Senior Analyst, Medical Economics - Senior Analyst, Medical Economics (Trend Analytics, SQL, Power BI, Medicaid) - REMOTE Molina Healthcare IncSenior Analyst, Medical Economics - Senior Analyst, Medical Economics (Trend Analytics, SQL, Power BI, Medicaid) - REMOTECARemoteDemonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. Provides senior-level analytical support for Medical Economics initiatives through the extraction, analysis, and synthesis of complex healthcare data to identify risks, opportunities, and drivers of medical cost and utilization trends.
HCC Coder NORTHEAST COMMUNITY CLINIC, INCHCC CoderAlhambra, CAThe HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (with knowledge and demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements is preferred) Ability to work as a team player and work independently.
NewHealth Center Medical Biller II Behavioral Health Services IncHealth Center Medical Biller IIGardena, CAThe Medical Biller II is responsible for performing advanced revenue cycle functions, including complex claim resolution, denial management, and ensuring accurate reimbursement for services rendered within a health center setting. The Medical Biller II works independently and collaboratively with clinical and administrative teams to resolve billing issues, improve processes, and support continuity of care.
Senior Consultant Healthcare RCM (FQHC, Medi Cal, CPC/COC) Health Management Associates, Inc.Senior Consultant Healthcare RCM (FQHC, Medi Cal, CPC/COC)CAThe Senior Consultant is responsible for helping organizations through healthcare-related research, technical assistance, grant writing, policy analysis, strategic planning, procurements, program development, quality improvement, financial and reimbursement strategies, operational support, evaluation, product development and a range of other tasks. Success as a Senior Consultant in Revenue Cycle requires the technical expertise, consulting experience, and analytical capabilities needed to advise healthcare organizations, identify opportunities for financial and operational improvement, and deliver measurable, sustainable client results.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)CA$43,888–$102,081 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Health Center Medical Biller I/II Behavioral Health Services IncHealth Center Medical Biller I/IIGardena, CAThe Medical Biller II is responsible for performing advanced revenue cycle functions, including complex claim resolution, denial management, and ensuring accurate reimbursement for services rendered within a health center setting. The Medical Biller I is responsible for supporting the revenue cycle by accurately preparing, submitting, and following up on medical claims for services rendered within a health center setting.
Senior Consultant - Clinical Documentation Specialist DeloitteSenior Consultant - Clinical Documentation SpecialistLos Angeles, CA$95,600–$188,400 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Lead, Medical Review Nurse (RN) Molina Healthcare IncLead, Medical Review Nurse (RN)CAREQUIRED QUALIFICATIONS: At least 4 years clinical nursing experience, including broad knowledge of utilization management, medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology, and 4 years claims auditing, quality assurance, and/or recovery auditing experience, ideally in a DRG/clinical validation setting, and 3 years utilization review and/or medical claims experience, or equivalent combination of relevant education and experience. PREFERRED QUALIFICATIONS: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
Specialty Physician Coder 26-00243 Alura Workforce SolutionsSpecialty Physician Coder 26-00243Fountain Valley, CARemote$43.75–$46 / hourWe're looking for an experienced Specialty Physician Coder to join a growing Coding Compliance team, remote, with real variety in your day-to-day work. If this sounds like the kind of role where your specialty experience actually gets used, not just your general coding skills, let's talk.
Medical Auditor - Remote YO AI LabsMedical Auditor - RemoteLos Angeles, CARemoteWe are seeking experienced Medical Auditors to contribute their specialized expertise to an innovative healthcare AI project. This opportunity is ideal for professionals with strong experience in outpatient professional fee coding, auditing, and academic medical center environments.
Charge Capture Specialist Career StrategiesCharge Capture SpecialistLos Angeles, CaliforniaWe encourage candidates who meet these qualifications to apply for this exciting opportunity to contribute to our dedicated team in the healthcare field. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification (preferred).
Patient Access Supervisor 1 - GHEI Orange Ophth Clinic - FT Days University of California, IrvinePatient Access Supervisor 1 - GHEI Orange Ophth Clinic - FT DaysOrange, CaliforniaFull timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
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.
SENIOR APPLICATION DEVELOPER (DATA & ANALYTICS) Los Angeles CountySENIOR APPLICATION DEVELOPER (DATA & ANALYTICS)Los Angeles, CA$99,735.36–$134,407.68 / yearBachelors degree* from an accredited college or university in Computer Science, Information Systems, or Data Science AND three (3) years of enterprise-level, full-time, paid experience, obtained within the last three (3) years, in a data and analytics unit, designing, developing, troubleshooting, and optimizing complex Transact-SQL and PL/SQL (Procedural Language/Structured Query Language) code, including stored procedures, queries, and database performance tuning. Veteran's Credit: Pursuant to the County Charter and County policy, in all open competitive examinations (i.e., examinations open to everyone), the County of Los Angeles will add a credit of 10 percent of the total credits specified for such examination to the final passing score of an honorably discharged veteran, as well as the spouse of a deceased or disabled veteran, who served in the Armed Forces of the United States under specific conditions.
Medical Coder (FQHC) Healthcare ISMedical Coder (FQHC)CAWe are seeking an experienced medical coder to join the revenue cycle team at a federally qualified health center (FQHC). Responsibilities: Review clinical documentation from patient medical records and assign appropriate ICD-10, CPT, and HCPCS codes.
Billing Clerk Camino Health CenterBilling ClerkSan Juan Capistrano, CAUnder the direct supervision of the Revenue Cycle Manager, the Billing Clerk is responsible for capturing all medical, behavioral health, and dental clinic encounters; submitting claims associated with the billable programs and for reconciling those claims with the program's explanations of benefits. The Billing Clerk is charged with supporting health center staff in appropriately educating and referring patients to wellness, health care and financial assistance resources.
Medical Billing Supervisor - Data Entry & Payment Posting California Medical Business ServicesMedical Billing Supervisor - Data Entry & Payment PostingArcadia, CaliforniaOccasional weekend work may be required for special projects Pay Range: $28/hour-$30/hour In this vital role you will be responsible for overseeing the accurate and timely completion of data entry functions, including charge entry and payment posting for all assigned practices. This position supervises departmental staff, monitors daily workflow, ensures receipt and processing of charge and payment files, and supports clean-claim submission through effective front-end controls and issue resolution.
Medical Biller ObjectWin Technology IncMedical BillerCASpecific Skills Needed: Medical Billing, cash application and collection (collection is not calling demanding payment; it''s researching why a claim didn''t get paid and taking steps necessary to correct the info). Utilize a practice EHR system and clearing house to review and submit claims to multiple medical insurance carriers Review open/unpaid claim balances and take required action.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Remote) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Remote) (Exempt) (Non-Union)Alhambra, CARemote$99,507–$130,000 / yearThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union) University of Southern CaliforniaSenior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)Alhambra, CaliforniaRemoteThe Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.