Inc.Jr. Quality Improvement CoderOrange, CAIn this role, the Junior QI Coder will partner with the Director to collaborate with network providers and IPA's to improve the quality of care through quality improvement activities that will include RAF, HEDIS, CMS Star Ratings and other health plan reporting. Apply official CPT/HCPCS and ICD10 coding guidelines, internal guidelines, and state specific Medicare/Medicaid coding instructions to review and analyze professionally coded services and coding queries.
Manager, Administrative Operations - Patient Accounting - Full Time 8 Hour Days (Exempt) (Non-Union) University of Southern CaliforniaManager, Administrative Operations - Patient Accounting - Full Time 8 Hour Days (Exempt) (Non-Union)Los Angeles, CA$99,507–$164,559 / yearWhen extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. It will also include oversight and tasks associated with vendor management, more specifically, controlling costs, reducing vendor related risks, facilitates all communications between the PFS Business Office and the vendors and ensures service delivery by creating vendor expectations.
Coder FT Days 8am-4:30pm AHMC HealthcareCoder FT Days 8am-4:30pmMonterey Park, CaliforniaUnder the direction of the Director of Health Information Management, Identifies and codes Newborns, Obstetrics, ER’s and outpatient records for the purpose of reimbursement, research, and compliance with Federal Regulations using the ICD-10-CM/CPT coding classification systems. Queries are formulated well; are clear, concise, and affect efficient assistance to the medical staff member for timely and accurate query response, complete documentation, and final coding.
Coder FT Days 8am 4:30pm AHMC Healthcare IncCoder FT Days 8am 4:30pmMonterey Park, CACurrent coding certification-RHIA, RHIT, or CCS 1-2 years of coding experience in acute hospital setting Knowledge and application of ICD10 classifications, CPT-4 and HCPCS with an accuracy level of 95% Must be able to work in a very challenging environment. JOB SUMMARY: Under the direction of the Director of Health Information Management, Identifies and codes Newborns, Obstetrics, ER's and outpatient records for the purpose of reimbursement, research, and compliance with Federal Regulations using the ICD-10-CM/CPT coding classification systems.
Manager, Revenue Assurance - Revenue Integrity (Medical Coding) Kaiser PermanenteManager, Revenue Assurance - Revenue Integrity (Medical Coding)Pasadena, CAOversees routine review and maintenance of system codes by: monitoring the regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; providing guidance on conducting pre- and post- implementation assessments of automated and manual charge capture for quality and accuracy; reviewing analyses of complex and/or region-wide billing issues related to charges/codes and guiding the resolution of charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications. Manages monitoring activities and process improvements by: overseeing the performance of tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; providing guidance on analyzing findings from monitoring activities to identify deficiencies and/or compliance issues in billing codes and processes and partnering with other departments to resolve deficiencies and/or compliance issues; driving the development of reports of monitoring activity results to share with department leaders and/or other departments; and ensuring the implementation of corrective action plans resulting from monitoring activities.
Collection Representative Children's Hospital Los AngelesCollection RepresentativeGlendale, CA$43,680–$65,062 / yearPurpose Statement/Position Summary: The Collection Representative is responsible for the billing and follow-up related to HMO's, PPO's, Medi-Cal, CCS, GHPP, PCCM's Managed Care and outside organizations. Childrens Hospital Los Angeles is consistently ranked among the top 10 children's hospitals in the nation, delivering world-class care through more than 350 specialized programs and services.
Medical Coding Specialist OneOncology IncMedical Coding SpecialistCARemoteOneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.
Professional Fee Coding Educator Community Health Systems IncProfessional Fee Coding EducatorCAConducts training sessions, seminars, and educational meetings for CHS-affiliated providers and staff, including the PPS Physician Coding and Documentation Seminar. The Physician Education Specialist provides training and education to CHS-affiliated providers and staff on accurate coding and documentation to ensure compliance with federal, state, and local laws.
Revenue Assurance Specialist IV - CDM and Epic experience needed Kaiser PermanenteRevenue Assurance Specialist IV - CDM and Epic experience neededPasadena, CAPerforms routine review and maintenance of system codes by: performing a regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; conducting pre- and post-implementation assessments of automated and manual charge capture for quality and accuracy; analyzing moderately complex billing issues related to charges/codes and proposing and implementing action plans to resolve charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications. Executes monitoring activities and process improvements by: independently performing tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; recording findings in accordance with relevant policies/procedures to ensure complete and consistent data integrity, partnering with other departments to resolve moderately complex deficiencies and/or compliance issues identified through monitoring activities; communicating results of monitoring activities to senior team members and/or department leaders; and implementing corrective action plans resulting from monitoring activities.
Senior Product Manager (PM/RCM) - Full Time - Remote Experity IncSenior Product Manager (PM/RCM) - Full Time - RemoteCARemote$107,750–$151,400 / yearResponsibilities: Own day-to-day execution of the Revenue Cycle Management product roadmap, ensuring on-time delivery of capabilities across charge capture, coding, claim creation and submission, payer processing, payment posting, denial management, accounts receivable, patient balances, reporting, and related billing workflows. Deep knowledge of healthcare revenue cycle management, including charge capture, coding, claim submission, clearinghouses, payer adjudication, remittance processing, denial management, accounts receivable, and payment posting.
Payment Specialist I El Proyecto del Barrio IncPayment Specialist ICAEmployees driving personal vehicles for El Proyecto business must provide El Proyecto proof of a valid driving license, and auto liability insurance. To receive mileage reimbursement, the employee must log their mileage and submit the mileage expense report to their Appropriate Administrator.
Provider Service Representative III L.A. Care Health PlanProvider Service Representative IIILos Angeles, CAThe Provider Service Representative (PSR) III is the first point of contact for providers and stakeholders, delivering complete and accurate support on eligibility, benefits, claims, authorizations, Primary Care Physician (PCP) changes, and other service needs ensuring seamless support across the provider service journey. Required: At least 3 years of Managed Care experience in provider relations or customer service, including 1 year of experience handling provider inquiries related to claims, benefits, authorizations, and payments in a contact center environment.
NewForward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_Transformation DeloitteForward Deployed Engineer, Data Studio Revenue Cycle - Innovation_Delivery_TransformationLos Angeles, CA$105,400–$207,800 / yearWorking knowledge of the retrieval and knowledge layer behind agentic systems - RAG pipelines, embeddings and vector stores, and increasingly knowledge graphs - including how to ground use cases in large volumes of unstructured healthcare data (e.g., clinical notes, payer policies, contracts) alongside structured sources. Partner with Health Care consulting teams and Converge for Healthcare's account and product teams during the sales cycle - running technical discovery, demonstrations, and use-case fit assessments - such as denial prevention, prior authorization automation, or AR follow-up - that qualify client needs and shape a credible path to production value.
Clinical Documentation Integrity Specialist- Onsite, Los Angeles UnitedHealth Group IncClinical Documentation Integrity Specialist- Onsite, Los AngelesLos Angeles, CA$72,800–$130,000 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Primary Responsibilities: Provides expert level review of inpatient clinical records within 24-48 hours of admit; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the condition and acuity of care provided.
Chart Auditor - Glendale Adventist Health SystemChart Auditor - GlendaleGlendale, CAJob Summary: Supports the Revenue Management Department by auditing medical records and clinical documentation to ensure proper patient status placement, accurate coding, and defensible payer billing. Essential Functions: Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials.