Medical Review Nurse II - SNF/MDS Auditor MachinifyMedical Review Nurse II - SNF/MDS AuditorCA$85,000–$100,000 / yearMust be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
Billing Operations Specialist PST Octave Health Group IncBilling Operations Specialist PSTCA$23.51–$25 / hourHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Octave's legal duty to furnish information. Efficiently utilizes multiple software systems to perform eligibility checks, generate superbills, process and post payments, submit insurance claims, respond to patient billing inquiries, and alert management of potential concerns.
Medical Records Universal Community Health CenterMedical RecordsLos Angeles, CAReporting to the Director of Operations, the coordinator will be responsible for accessing third-party portals, managing medical records email correspondence, updating electronic medical record (EMR) systems, scheduling appointments, coordinating pre-op clearances, and facilitating communication between patients, providers, and specialists. The Medical Records Care Coordinator plays a crucial role in ensuring the efficient management and accessibility of medical records essential for patient care and administrative processes.
NewSenior Professional Fee Medical Coder UCSF Medical CenterSenior Professional Fee Medical CoderCACertified Professional Coder (CPC), Certified Coding Specialist-Physician Based (CCS-P), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or licensure equivalent to be evaluated by FPRMO management. Stay current on upcoming coding audits, regulations, trends, OIG initiatives, and applicable carrier initiatives as they pertain to the subspecialties led by the coder to provide pertinent information and tools to the team, minimize risk, and enhance education efforts.
NewDirector, Safety Physician Summit Therapeutics IncDirector, Safety PhysicianCA$190,000–$237,000 / yearHARMONi: Phase 3 clinical study which was intended to evaluate ivonescimab combined with chemotherapy compared to placebo plus chemotherapy in patients with EGFR-mutated, locally advanced or metastatic non-squamous NSCLC who were previously treated with a 3rd generation EGFR TKI. Primary responsibilities include medical review of individual case safety reports (ICSRs), strategic input for adverse event monitoring and signal detection, ensuring global pharmacovigilance regulatory requirements are met, and safeguarding patients enrolled in our trials or administered our products.
Senior Specialist, Coding (Remote) Molina Healthcare IncSenior Specialist, Coding (Remote)CARemoteJob Description: The Senior Specialist, Coding Research supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and accuracy trends within assigned scope. This role partners with Health Plans, vendors, and internal stakeholders to support consistent application of coding guidelines, timely issue resolution, savings integrity, and accurate claim edit outcomes.
NewAdult Education Career Technical: Medical Office Assistant/Administrative Medical Assistant (MOA/AMA) Chaffey Joint Union High School DistrictAdult Education Career Technical: Medical Office Assistant/Administrative Medical Assistant (MOA/AMA)Ontario, CA$65.75–$68 / hourDEFINITION: The MOA/AMA Teacher provides career technical instruction preparing adult learners for entry-level employment in medical office and administrative healthcare support roles. Oduro@cjuhsd.net; Title IX Coordinator: Dr. Kern Oduro, Assistant Superintendent of Student Services, 211 W. 5th Street, Ontario, CA 91762, 909-988-8511, Kern.
Medical Claims Resolution Specialist Kinetic Personnel Group, Inc.Medical Claims Resolution SpecialistOrange, CA$25–$31 / hourA full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one! Job duties: Addresses provider inquiries, questions, and concerns in all areas including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.
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.
Coder II Apidel TechnologiesCoder IICosta 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. Utilization Management Process, Word, Comprehensive Error Rate Testing (Cert), Office Of Inspector General (Oig), Medicaid Audits, Medi-Cal Audits Outlook, Acute Care Experience, Government Audits, Coding, Medical Necessity Criteria, CMS Billing, payment methodologies, reimbursement methodologies, privacy regulations.
Jr. Quality Improvement Coder Astiva HealthJr. 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.
NewMedical Director - Orthopedic Surgeon - Remote From Anywhere UnitedHealth Group Inc.Medical Director - Orthopedic Surgeon - Remote From AnywhereLos Angeles, CARemote$248,500–$373,000 / yearWe are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
Online Visiting Professor Outpatient Coding DeVry University IncOnline Visiting Professor Outpatient CodingCA$1,500–$2,700 / weekFaculty must have a minimum of 5 years of working knowledge of healthcare operations related to the following areas: Faculty must have a minimum of five years of recent in-field outpatient coding experience. Uses appropriate technological options for online technologies and course-related software, including Websites, e-mail, and online discussions for preparing the course and making it accessible to students.
Auditor Technical Trainer POS Cotiviti Holdings Inc. (Inactive)Auditor Technical Trainer POSCARemote$105,000–$125,000 / yearAssess job-specific needs and develop technical training plans with clear business objectives, including working with subject matter experts, developing training materials, and developing appropriate assessments and measurements of success. The individual will work collaboratively with subject matter experts in the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction.
Optometric Technician (Pre-Testing and Front Office) Santa Fe Springs OptometryOptometric Technician (Pre-Testing and Front Office)Santa Fe Springs, CAFull timeWork-up patients prior to seeing doctor Includes autorefraction, lensometry, retinal photos (Optos), intraocualar pressure assessment (using iCare), visual acuities, case history, medical history and recording all above tests in patient's electronic medical record (average 10 patients per day). When not working directly with patients, your role will be to assist the front office with answering phones and emails to communicate with our patients, as well as assist with medical billing and processing orders for glasses and contact lenses.
DRG Clinical Validation Lead Elevance HealthDRG 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.
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.
Medical Billing / Frontdesk Kohan International FoundationMedical Billing / FrontdeskCULVER CITY, CAMedical Biller/Office Administrator (Full-Time, In-Person) We are a non-profit group therapy practice seeking a skilled and dedicated Medical Biller/Office Administrator to join our team immediately! Fluency in Tagalog/Filipino is A MUST to effectively serve our diverse clientele and team but not required.
NewSr Bill Review Analyst MedRisk LLCSr Bill Review AnalystCAJob Purpose: Under moderate supervision, this position is responsible for analyzing incoming medical bills for fee schedule or usual and customary application as well as PPO interface while meeting contractual client requirements. Strong knowledge of Medical Terminology and CPT / ICD-9 / ICD-10 coding - Knowledge of multi-state fee schedules preferred.
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.