NewCode Enforcement Attorney JobotCode Enforcement AttorneyRiverside, CA$140,000–$220,000 / yearInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. This role focuses on representing cities, counties, special districts, and public agencies in complex public safety matters and civil and criminal prosecution.
Government Audit Recovery Specialist IconmaGovernment Audit Recovery SpecialistCosta Mesa, CA$27–$32 / hourResponsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits.
Risk Adjustment Coding Specialist II - Orange County Astrana Health, Inc.Risk Adjustment Coding Specialist II - Orange CountyOrange, California$70,000–$85,000 / yearPerform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines. Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
Risk Adjustment Coding Specialist II - Orange County Astrana Health IncRisk Adjustment Coding Specialist II - Orange CountyOrange, CAIn this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. Additionally, you'll track and report on key performance metrics-such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
Risk Adjustment Coding Specialist II - South Bay/LA/OC Astrana Health IncRisk Adjustment Coding Specialist II - South Bay/LA/OCOrange, CAIn this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. Additionally, youll track and report on key performance metrics-such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
ORANGE, CA | Substitute Teacher, Teacher, Coding Robotics PARENT EDUCATION BRIDGE FOR STUDENT ACHIEVEMENT FOUNDATION LLCORANGE, CA | Substitute Teacher, Teacher, Coding RoboticsOrange, CAYour goal is to create a welcoming learning environment and provide parents with the tools they need to help their children reach their full potential. We are seeking an energetic and experienced Substitute Teacher to join our team of Parent Education Instructors!
Substitute Teacher, Teacher, Coding Teacher, Parent Instructor PARENT EDUCATION BRIDGE FOR STUDENT ACHIEVEMENT FOUNDATION LLCSubstitute Teacher, Teacher, Coding Teacher, Parent InstructorRialto, CAYour goal is to create a welcoming learning environment and provide parents with the tools they need to help their children reach their full potential. We are seeking an energetic and experienced Substitute Teacher to join our team of Parent Education Instructors!
HIGH DESERT, CA | Substitute Teacher, Teacher, Coding Robotics CbHIGH DESERT, CA | Substitute Teacher, Teacher, Coding RoboticsRiverside, CaliforniaInspired by the groundbreaking work of Joyce Epstein, a renowned expert in family engagement, PEBSAF's comprehensive virtual parent workshops provide a wealth of resources and guidance on a wide range of topics, from effective communication strategies to homework support and navigating the school curriculum. Recognizing the profound impact of parental involvement in a child's educational journey, PEBSAF has made it its mission to bridge the gap between home and school, empowering parents with the knowledge and skills they need to actively support their children's learning.
ORANGE, CA | Substitute Teacher, Teacher, Coding Robotics CbORANGE, CA | Substitute Teacher, Teacher, Coding RoboticsOrange, CaliforniaInspired by the groundbreaking work of Joyce Epstein, a renowned expert in family engagement, PEBSAF's comprehensive virtual parent workshops provide a wealth of resources and guidance on a wide range of topics, from effective communication strategies to homework support and navigating the school curriculum. Recognizing the profound impact of parental involvement in a child's educational journey, PEBSAF has made it its mission to bridge the gap between home and school, empowering parents with the knowledge and skills they need to actively support their children's learning.
Substitute Teacher, Teacher, Coding Teacher, Parent Instructor CbSubstitute Teacher, Teacher, Coding Teacher, Parent InstructorRiverside, CaliforniaInspired by the groundbreaking work of Joyce Epstein, a renowned expert in family engagement, PEBSAF's comprehensive virtual parent workshops provide a wealth of resources and guidance on a wide range of topics, from effective communication strategies to homework support and navigating the school curriculum. Recognizing the profound impact of parental involvement in a child's educational journey, PEBSAF has made it its mission to bridge the gap between home and school, empowering parents with the knowledge and skills they need to actively support their children's learning.
Healthcare Coding Compliance Auditor - RUHS County of Riverside, CaliforniaHealthcare Coding Compliance Auditor - RUHSRiverside, CA$105,597.80–$145,114.92 / yearExperience: Minimum of three years experience in an administrative or staff capacity which must have included at least two years of experience supervising professional and technical staff in two of the following areas: gathering and compiling facts and statistics to evaluate program effectiveness and recommend program revisions; preparing and maintaining a program budget or maintaining and controlling the fiscal record keeping functions and systems in a department, agency, division, unit or company; coordinating and conducting studies of administrative and operational activities including budget preparation and control, equipment usage, staff patterns, work flow and space utilization. How many years of experience do you have in an administrative or staff capacity SUPERVISING professional and technical staff in two of the following areas: gathering and compiling facts and statistics to evaluate program effectiveness and recommend program revisions; preparing and maintaining a program budget or maintaining and controlling the fiscal record keeping functions and systems in a department, agency, division, unit or company; coordinating and conducting studies of administrative and operational activities including budget preparation and control, equipment usage, staff patterns, work flow and space utilization?.
Healthcare Coding Compliance Auditor - RUHS County of RiversideHealthcare Coding Compliance Auditor - RUHSRiverside, CAFull timeExperience: Minimum of three years experience in an administrative or staff capacity which must have included at least two years of experience supervising professional and technical staff in two of the following areas: gathering and compiling facts and statistics to evaluate program effectiveness and recommend program revisions; preparing and maintaining a program budget or maintaining and controlling the fiscal record keeping functions and systems in a department, agency, division, unit or company; coordinating and conducting studies of administrative and operational activities including budget preparation and control, equipment usage, staff patterns, work flow and space utilization. This includes extensive expertise in inpatient and outpatient auditing (MS-DRGs, CC/MCC validation, POA indicators, PSI/HAC implications), managing external audits (RAC, MAC, OIG, UPIC, commercial payers), and strong knowledge of CMS IPPS/OPPS regulations, OIG Work Plan priorities, Medicare Conditions of Participation, Official Coding Guidelines, NCCI edits, and medical necessity rules.
IT Consultant IV, Solutions - SNOMED CT, Clinical Coding, Epic, EHR, Informatics Kaiser PermanenteIT Consultant IV, Solutions - SNOMED CT, Clinical Coding, Epic, EHR, InformaticsCorona, CAEssential Responsibilities: Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating and assigning resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks, as appropriate; and recognizing and capitalizing on improvement opportunities. Ability and/or having the capacity to learn -knowledge representation- logic to create, maintain subsets of clinical records to support reporting, business intelligence in the areas of best practice alerts, population and healthcare management, quality measurements, and health information exchanges.
Trainer-Coding & QA Loma Linda University Medical CenterTrainer-Coding & QASan Bernardino, CAKnowledge of a minimum of five of the following categories of coding required: Inpatient Medicare, Inpatient Non-Medicare, Outpatient Radiology including Interventional, Outpatient Satellite/Clinics, Outpatient Diagnostic, Outpatient Surgery, Emergency Department, observation, recurring, Inpatient Surgery. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
SPECIALIST II, CLINICAL CODING Pomona Valley Hospital Medical CenterSPECIALIST II, CLINICAL CODINGPomona, CA$39.89–$56.13 / hourPosition Summary:Responsible for the review and evaluation of the medical record in order to assign accurate diagnosis and procedural codes ensuring optimal reimbursement while remaining compliant with all regulatory agencies. As part of our ongoing effort to remain an employer of choice, eligible employees who work qualifying weekend shifts receive a competitive weekend rate.
Associate Project Manager Code -Existing Installation Schindler Holding LtdAssociate Project Manager Code -Existing InstallationIrvine, CA$90,300–$112,900 / yearYou will track and report on key performance indicators such as confirmation of periodic safety inspections, resolution of non-conformances, and adherence to regulatory deadlines, helping deliver safe, reliable, and compliant service to customers. Once sold, coordinate and schedule test dates with third parties (e.g., fire testing), schedule CAT1 inspections with mechanics, and/or arrange repairs while maintaining constant communication with Superintendents and sales reps.
NewCode Compliance Inspector I/II Flex City of CoronaCode Compliance Inspector I/II FlexCorona, CA$5,258–$7,062Eligible Opt-Out Arrangement: Upon providing reasonable evidence of alternative coverage as required by the Affordable Care Act (ACA)'s Eligible Opt-Out Arrangement rules (below), employees shall be entitled to the following dollars in the first two pay periods each month in taxable cash, in lieu of the amount provided in Section 10.2 above: (a) $300.00 ($600 per month) for Employee + 2 or more dependents. The Medical Allowance shall consist of the following: (1) the Base Contribution Rate, plus (2) an amount equal to the difference between the Base Contribution Rate and the following amounts, as applicable: $978.00 per month for Members electing Employee only coverage; $1,646.00 per month for Members electing Employee plus one dependent coverage; or.
NewG‑Code Lathe Manufacturing Technician (Live Tooling Preferred) Express Employment Professionals - CovinaG‑Code Lathe Manufacturing Technician (Live Tooling Preferred)Covina, CAFrom first article to final piece, you turn engineering intent into reality—writing and editing code, selecting tooling, setting offsets, and executing inspections that keep parts within spec. Through Express Employment Professionals in Covina, you’ll join a shop that counts on you to program, set up, operate, and fine‑tune CNC lathes to meet demanding quality targets.
Sleep Apnea Medical Biller Aava InternationalSleep Apnea Medical BillerIrvine, CAZapZzz is a specialized sleep apnea treatment program with a mission of improving patients’ overall health and quality of life by providing advanced, patient-centered solutions for sleep apnea. The Medical Biller will be responsible for accurately preparing, submitting, and managing insurance claims related to sleep apnea treatment and oral appliance therapy.
Medical Biller Family Health MattersMedical BillerAnaheim, CA$22–$25 / hourExperience with: o Medi -Cal PPS billing o T1015 encounter billing o Managed care wrap payments o Medicare FQHC billing o Safety -net population billing (preferred) Knowledge & Skills • Strong understanding of: o HRSA FQHC billing guidelines o PPS methodology o CPT, ICD -10, HCPCS coding o Revenue cycle management • Experience with EHR and practice management systems. • Ensure correct use of FQHC billing codes, including: o Revenue code 0521 o T1015 (FQHC encounter code) o Appropriate CPT/HCPCS codes • Verify encounters meet billable visit criteria under HRSA and Medi -Cal guidelines.
Sr. Medical Billing & Collections Specialist Leaps & Bounds Pediatric TherapySr. Medical Billing & Collections SpecialistNorco, CaliforniaBilling & Collections Specialist is responsible for ensuring accurate and timely billing, proactive collections, and consistent follow-up on outstanding accounts to support the financial health of the organization. In accordance with Company policy, perform timely and aggressive follow-up on outstanding claims, meticulously resolve denials by correcting errors, gathering necessary documentation, and resubmitting claims efficiently.
Hospital Billing Coordinator Deloitte Touche Tohmatsu LtdHospital Billing CoordinatorCA$50,000–$60,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Director of Charge Description Master (CDM) & Clinical Auditing - Patient Accounting & Billing Unit County of Riverside, CaliforniaDirector of Charge Description Master (CDM) & Clinical Auditing - Patient Accounting & Billing UnitRiverside, CA$102,746.17–$162,990.68 / yearTier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. Knowledge of: The principles of effective personnel management and supervision; principles and practices involved in patient access or revenue cycle activities, including knowledge of applicable health information systems; laws, rules, regulations, and policies affecting revenue cycle, charge master or patient access functions.
Government Audit Recovery Specialist IMCS Group IncGovernment Audit Recovery SpecialistCosta Mesa, CAAs an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. As an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits.
Director of Charge Description Master (CDM) & Clinical Auditing - Patient Accounting & Billing Unit County of RiversideDirector of Charge Description Master (CDM) & Clinical Auditing - Patient Accounting & Billing UnitRiverside, CAFull timeKnowledge of: The principles of effective personnel management and supervision; principles and practices involved in patient access or revenue cycle activities, including knowledge of applicable health information systems; laws, rules, regulations, and policies affecting revenue cycle, charge master or patient access functions. Additionally, the Director will collaborate with RUHS stakeholders to identify charge-related opportunities, evaluate current procedures, and assess internal controls to ensure charge master code compliance, charge accuracy, and improved charge capture.
Revenue Cycle Specialist SilveradoRevenue Cycle SpecialistIrvine, CaliforniaYou thrive in fast-paced environments, enjoy solving complex billing challenges, and bring precision and accountability to every step of the revenue cycle. Join Silverado Home Office, a memory care innovator ranked in the top 10 nationwide by Fortune Magazine Best Workplaces in Aging Services .
Government Audit Recovery Specialist ICONMA, LLCGovernment Audit Recovery SpecialistCosta Mesa, CA$27–$32 / hourResponsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits.
Hospital Billing Operator Deloitte Touche Tohmatsu LtdHospital Billing OperatorCA$70,000–$90,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
NewGovernment Audit Recovery Specialist - 6 TalentBurst, Inc.Government Audit Recovery Specialist - 6Costa Mesa, CA$25 / hourAs an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits.
Government Audit Recovery Specialist TalentBurst, Inc.Government Audit Recovery SpecialistCosta Mesa, CA$1,000 / weekAs an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits.
Government Audit Recovery Specialist Integrated Resources, IncGovernment Audit Recovery SpecialistCosta Mesa, CA$25–$28 / hourAs an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Client Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. Position Summary: The Government Recovery Specialist performs duties associated with Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program and other government regulatory and enforcement agency audits for documentation and billing compliance.
Prior Authorization Department One Stop Hospice IncPrior Authorization DepartmentSanta Ana, CAThis role works closely with physicians, clinical staff, insurance companies, and patients to ensure timely approvals and accurate documentation while maintaining compliance with payer guidelines and company policies. The Prior Authorization Specialist is responsible for obtaining insurance authorizations and approvals for medical services, treatments, medications, procedures, and equipment.
Medical Records Technician (Coder) US Department of Health and Human ServicesMedical Records Technician (Coder)CA$50,460–$72,644 / yearRequired as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements: Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only." Refer to BIA-4432 link: Verification of Indian Preference for Employment in the BIA and IHS When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference.
Senior Medical Assistant- Santa Ana CA UnitedHealth Group IncSenior Medical Assistant- Santa Ana CASanta Ana, CAAdministrative Duties Responsible for routine and basic front and back-office duties to include answering phones scheduling and confirming appointments preparing schedules data entry including referral contracts post appointment information prefill document retrieval filing performing data entry and assisting in the examination process of patients under the direction of a physician or other licensed provider. Direct individual patient care activities and coordination including interviewing patients measuring vital signs and records information on patients charts drawing and collecting blood samples from patients preparing specimens for laboratory analysis complete lab requisitions and conducting a variety of diagnostic tests.
Biller/Collector III HireTalentBiller/Collector IIIIrwindale, CAMaintains superior understanding of CPT/HCPCS codes, ICD-10 codes, CMS 1500 form guidelines, eligibility and coverage requirements, remit and remark codes, payor/plan codes, claims management, third-party payer guidelines, state and federal regulations, claims clearinghouse workflow, and all other pertinent functions of the job. % Assists staff in identifying high-risk accounts and prioritizing resolution efforts; Ensures staff is researching high dollar accounts, high volume denials, credits, adjustments, and undistributed balances, etc. in adherence to internal policies and procedures.
Government Audit Recovery Specialist Apidel TechnologiesGovernment Audit Recovery SpecialistCosta Mesa, CAContractorAs an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO) and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits. Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits.
NewDRG Clinical Validation Lead Elevance Health IncDRG Clinical Validation LeadCosta Mesa, CA$89,520–$161,136 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
NewCoordinator-Revenue Integrity Loma Linda University Medical CenterCoordinator-Revenue IntegritySan Bernardino, CAAble to distinguish colors and smells as necessary for patient care; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the workplace/patient care; see adequately to read computer screens, medical records, and written documents necessary to position; discern temperature variances through touch. Job Summary The Coordinator-Revenue Integrity is responsible for managing multiple billing work queues (WQs) which requires an understanding of not only basic billing processes but also knowledge of research billing requirements, Medicare rules and regulations, Recovery Audit Contractor (RAC) processes, and billable components pertinent to LLUH Client agreements.
Insurance Billing Clerk - Finance and Business County of RiversideInsurance Billing Clerk - Finance and BusinessRiverside, CAFull timeprocedures and methods; determine appropriate applications of various billing procedures; perform basic arithmetic computations rapidly and accurately and post the results on accounting records; organize work to meet prescribed deadlines; operate automated keyboard equipment; follow oral and written directions. Under supervision, the incumbent will be responsible for making follow-up calls checking on claim statuses and eligibility, and working on special projects ; performing fiscal clerical work processing and billing fiscal intermediaries for medical services rendered to patients; and to do other work as required.
DRG Coder Astrana Health, Inc.DRG CoderCA, CaliforniaRemote$33–$38 / hourIn 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. 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.
Certified Medical Records Coder-Inpatient (Riverside) County of Riverside, CaliforniaCertified Medical Records Coder-Inpatient (Riverside)Riverside, CA$70,044.85–$104,320.89 / yearAbility to: Utilize the ICD-CM classification system to code medical record entries either by use of coding books or encoder product; abstract pertinent information from medical records; follow oral and written instructions; operate PC with Windows software, coding software and abstract package; effectively communicate technical information to medical and administrative personnel; maintain effective working relationships with others. I understand that I must upload my current valid certification (Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA) or a Registered Health Information Technician (RHIT) issued by American Health Information Management Association, or Certified Professional Coder-Hospital (CPC-H) issued by the American Academy of Professional Coders) at time of application in order to be considered for an interview.
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.
NewCoder Auditor Prime Healthcare Management IncCoder AuditorOntario, California$28–$43.40 / hourFull timeThe Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International Classifications of Diseases, tenth revision (ICD-10/PCS), Current Procedural Terminology (CPT), and Health Care Procedure Coding System (HCPCS), are accurate and supported by the clinical documentation of the respective medial record. 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.
Sr Fraud, Waste and Abuse Investigator (Investigator Sr) CalOptimaSr Fraud, Waste and Abuse Investigator (Investigator Sr)Orange, CA$72,096–$115,353 / yearWe are hoping you will join us as a Sr Fraud, Waste and Abuse Investigator (Investigator Sr) and help shape the future of healthcare where you'll be an integral part of our OOC - Fraud & Waste team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Sr. Investigator, Fraud, Waste and Abuse CalOptimaSr. Investigator, Fraud, Waste and AbuseOrange, CA$72,096–$115,353 / yearInvestigator, Fraud, Waste and Abuse and help shape the future of healthcare where you'll be an integral part of our OOC - Fraud & Waste team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Bachelor's degree in health care administration, criminal justice or related field PLUS 5 years of experience in health care-related investigations required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Certified Medical Records Coder-Inpatient (Riverside) County of RiversideCertified Medical Records Coder-Inpatient (Riverside)Riverside, CAFull timeAbility to: Utilize the ICD-CM classification system to code medical record entries either by use of coding books or encoder product; abstract pertinent information from medical records; follow oral and written instructions; operate PC with Windows software, coding software and abstract package; effectively communicate technical information to medical and administrative personnel; maintain effective working relationships with others. License/Certificate: Possession of current valid certification as a Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA) or a Registered Health Information Technician (RHIT) issued by American Health Information Management Association, or Certified Professional Coder-Hospital (CPC-H) issued by the American Academy of Professional Coders.
Patient Care Coordinator Upperline Health IncPatient Care CoordinatorCAUpperline Health providers coordinate patients' care among a team of physician specialists, nurse practitioners, care navigators, nutritionists, social workers, and pharmacists for integrated treatment that addresses patients' immediate and long-term health needs. The Patient Care Coordinator will be responsible for medical front desk receptionist duties including greeting patients in a friendly manner, and ensuring patients are accurately checked in and prepared for their appointments in a timely manner.
Director II Eye Care Payer Strategy AbbVie IncDirector II Eye Care Payer StrategyIrvine, CAThis individual will effectively orchestrate communication and drive strategic alignment across multiple stakeholders and leadership teams such as the Market Access Leadership Team, multiple Brand Teams, Account Management teams, and across multiple HEOR, MOSL, Medical, Reimbursement Advisor Teams, MABI, Finance, Sales, and Government Affairs/Advocacy teams. Major responsibilities include (but are not limited to): Develop payer positioning and pricing strategies for multiple Eye Care brands with focus on device and medical reimbursement, across all payer channels, and for highly competitive inline and pipeline assets.
NewPharmacy Care Technician - Redlands, CA CVS Health CorpPharmacy Care Technician - Redlands, CARedlands, CAPharmacy Care Technicians assist with inbound phone calls; interact with customers and cross functional team to answer questions, solve problems, provide education, and maintain our company's reputation for high-quality service. In this role, you will assist in accurately reading, interpreting and entering prescriptions into the computer system including calculation of doses and assignment of directions and accepting proper insurance payment in a timely fashion.
Claims Adjudicator Sr Loma Linda University Medical CenterClaims Adjudicator SrRedlands, CAAble to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Knowledge and Skills: Extensive experience in health insurance claims processing, HMO claims or managed care environment is required, in-depth knowledge of medical billing and coding, knowledge of health insurance, HMO and managed care principles.