Audit and Appeals Recovery Specialist - Medicaid/Medicare Iconma LLCAudit and Appeals Recovery Specialist - Medicaid/MedicareCosta 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. 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.
NewMedical Records Specialist & Audit Clerk Infusion for HealthMedical Records Specialist & Audit ClerkCAThis role responds to payer audits with the correct medical records and supporting documentation including verifying coding and billing accuracy to support reimbursement requirements. Ensure timely retrieval and submission of medical records to patients, providers, attorneys, government agencies, insurance companies, and payers.
Documentation Integrity Specialist IV, Clinical Licensure-Risk Adjustment-RN Kaiser PermanenteDocumentation Integrity Specialist IV, Clinical Licensure-Risk Adjustment-RNPasadena, CAWorks on clinical documentation reviews by: reviewing a moderate caseload of medical/health records to promote accuracy and completeness of clinical documentation; reviewing results of a moderate to large caseload of medical record reviews and working alongside others to rectify identified omissions or contradictions in medical records; completing medical codes and diagnostics-related groups (DRGs) to facilitate the accurate capture of diagnoses in collaboration with senior team members and leadership; contributing to the identification of medical conditions that impact the severity of illness (SOI) and risk of mortality (ROM) indicators; and monitoring the documentation clarification queries to support efficient resolution of open queries. Integrates processes to improve clinical documentation by: supporting reviews of clinical documentation improvement/integrity (CDI) programs and integrating processes to improve the accuracy and completeness of clinical documentation and documentation issue resolution; determining areas to improve clinical review and documentation processes; and collaborating with team members to identify and implement documentation improvement initiatives.
Sr. Coordinator, Individualized Care (Case Manager) Cardinal Health IncSr. Coordinator, Individualized Care (Case Manager)CA$21.40–$30.60 / hourDelivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, and support organizations to facilitate coverage and delivery of product in a timely manner.
Sr. Coordinator, Individualized Care Cardinal Health IncSr. Coordinator, Individualized CareCA$21.40–$30.60 / hourDelivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, and support organizations to facilitate coverage and delivery of product in a timely manner.
SIU Investigator Centene Corporation GroupSIU InvestigatorCA$56,200–$101,000 / yearLicenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.
NewCase Manager, West Coast Alnylam Pharmaceuticals IncCase Manager, West CoastCA$85,500–$115,600 / yearThanks to the commitment of every employee globally, Alnylam is proud to have been recognized as one of Fast Company's 2021 Best Workplaces for Innovators, a Science Magazine Top Employer three years in a row (2019-2021), a Boston Globe Top Places to Work seven years in a row (2015-2021), a Great Place to Work in Asia, Japan, Brazil, the U.K., Germany, Spain, Netherlands, Italy, France and Switzerland, Seramount's 100 Best Companies (formerly Working Mother 100 Best Companies) and Best Companies for Dads, Bloomberg's Gender Equality Index two years in a row (2021-2022), among others. Long focused on rare and genetic diseases, our scientific advances are now allowing us to bring the power of RNAi therapeutics to more prevalent diseases and as a result, we are beginning to recognize the full potential of this new class of medicines.
Nurse Practitioner Circadia HealthNurse PractitionerLos Angeles, CaliforniaFull-scope E&M visits: Conduct comprehensive assessments, initiate or adjust plans of care, place orders, reconcile medications, and document medical necessity — 30+ visits per day across new admissions, Circadia-flagged patients, COC escalations, and programmatic rounds. Quality & continuous improvement: Participate in monthly internal chart audits, track facility-level KPIs (readmissions, fall rates, COC response times), and surface field insights to clinical ops and product teams.
Clinical Documentation Integrity Specialist- Onsite, Los Angeles UnitedHealth Group IncClinical Documentation Integrity Specialist- Onsite, Los AngelesLos Angeles, CA$72,800–$130,000 / yearPrimary 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. The Clinical Document Integrity Specialist - (CDIS) is responsible for providing CDI program oversight and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients' patients.
NewPhysical Therapist Progressive Physical TherapyPhysical TherapistTarzana, CaliforniaFull timeAbout: Compensation: $90,000 - $115,000/year + daily productivity incentives, $5K sign on bonus, $25K in student loan reimbursement, with additional compensation opportunities for certifications. If so, then Progressive Physical Therapy in Tarzana, CA is looking for a driven and compassionate Physical Therapist (PT) to join our close-knit, outpatient orthopedic team.
NewPhysical Therapist - Outpatient - Full-Time Progressive Physical TherapyPhysical Therapist - Outpatient - Full-TimeChatsworth, CaliforniaFull timeAbout: Compensation: $90,000 - $110,000/year + daily productivity incentives, $5K sign on bonus, $25K in student loan reimbursement, with additional compensation opportunities for certifications. If so, then Progressive Physical Therapy in Chatsworth, CA is looking for a driven and compassionate Physical Therapist (PT) to join our close-knit, outpatient orthopedic team.
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.
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.
Director - Clinical Research Billing (Remote - CA) Stanford Health CareDirector - Clinical Research Billing (Remote - CA)CARemote$94.35–$125.03 / hourThe Director of Clinical Research Billing will collaborate and have direct interaction with a broad set of stakeholders across the institution, including Principal Investigators, study sponsors, study teams, finance/accounting, revenue cycle, internal audit, compliance, business office leaders, and clinic operational teams. Responsible for overseeing revenue cycle post-award activities, such as research charge review, patient care billing for all clinical trials, reviewing trends in revenue capture and reimbursement, and forecasting financial impacts pertaining to clinical research activities.
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.
Chart Auditor - Glendale Adventist HealthChart Auditor - GlendaleGlendale, CAWe are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley. Essential Functions: Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials.
Emergency Department ChargerCoder UCLA Health SystemEmergency Department ChargerCoderLos Angeles, CA$40.04–$52.83 / hourAs a condition of employment, the final candidate who accepts an 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; or have filed an appeal of a finding of substantiated misconduct with a previous employer. You will assign ICD-10-CM and CPT/HCPCS codes for emergency department patients while ensuring accurate charge assignments using ASAP software within EPIC (CareConnect).
Collector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern CaliforniaCollector, Management Services Organization/Centralized Billing Office - CBO - Full Time 8 Hour Days (Non-Exempt) (Non-Union)Pasadena, CA$26–$41.28 / hourResponsible for ensuring timely filing and guidelines are met; provided quality control checks on paper and electronic claims; process tracers, denial and related correspondence; initiate appeals; compose and submit appeal letters specific challengeable denial issues consistent with the most update American Medical Association Current Procedural Terminology. System Folder Notes / Account Documentation Documents claim bill date, billed amounts, billing address, billing attachments, invoice number, expected payment, contractual amount, received payments, actual transplant date(s), type of transplant, pre and post periods for transplant days, and all pertinent billing data relevant to billing the claim.
Clinical Data AMS Sr. Consultant Deloitte Touche Tohmatsu LtdClinical Data AMS Sr. ConsultantCosta Mesa, CA$120,200–$140,000 / yearThis role owns the health, stability, and compliance posture of a suite of clinical and regulatory R&D platforms - including Axway Secure Transport (ST), eClinical Elluminate, Eclipse (medical coding), and EAST - across the full engagement lifecycle: implementation, configuration, validation, and steady-state managed services. The team operates at the intersection of IT infrastructure, clinical operations, and quality/regulatory compliance, partnering closely with global business and technology stakeholders to support end-to-end clinical trial data lifecycles from data capture and coding through statistical analysis and submission-ready outputs.
Profee Audit Specialist - Remote - FT Datavant LLCProfee Audit Specialist - Remote - FTCARemote$35–$45 / hourWhat We're Looking For: As a Profee Auditing & Education Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.