• Specialty Health Plans Auditor III, $5,000…

    LA Care Health Plan (Los Angeles, CA)
    …And/Or any of the following Licenses/ Certifications: Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Certified Fraud Examiner (CFE) ... Specialty Health Plans Auditor III, $5,000 SIGN ON BONUS Job Category:...and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors.… more
    LA Care Health Plan (07/06/25)
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  • Coding Auditor Educator

    Highmark Health (Sacramento, CA)
    … Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
    Highmark Health (08/08/25)
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  • Manager, Financial Compliance Audit, $10,000 Sign…

    LA Care Health Plan (Los Angeles, CA)
    …any of the following Licenses/ Certifications: Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Certified Management Accountant (CMA) ... data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements. Manages complex… more
    LA Care Health Plan (08/09/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Walnut Creek, CA)
    **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time, ... required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
    Elevance Health (08/23/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Sacramento, CA)
    …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... compliance, mainly primary care and risk adjustment, pharmacy knowledge a plus + Certified Coder (CPC, CRC, and/or CMC) + Experience with metrics and reporting… more
    Humana (08/23/25)
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