Trabajos medical coder en Universal City, CaliforniaCrear alertas

Job DescriptionMISSION, VISION, AND VALUES Our mission is to provide quality, comprehensive healthcare and supportive services to our community. Our vision is “Improving the Health and Well-Being of Our Community.” Our core values are Integrity, Compassion, and Excellence. Employees are expected to demonstrate a strong commitment to the mission, policies, goals, and philosophy of Harbor Community Health Centers. JOB SUMMARY Reporting to the Revenue Cycle Manager (RCM), the Medical Biller II independently performs billing, claims submission, payment posting, denial resolution, accounts receivable follow-up, and account reconciliation activities for HarborCHC’s primary care, pediatric, behavioral health, and dental services. This position works collaboratively with providers, Patient Experience staff, and other departments to support accurate and timely reimbursement, resolve complex billing issues, and identify opportunities for revenue cycle process improvement. ESSENTIAL DUTIES & RESPONSIBILITIES Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. An individual must be able to perform each essential duty satisfactorily to be successful in this role. The requirements below represent the knowledge, skills, and abilities needed for the position. Insurance Verification and Claim Scrubbing: • Reviews insurance information, financial classification, and eligibility for all claims prior to submission., • Applies payer-specific billing requirements, including Medi-Cal, Newborn Gateway, CPE, PE4PP, Medicare, commercial insurance plans, and applicable dental programs., • Applies Sliding Fee Discount Program requirements, documents discrepancies, and reviews findings with the RCM to support corrective action and process improvement., • Ensures that all conditions for claim submission have been satisfied, including but not limited to accurate charges and financial class, authorization/certification information, and demographic and insurance information. Claims Submissions • Ensures complete filing and follow-up of encounter data submissions to health plans, IPAs, and other payers, including secondary and crossover billing., • Submits claims electronically or via applicable paper claim forms, including CMS-1500 and UB-04, as applicable, to payers in a timely manner. Communication: • Monitors, tracks, and communicates with providers to ensure progress notes are closed in a timely manner., • Responds professionally to billing inquiries from patients, payers, providers, and staff., • Tracks discrepancies in front office operations and provides feedback and recommendations for process improvements based on findings. Patient Statements & Collections: • Thoroughly analyzes patient accounts to ensure patient balances are accurate., • Generates and submits patient statements monthly., • Reconciles and audits patient payment activity and identifies and reports discrepancies in accordance with established cash-handling and reconciliation procedures. Payment Posting and A/R Reconciliation • Posts and reconciles payments, contractual adjustments, denials, and other account activity accurately and timely., • Reviews outstanding accounts receivable and performs appropriate payer follow-up to facilitate timely resolution and reimbursement., • Identifies payment discrepancies, underpayments, and unresolved account balances and takes appropriate follow-up action. Denials & Follow-Up • Reviews and resolves claim denials and rejections, determines appropriate corrective action, and completes timely follow-up through resolution., • Reviews EOBs and other payer correspondence to identify denial and payment issues; submits corrected claims, reconsiderations, or appeals as appropriate; and identifies recurring denial trends for communication to the RCM. Collaboration and Compliance • Ensures compliance with HIPAA and payer-specific guidelines., • Assists with month-end billing close activities within 10 business days following month-end., • Participates in training and professional development opportunities to maintain up-to-date knowledge., • Works closely with Front Office staff (Patient Experience Specialists) on various projects., • Performs other duties as assigned. QUALIFICATIONS Experience: • Must have at least 2–3 years of direct medical billing experience (FQHC experience strongly preferred)., • Experience with an electronic health record (EHR) system required; eClinicalWorks experience preferred. Skills and Attributes: • Reviews claims to verify that applicable ICD-10 and CPT/HCPCS codes are present prior to submission; does not assign, select, or determine diagnosis or procedure codes. Maintains working knowledge of Medi-Cal, Medicare, managed care, commercial insurance, and FQHC billing requirements., • Must be bilingual and fluent in English and Spanish., • Must demonstrate good attendance and punctuality and complete all assignments in a timely manner., • Must have proficient computer skills, including Microsoft Office, with intermediate Excel skills., • Must demonstrate a high level of accuracy and possess strong analytical, problem-solving, time-management, and organizational skills., • Ability to adapt to changes in the clinic setting and insurance payer requirements., • Communicates effectively with providers, staff, and outside vendors., • Works collaboratively in a team environment, demonstrates strong written communication skills, and prioritizes work effectively., • Must maintain confidentiality and handle sensitive information with discretion., • Must demonstrate willingness and ability to adapt to change, including advances in technology. Education and Preferred Credentials: • High school diploma or GED required., • Certified Professional Coder and/or Certified Professional Biller preferred. EXPECTATIONS • Adheres to all HarborCHC policies, procedures, and applicable organizational standards., • Demonstrates HarborCHC's core values of Integrity, Compassion, and Excellence and maintains a strong commitment to HarborCHC's mission and goals., • Maintains a positive, professional, and respectful approach in all work-related interactions., • Communicates regularly and effectively with their immediate supervisor regarding departmental and organizational matters., • Maintains regular and reliable attendance and reports to work prepared to perform the duties of the position., • Meets established productivity, quality, and timeliness expectations and performs duties as workload requires., • Maintains strict confidentiality and handles sensitive information with discretion., • Demonstrates accountability and professionalism in carrying out assigned duties and responsibilities., • Responds to work-related communications, including phone calls and emails, in a timely and professional manner.PHYSICAL REQUIREMENTS The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of the position. While performing the duties of this job, the employee is regularly required to sit for extended periods; use a computer, keyboard, mouse, telephone, and other standard office equipment; and communicate effectively with others. The employee may occasionally be required to stand, walk, reach, bend, and lift or move items weighing up to 25 pounds. The position requires the visual ability necessary to perform computer-based work and review electronic and written information. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. HOURS OF OPERATIONS HarborCHC's hours of operation are • Monday–Thursday: 7:00 a.m.–7:00 p.m., • Friday & Saturday: 8:00 a.m.–5:00 p.m. Employee work schedules may vary based on departmental and operational needs. HR PROCEDURAL REQUIREMENTS • Must be legally authorized to work in the United States, • Must successfully complete post-offer background screening and verification requirements, • This job description is not intended to be all-inclusive; additional duties may be assignedEQUAL EMPLOYMENT OPPORTUNITY STATEMENT HarborCHC is an equal opportunity employer and is committed to providing employment opportunities without discrimination on the basis of race, color, religion, sex, gender, gender identity, gender expression, pregnancy, childbirth, breastfeeding or related medical conditions, sexual orientation, national origin, ancestry, age, physical or mental disability, medical condition, genetic information or characteristics, marital status, registered domestic partner status, reproductive health decision-making, military or veteran status, or any other characteristic protected by applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including recruitment, hiring, placement, promotion, compensation, training, transfer, leaves of absence, discipline, termination, layoff, and recall. DISCLAIMER The above statements describe the general responsibilities and requirements of this position and are not intended to be an exhaustive list of all duties, responsibilities, or requirements. HarborCHC reserves the right to assign additional duties and modify job responsibilities based on operational needs. Employment with HarborCHC is at will. HarborCHC may change an employee's duties, compensation, hours, or other terms and conditions of employment, or transfer, reassign, promote, demote, or suspend an employee, with or without cause or prior notice, subject to applicable law. Nothing in this job description alters the at-will employment relationship. Monday–Thursday: 7:00 a.m.–7:00 p.m. Friday & Saturday: 8:00 a.m.–5:00 p.m. Employee work schedules may vary based on departmental and operational needs. Compensation details: 25-28 Hourly Wage PI1de00fb595e0-25405-41717038

Job Category: Administrative, HR, Business Professionals Department: Special Investigations Unit Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Special Investigation Unit (SIU) Investigative Analyst III is responsible for overseeing the initial intake and regulatory reporting of all source investigative leads. The SIU Analyst III triages all investigative leads including hotline complaints, e-mail reports, referrals from the Credentialing Department, referrals from Law Enforcement and referrals from Federal and State regulatory agencies. This includes review of the investigative lead and entering the complaint information into the Health Care Fraud Shield (HCFS) case management data system and the preparation of the Federal and State regulatory reports. This position ensures that these regulatory reports are submitted onetime, within the 10-day reporting period. The SIU Analyst III serves as the point of contact with the Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS). This position takes the lead in developing the reporting functions of HCFS and maintains regular contact with HCFS on issues relating to the development and reconstruction of the HCFS reporting system. This position also is responsible for analyzing all new case leads to determine if Planned Partners (PPs) or Professional Provider Groups (PPGs) require notification. If the PP/PPGs have an investigative jurisdiction, the SIU Analyst III ensures the proper CMS and DHCS reports are sent to the agencies in a timely manner. The SIU Investigative Analyst III oversees data analysis in support of ongoing Investigative matters and assists SIU Investigators in the development of reporting for complex health care fraud investigations. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Oversees the initial intake, triage and regulatory reporting of all investigative leads including hotline complaints, e-mail reports, referrals from the Credentialing Department, referrals from Law Enforcement and referrals from Federal and State regulatory agencies. Ensures Federal and State regulatory reports (CMS and DHCS) are submitted onetime, within the 10-day reporting period. Serves as a Subject Matter Expert (SME) on the HCFS Data system and is the point of contact to HCFS on matters of system updates regarding the development and updates of the HCFS reporting system. Evaluates investigative leads and determines if the need exists to distribute these leads to PP or PPGs. Uses knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability, reimbursement methodologies, and relevant laws to find suspicious patterns in claims data, provider enrollment data, and other sources. Prepares clear and concise investigative reports to support analytical findings, recommendations, and actions. As a Subject Matter Expert, develops and conducts training on unit processes, for lower-tiered positions. Performs other duties as assigned. Duties Continued Education Required Associate's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Bachelor's Degree Experience Required: Minimum of 4 years of experience in healthcare fraud investigation/ detection. Preferred: Experience in CA Medi-Cal/ Medicare/ Medicaid Services Payment Services. Skills Required: Strong project leadership skills; ability to prioritize, plan and handle multiple tasks/demands simultaneously. Ability to support heavy workload volume and meet critical regulatory guidelines. Understanding of Federal and State healthcare fraud regulatory reporting requirements. Strong understanding of HCFS and HPMS. Understanding of healthcare operational systems and processes. Strong understanding of Accurint, MS Excel, Word, PowerPoint, SharePoint. Ability to navigate and master L.A. Care proprietary software programs. Excellent verbal and written communication skills. Strong knowledge of standard industry coding guides such as CPT, HCPCS, ICD-10 CMS 1500 and UB04 data elements. Knowledge of the Healthcare Fraud Shield Case Management system. Knowledge of state and federal laws and ability to interpret and take action on the aspects of such laws that impact the business. Licenses/Certifications Required Licenses/Certifications Preferred Certified Medical Coder Accredited Health Care Fraud Investigator (AHFI) Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)

In/Outpatient Remote Medical Coders. The Medical Coder is expected to do the following:. Knowledge and understanding of medical clinics and clinical documentation.

Meet productivity and quality standards. Experience: Minimum 3 years of Profee Coding to include proficiency in Internal Medicine coding. Ability to maintain required CPH (charts per hour) and accuracy standards.

BerryDunn is seeking a Medicaid Program Integrity Analyst to support Hawai?i Med-QUEST's (MQD) Third Party Liability (TPL) Unit and Program Integrity activities. This role will support Medicaid program integrity activities related to fraud, waste, and abuse prevention; provider oversight; compliance monitoring; risk assessment; external audit coordination; recovery efforts; and Medicaid medical, dental, behavioral health, and pharmacy claims audits. In this role, the Medicaid Program Integrity Specialist will work closely with Program Integrity staff, TPL experts, forensic specialists, data analysts, compliance SMEs, integrated IT, operations, and policy workstream members, vendor partners, and project leadership to translate Medicaid policy, program needs, claims analytics, and audit findings into practical monitoring approaches, review priorities, system requirements, change requests, operational recommendations, corrective action supports, and process improvement considerations. This individual will support dashboards, reporting, documentation quality, issue escalation, knowledge transfer, quality assurance, and ongoing improvement of payment integrity activities. Work location: This position offers flexibility in work location, including fully onsite, hybrid, or remote arrangements. The preferred location is Kapolei, Hawai?i, or the U.S. West Coast. Regardless of location, the role requires availability during Hawaii Standard Time (HST) working hours. Travel expectations: This role requires travel approximately 30%50% of the time, including travel to Hawai?i for onsite client meetings, release activities, training support, go-live readiness, payment integrity workgroup sessions, and related project needs. • Support development of recommendations for cost avoidance, recovery, improved program controls, policy clarification, process improvement, system edits, vendor follow-up, and corrective action planning based on claims analytics and program integrity findings., • Research, interpret, and apply Medicaid payment policy, program integrity requirements, audit findings, federal and state requirements, managed care contract expectations, provider billing guidance, and operational procedures to support defensible review conclusions and recommendations., • Document and report claims audit findings, payment integrity observations, risk indicators, analytical results, and recommended actions clearly and consistently for management, client stakeholders, vendors, and project leadership., • Support training, technical assistance, workgroup facilitation, release readiness, go-live support, and knowledge transfer related to payment integrity analytics, review processes, dashboard use, documentation expectations, and follow-up procedures., • Provide quality assurance reviews of work completed by peers, including claims audit documentation, analytical findings, review protocols, reports, corrective action supports, and client-facing deliverables., • Use Jira, SharePoint, meeting notes, decision logs, action item trackers, dashboards, and reporting tools to support transparent issue tracking, documentation, coordination, and follow-through across our workstreams., • Support onsite planning, release activities, operational readiness, and related project needs in coordination with project leadership and workstream leads. Use the following key tools and systems: • Microsoft Excel, and analytics and dashboarding tools for claims analysis, payment integrity monitoring, validation, visualization, and reporting., • Jira for action items, risks, blockers, dependencies, audit follow-up, corrective action tracking, dashboard visibility, release readiness, and project coordination., • SharePoint for project documentation, report templates, payment integrity methodology, review protocols, version control, quality review, training materials, and knowledge management., • Microsoft Teams and Outlook for meeting coordination, stakeholder communication, workgroup facilitation, audit follow-up, training support, and client/vendor collaboration, • Strong leadership, communication, facilitation, organization, and attention to detail., • Knowledge of Medicaid program integrity, fraud, waste, and abuse prevention, provider oversight, claims review, audit support, compliance monitoring, or related public sector healthcare operations., • Knowledge of quality assurance/control procedures, corrective action tracking, and proactive problem management., • Demonstrated ability to work effectively in a team setting and coordinate across multiple stakeholders, including clients, vendors, project leadership, and internal teams., • Experience coordinating recurring meetings, documenting follow-up items, maintaining workstream alignment, and supporting escalation pathways., • Strong experience with Microsoft applications and artificial intelligence tools., • Bachelor's degree preferred; applicable experience may be considered in lieu of degree requirements., • Experience using Jira, SharePoint, Microsoft Teams, Outlook, Excel, Power BI, Tableau, SQL, or comparable tools to manage action items, documentation, reporting, follow-up, and project coordination., • Minimum three (3) years of experience in a comparable analytics, payment integrity, program integrity, claims audit, Medicaid operations, healthcare compliance, or consulting role preferred. Preferred Qualifications: • Prior consulting experience in a national or regional consulting firm, health plan, Medicaid agency, program integrity unit, or public sector health and human services environment., • Experience with government agencies, Medicaid program integrity units, fraud risk assessments, internal audits, external audits, claims audit reviews, quality assurance, corrective action planning, or improper payment prevention efforts., • Bachelor's Degree (BA/BS)may substitute four years of applicable experience for the degree., • Preference may be given to candidates with certifications such as Certified Professional Coder, Certified Fraud Examiner, Certified Professional Medical Auditor, Certified Internal Auditor, or equivalent credentials. The base salary range targeted for this role is $95,000-$120,000. This salary range represents BerryDunn's good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations. Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what's expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn. We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact careers@berrydunn.com to request an accommodation. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. About BerryDunn BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm's tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm. BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. The firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com.

Job DescriptionDescription: GeBBS Healthcare Solutions is a leader in Health Information Management (HIM) and Revenue Cycle Management (RCM). We are committed to fostering a culture of excellence, integrity, and collaboration within the healthcare industry. We are building a talent pool of credentialed Outpatient Facility Coding Specialists for upcoming and future opportunities. While we may not have an immediate opening, we regularly partner with large health systems and Level I Trauma facilities and anticipate continued growth in this space. If you have strong outpatient facility coding experience and are interested in being considered for future roles, we encourage you to apply. Position Overview As an Outpatient Facility Coding Specialist, you would be responsible for coding diseases, operations, and procedures for outpatient encounters in accordance with ICD-10-CM, UHDDS, and AMA CPT-4 standards. Opportunities may support large, complex health systems, including Level I Trauma facilities. Potential Responsibilities • Code outpatient procedures according to client-specific guidelines, • Abstract patient data with accuracy and compliance, • Stay current on coding policies and regulatory updates, • Utilize healthcare abstracting software and ICD-10 data sets, • Initiate physician queries per client protocols, • Communicate regulatory or compliance changes to leadershipRequirements: Preferred Qualifications • Credentialed medical coder with 3+ years of experience, • AHIMA credential preferred; AAPC credentials considered, • Experience in facility OP & ED coding within large Level I Trauma facilities (SDS, OBS, ED; IR/Cath preferred), • Strong attention to detail and commitment to accuracy, • US-based candidates Additional Information By applying to this talent pool, you will be considered as upcoming opportunities become available that align with your skills and experience. We look forward to connecting with experienced outpatient facility coders who are interested in growing with GeBBS Healthcare Solutions.

Job DescriptionDescription: Inpatient Facility Coder – Future Opportunities (Talent Pool) Remote GeBBS Healthcare Solutions, an industry leader in Health Information Management (HIM) and Revenue Cycle Management (RCM) solutions, is building a talent pool of highly motivated Inpatient Facility Coders for future, upcoming opportunities. This posting is to connect with experienced coding professionals who have a passion for excellence and collaboration and would like to be considered as new projects and roles become available. These future roles are anticipated to be full and part-time, remote W-2 positions with flexible schedules. In upcoming opportunities, coders may be responsible for medical coding for one of our facility clients, including reviewing charts, assigning appropriate diagnosis and procedure codes, and ensuring high-quality standards are consistently met. The Inpatient Coder typically assigns diagnostic and procedural codes to patient charts using ICD-10-CM, ICD-10-PCS, or other designated coding classification systems in accordance with coding rules and regulations, and abstracts required clinical information. Requirements: Typical Requirements for Future Roles • RHIA, RHIT, or CCS certification through AHIMA required, • Minimum of 3 years of recent inpatient facility coding experience, • Ability to maintain standard industry productivity rates for inpatient coding, • Demonstrated ability to maintain high quality standards of 95% or greater, • Proficient with technology (computer, VPN, MS Office, coding software), • Strong verbal and written communication skills, • Must have ICD-10 coding experience and have completed an ICD-10 course, • Experience with trauma and highly complex cases preferred Why Join Our Talent Pool? By applying, you’ll be considered for future inpatient coding opportunities with GeBBS as new client needs and projects arise. Our recruiting team may reach out to discuss upcoming roles that align with your background and interests.

Job DescriptionJob Title: Medical Coder Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Coders to contribute their healthcare coding expertise to an innovative project focused on improving next-generation AI systems. In this role, you will review and annotate medical records, evaluate coding accuracy, and provide expert feedback to support the development of high-quality medical datasets. No prior AI experience is required—your coding expertise and attention to detail are what matter most. Key Responsibilities Review and annotate medical records to accurately assign ICD-10 and CPT codes based on clinical documentation. Apply Evaluation & Management (E&M) guidelines to assess coding levels and validate healthcare datasets. Ensure compliance with current medical coding standards and guidelines. Analyze clinical documentation and identify coding-related ambiguities or inconsistencies. Provide expert feedback on coding guidelines, edge cases, and documentation scenarios. Collaborate with project teams through written and verbal communication to improve AI training data quality. Required Skills Medical Coding ICD-10 CPT CPC Certification Evaluation & Management (E&M) Clinical Documentation Review Coding Accuracy & Compliance Attention to Detail Written & Verbal Communication Preferred Qualifications Active AAPC Certified Professional Coder (CPC) certification required. Strong knowledge of ICD-10, CPT coding systems, and E&M leveling guidelines. Experience working with diverse clinical documentation types. Ability to interpret complex medical records and apply appropriate coding standards. Strong written and verbal communication skills. Familiarity with digital annotation tools or healthcare data projects is a plus. Commitment to accuracy, quality, and continuous learning in healthcare coding and technology

Job Description Primary Purpose of the Position: The Revenue Cycle Medical Coder II is responsible for assigning diagnosis, procedural, and modifier(s) codes for medical billing purposes which includes verification of charge capture. Position also performs a wide variety of duties, which may include coding accuracy and completeness prior to tickets being processed for billing, insurance filing, and revenue reporting. Monitors daily flow of charge tickets to ensure claim accuracy. This is not a Remote position as you will be expected to come into the Los Angeles Office. Essential Duties of the Position May Include The Following: • Reviews charge tickets, identifies and corrects errors, prepares tickets for review, including proper CPT and ICD-10 codes and proper linkage between the two., • Abstracts all surgical and designated diagnostic procedures and assigns appropriate procedure codes and modifiers using the International Classification of Diseases (ICD-10) system, and the Physicians’ Current Procedural Terminology (CPT-4)., • Reviews and maintains Athena worklist claims on a daily basis., • Consistently meets and exceeds daily productivity and quality standards., • Effectively works on complex and escalated cases., • Cross-trained; i.e coding different specialties., • Reviews scanned paper charge tickets for accuracy and completeness of codes., • Maintains and expands knowledge of Anatomy and Physiology, Pathophysiology, Pharmacology, and Medical Terminology as basic building blocks for ICD-10-CM coding., • Compiles, reviews and performs data reports and other duties assigned by Management., • Identifies trends and communicates to the management team with findings., • Works and collaborates closely with Revenue Cycle Team Members, Clinician, Physician, Division Leadership and Management., • Keeps current of coding requirements by reviewing payer guidelines and regulations., • Maintains a log of coding errors and omissions for review with the management team., • Stays current on coding and compliance regulatory requirements through professional membership literature, continuing education classes, support and networking groups., • Maintains current knowledge of regulatory requirements by CMS NCCI and MUE edits, Medi-Cal/CCS policies, and certain Medicare requirements., • Attends various meetings and professional development programs on a regular basis; makes recommendations for revisions and/or new departmental procedures under the direction of management., • Maintains audit record systems for radiology department., • Performs other related duties as assigned by Management. Job Qualifications: Knowledge and skill: • Coding Certification, CPC from AAPC or CCS from AHIMA, • At least five (5) years of medical coding experience preferred., • Orthopedic Surgical Coding required, • Ability to communicate in both written and verbal formats with internal and external stakeholders., • Ability to handle multiple tasks., • Knowledge of medical terminology, CPT and ICD-10 coding, CMS NCCI and MUE edits., • Familiarity with payer billing and reimbursement guidelines and regulations, including the ability read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD)., • Ability to meet deadlines and to follow assignments through to completion., • Ability to organize and manage time effectively., • Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA and PHI guidelines., • Ability to work independently and as a part of a larger team., • Microsoft Word, Outlook and Excel knowledge preferred., • Ability to prepare, file and maintain patient records, file reports, and other correspondence.\nCompany Description Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles. Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.

Job Description MAJOR RESPONSIBILITIES/ESSENTIAL FUNCTIONS The Revenue Integrity Analyst is responsible for supporting the hospital’s revenue cycle by ensuring accurate charge capture, compliant billing practices, and optimal reimbursement. This role analyzes clinical and financial data to identify revenue leakage, resolve billing discrepancies, and ensure adherence to regulatory and payer requirements within an acute care hospital environment. The analyst collaborates with clinical departments, coding, patient financial services, and compliance teams to maintain revenue integrity across all service lines. Key Responsibilities: • Monitor and analyze charge capture processes to identify missing, incorrect, or duplicate charges., • Conduct revenue integrity audits across hospital departments including inpatient, outpatient, and ancillary services., • Collaborate with coding, HIM, and patient financial services teams to ensure accurate coding and billing compliance., • Analyze payer policies and regulatory requirements to ensure compliance with federal and state guidelines., • Participate in process improvement initiatives to enhance revenue cycle efficiency and reduce revenue leakage, • Provide education and guidance to clinical and operational staff regarding proper charge capture and documentation., • CDM maintenance and governance, including adding, revising, and retiring charge codes, • Charge capture review and reconciliation to ensure services are billed appropriately, • Compliance monitoring related to CPT/HCPCS coding, payer guidelines, and regulatory requirements, • Pricing validation and updates within the Charge Description Master, • Coordination with departments to ensure accurate charge mapping and revenue capture, • Charge audits and variance analysis to identify revenue leakage or compliance risks, • Strong knowledge of medical terminology, coding guidelines, NCCI edits, and billing regulations., • Strong communication and interpersonal skills, with the ability to work collaboratively with clinical and administrative staff., • Ability to prioritize tasks and manage time effectively in a fast-paced environment., • Performs other job related duties as assigned. JOB QUALIFICATIONS Minimum Education (Indicate minimum education or degree required.) • Bachelor’s Degree in Healthcare Administration, Health Information Management, Finance, Business Administration, or a related field Preferred Education (Indicate preferred education or degree required.) • Master’s degree in Healthcare Administration, Business Administration, or related field Required work Experience and Qualification (Indicate minimum years of job experience, skills or abilities required for the job.) • Strong understanding of hospital revenue cycle operations including charge capture, coding, billing, and reimbursement., • Knowledge of Medicare, Medicaid, and commercial payer regulations, • Experience with electronic health records (EHR) and hospital billing systems, • Advanced analytical and problem-solving skills, • Strong proficiency in Microsoft Excel and data analysis tools, • Ability to interpret financial, clinical, and operational dataPossess excellent written/verbal communication skills in addition to the ability to work with minimal supervision Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.) • Proven experience in charge capture, medical billing, or a similar role within a hospital setting 3-5 years' experience.Certified Revenue Integrity Professional (CRIP), • Certified Coding Specialist (CCS), • Certified Professional Coder (CPC), • Certified Healthcare Financial Professional (CHFP) Required Licensure, Certification, Registration or Designation (List any licensure or certification required and specify name of agency.) • Current Los Angeles County Fire Card (or must be obtained within 30 days of employment), • Assault Response Competency (ARC) required (within 30 days of hire) Shift: Days Hours: 8 Weekly Hours: 40 Type: Exempt FTE: 1.0

Job Description Primary Purpose: Support the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures in Risk Adjustment, CMS 5 Star, and the commercial and Medi-Cal programs. Principal Duties and Responsibilities (* = essential functions): • Outreach and coordinate care for IPA members who need preventative and/or chronic care services such as mammograms, colonoscopies, uncontrolled HbA1c, uncontrolled blood pressure, etc., • Collaborate with Risk Adjustment and quality on provider education., • Maintain knowledge of clinical initiatives and risk adjustment program requirements, • Maintain knowledge of 5 Star performance and risk adjustment factors for all IPAs., • Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports., • Coordinate outreach to PCP offices on member due reports, including the No Annual Visits list., • Provide PCP offices with ongoing education on quality measures, • Work with health plans to provide supplemental data, • To contribute to a fair and positive work environment. *, • To perform other duties as assigned., • Review, monitor, and track medical record retrieval reports to identify provider issues, including but not limited to refusals to comply with medical record requests., • Identify and follow through on potential issues affecting the Risk Adjustment project Job Specifications (KSAs): • Requires at least two years of Risk Adjustment coder experience., • Requires knowledge of managed care processes, generally acquired through 1 or more years of experience in a Health Plan, IPA, or Medical Group environment., • Requires the ability to communicate clearly and effectively, verbally and in writing, with internal and external customers., • Requires an understanding of medical terminology, generally acquired through a relevant course or 2 years or more in a medical office setting or utilization management department., • Requires fast, accurate typing skills and proficiency in computer software, including Word and ExcelPosition Performance Criteria, • Consistently produces accurate and timely work as it relates to departmental goals., • Demonstrates high reliability through consistent punctuality and attendance., • Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through., • Uses sound judgment in time management and prioritizing work to balance multiple tasks and meet required timeframes for all administrative activities., • Demonstrates excellent interpersonal skills as discerned through observation and team project successes., • Accurately interprets and applies departmental policies and procedures using sound judgment., • Communicates clearly, professionally, and respectfully to peers, superiors, subordinates, and clients., • Provides constructive feedback on assigned work projects., • Demonstrates overall professionalism in attitude, demeanor, and personal appearance The hourly range is $25.00 to $30.00.

Medical Coder Job Duties: Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications. Analyzes

The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. Licenses/Certific