- LA Care Health Plan (Los Angeles, CA)
- …with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding , hierarchical models, and member risk scoring. Knowledge of diagnosis ... documentation, encounter data, and coding completeness to optimize plan revenue and quality scores. Knowledge of regulatory requirements impacting risk adjustment… more
- LA Care Health Plan (Los Angeles, CA)
- …end-to-end claims accuracy, including benefit interpretation, provider contract application, coding , pricing, and system logic. Oversees testing and validation of ... operational rigor, and continuous improvement. Perform other duties as assigned. Education Required Bachelor's Degree In lieu of degree, equivalent education… more
- Sutter Health (Emeryville, CA)
- …focus on high-impact performance areas such as front-end operations, CDI, coding , denials, underpayments, aged receivables, net revenue optimization, month-end close ... KPIs. Candidates must also demonstrate deep operational experience in providing education , guidance, and operational support to clinical care setting leaders,… more
- Ventura County (Ventura, CA)
- …has specialized expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal. Skilled in the Medi-Cal Provider Manual and ... the appropriate intermediary; + Ensures accuracy and compliance with billing, coding , and follow-up requirements and identifies overpayments and lack of… more
- CVS Health (CA)
- …criteria and policies in line with clinical editing, policy and coding standards. **Fundamental Components:** Reviews documentation and evaluates potential correct ... coding issues based on multiple clinical policies. Considers all...+ Experience with QuickBase. + Experience with Cotiviti Editing/CXT ** Education ** + Registered Nurse with compact license + Associates… more
- Element Consulting (Monterey Park, CA)
- …to the minimum stated above may be substituted in lieu of formal education . * Strong analytical capabilities, with the ability to organize and interpret complex ... and provide recommendations for optimizing resource allocation. * Validate cost coding and budget allocations for contract change orders and amendments, assessing… more
- Sutter Health (Oakland, CA)
- …level of care with supporting documentation of regulatory compliance and accurate coding . The Physician Advisor (PA) conducts clinical reviews on cases referred by ... ,and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk… more
- Cardinal Health (Sacramento, CA)
- …confidentiality for patients in accordance with HIPAA standards. + Utilize CPT coding , ICD-10 coding knowledge to accurately document procedures and diagnoses. ... interpreting EOBs. + Working knowledge of ICD-9/ICD-10, CPT, HCPCS, and CPT coding . + Experience with GE Centricity. Preferred experience in Oncology billing… more
- Herbalife (Los Angeles, CA)
- …logic and algorithms in line with business rules * Establish guidelines and coding standards focusing on the client/server communication and server system build * ... projects preferred * Dotnet Core (C#) Architecture using Dependency Injection coding patterns * Cross-platform development with Flutter framework * RESTful API… more
- Medtronic (Northridge, CA)
- …+ Working knowledge of pharmacy adjudication and operations (eg, NDC coding , adjudication rejection handling, ship-to-soon edits). + Familiarity with government and ... or DME order processing within the healthcare industry. + Proficiency in HCPCS coding , ICD-10 coding , modifiers, and unit of measure calculations. + Industry… more