Top 23 Billing compliance auditor Jobs in California

Claims Auditor
Imperial Management Administrators Services Inc —Pasadena, CA
- $30 - $35 an hour
- Microsoft Word
- Microsoft Excel
- Writing skills
Quick Apply
Certified Professional Coder, Auditor
Integrated Pain Management Medical Group, Inc. —Walnut Creek, CA
- $28 - $33 an hour
- Full-time
- 3 years
- High school diploma or GED
- Senior level
- Paid holidays
- Health insurance
Quick Apply
Billing Compliance Auditor
HOSPICE OF SAN JOAQUIN —Stockton, CA
- $24.60 - $25.60 an hour
- Full-time
- Microsoft Word
- Background check
- Microsoft Outlook
- Mileage reimbursement
- Health insurance
Facility Outpatient Surgical and Claims Edit Auditor (Remote)
Cedars-Sinai —Los Angeles, CA
- $45.89 - $73.42 an hour
- 8 hour shift
- Remote
- Surgery
- Mid-level
- 3 years
- Dental insurance
- 403(b)
Facility Inpatient Surgical and Claims Edit Auditor
Cedars-Sinai —Los Angeles, CA
- $45.89 - $73.42 an hour
- 8 hour shift
- Remote
- Surgery
- Mid-level
- 3 years
- Dental insurance
- Paid time off
Acute Coding Quality Review Auditor (Remote)
Adventist Health —Roseville, CA
- $36.91 - $50.62 an hour
- Remote
- 5 years
- Mid-level
- High school diploma or GED
Coding Compliance Auditor
Community Health System —Fresno, CA
- $44.52 - $56.65 an hour
- 8 hour shift
- Nursing
- 3 years
- Epic
- Free parking
- 403(b) matching
Certified Coding and Billing Compliance Specialist
Snowline Health —El Dorado, CA
- $26 - $36 an hour
- Full-time
- Hybrid work
- Anatomy knowledge
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Medical Auditor - Remote
Sprinter Health —Menlo Park, CA
- $36 an hour
- Full-time
- Remote
- Google Workspace
- HIPAA
- Mid-level
- Dental insurance
- Parental leave
Quick Apply
Coding Compliance Analyst III
Sutter Health —Sacramento, CA
- $93,953.60 - $176,155.20 a year
- Weekends as needed
- 5 years
- Word processing
- Writing skills
Billing Compliance Specialist
McKinley Children's Center —San Dimas, CA
- $20 - $22 an hour
- Extended hours
- Pass drug screening
- Mid-level
- Pre-employment physical examination
- 403(b) matching
- Paid holidays
Quick Apply
Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
USC —Los Angeles, CA
- $33.00 - $54.02 an hour
- 8 hour shift
- Surgery
- 5 years
- Clinic experience
Inpatient / Outpatient Coding Compliance Auditor
Healthcare Cost Solutions —Newport Beach, CA
- Part-time
- Microsoft Excel
- 5 years
- Senior level
- Profit sharing
- Health insurance
Auditor/Biller
Drive Medical —Perris, CA
- $20.93 - $23.25 an hour
- Full-time
- Basic math
- High school diploma or GED
- Ability to lift 50 pounds
- 401(k)
- Paid time off
Quick Apply
7d
Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
Keck Medical Center of USC —Los Angeles, CA
- $33.00 - $54.02 an hour
- 8 hour shift
- Background check
- Surgery
- 5 years
Senior Compliance Coding Auditor - CPMA
Wellpath —Santa Maria, CA
- $70,000 - $96,000 a year
- 8 hour shift
- 5 years
- Presentation skills
- Mentoring
- Wellness program
- Health savings account
Risk Adjustment Coding Auditor
Clever Care Health Plan —Huntington Beach, CA
- $72,800 - $80,000 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- Microsoft Excel
13d
Inpatient Medical Coding Quality Auditor
Pena4 Inc. —United States
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- 5 years
- US work authorization
- Senior level
- Health insurance
- Dental insurance
Quick Apply
8d

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Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —California
Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
$43,888 - $93,574 a year
7d
Senior Accountant – Financial Close & Audit Specialist
Sterling Pacific Financial —Watsonville, CA
Assist with AP/AR, payroll, fixed assets, budgeting, forecasting, and variance analysis. Background in real estate lending, development, construction, or…
$75,000 - $100,000 a year
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Inpatient Medical Coding Quality Auditor
Pena4 Inc. —United States
QIC is responsible for coordinating quality management efforts including development, implementation, education, data collection and analysis.
$80,000 - $90,000 a year
Quick Apply
8d

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billing compliance auditor jobs near california

Claims Auditor

Imperial Management Administrators Services Inc -
Pasadena, CA

Quick Apply

Job Details

$30 - $35 an hour

Qualifications

Microsoft Word
Microsoft Excel
Writing skills
Regulatory compliance in claims processing
English
Medical claims processing software
Health information regulatory compliance
Data interpretation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Clinical confidentiality policies
Medical terminology

Full Job Description

JOB DESCRIPTION

JOB TITLE: Claims Auditor FLSA STATUS: Non-Exempt

DEPARTMENT: Claims Audit

REPORTS TO: Claims Audit Manager / Claims Director

JOB SUMMARY:

The Claims Auditor is responsible for reviewing and auditing claims adjudicated by the system and claims examiners prior to check runs. This role ensures accuracy, identifies errors, verifies compliance with regulatory requirements, and provides recommendations for process and system improvements. The Claims Auditor also supports cross-departmental initiatives to maintain payment integrity and compliance with CMS, Medi-Cal, and commercial guidelines.

ESSENTIAL JOB FUNCTIONS:

Accurately apply Health Plan Benefit Matrices and DOFR (Division of Financial Responsibility) during audits.
Facilitate corrections of claim adjudication errors and recommend process improvements.
Test and audit new releases of Medicare and Medi-Cal Fee Schedules, and provider payment methodologies based on contract agreements.
Maintain a strong understanding of provider contracting arrangements and benefits administration to support accurate and timely claim payments.
Stay current on ICD-10, CPT, HCPCS, Revenue Codes, DRG, and billing procedures for healthcare providers and facilities, as well as Medicare and Medi-Cal reimbursement guidelines.
Test and audit claim payments for accuracy against contract data in E-CAP.
Generate and analyze audit reports to identify adjudication errors, overpayments, and underpayments.
Document audit findings with detailed review process, justification, and conclusions.
Track and analyze errors to identify trends and recommend training or system enhancements.
Provide training and mentoring for new staff to improve accuracy and productivity.
Maintain detailed knowledge of EZ-CAP rules related to claims payment.
Ensure compliance with claim timeliness standards:

Commercial: 45 working days
Medi-Cal: 30 calendar days
Medicare non-contracted: 30 calendar days
Medicare Contracted: 60 calendar days

Collaborate with the Recovery Team on overpayment resolution.
Perform Coordination of Benefits (COB) reviews as applicable.
Support overall business needs of the Claims Department and contribute to team goals.
Consistently meet productivity and quality standards as defined by management.

MARGINAL JOB FUNCTIONS:

Take on special projects as needed.
Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

Continuous Learning:

a. Attend required staff meetings.

b. Participate in relevant training, seminars, and workshops to stay informed and up to date.

Customer Focus:

Maintain client/customer confidentiality and privacy in compliance with HIPAA regulations and IMAS's Standards of Conduct.
Foster effective communication and collaboration with supervisors, co-workers, and other staff members.

Quality/Process Improvement/Safety

a. Report any security, health, or safety issues to the appropriate supervisor as soon as possible.

b. Demonstrate a commitment to safety in all duties performed.

c. Follow established policies, procedures, and comply with all regulatory standards set by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

Minimum 2 years’ experience in complex claims processing and/or auditing in the health insurance industry.
EZ-CAP knowledge strongly preferred.

SKILLS/KNOWLEDGE/ABILITY:

Strong knowledge of healthcare regulations and guidelines (CMS, DMHC, DHS).
Proficiency in claims coding and forms (CCI, CMS-1500, UB-04, CPT, ICD-10, HCPCS).
Familiarity with EZ-CAP or similar claims processing systems.
Proficiency in Microsoft Word and Excel; basic understanding of medical terminology.
Excellent organizational, multitasking, and deadline management skills.
Strong analytical and problem-solving abilities with keen attention to detail.
Ability to exercise sound judgment and work independently or collaboratively.
Strong written and verbal communication skills.
Ability to multitask and effectively solve problems in a fast-paced work environment.
Proficiency in reading, writing, speaking, and understanding English, with the necessary communication skills to provide accurate information to residents and staff.
Ability to follow both written and verbal instructions in English.
Commitment to maintaining appropriate levels of confidentiality and privacy in all interactions.
Professional demeanor and ability to interact courteously with customers, members, and co-workers, both independently and as part of a team.
Ability to effectively manage multiple tasks and adapt to shifting priorities as required.
Strong decision-making and problem-solving skills, with the ability to make appropriate judgments in a timely manner.
Ability to prioritize tasks effectively, ensuring that key items are addressed efficiently.
Self-motivated and capable of taking initiative as a self-starter.
Willingness and ability to understand and comply with all relevant Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

Quick Apply

Refine Your Search

billing compliance auditor jobs in california

Claims Auditor

Certified Professional Coder, Auditor

Billing Compliance Auditor

Facility Outpatient Surgical and Claims Edit Auditor (Remote)

Facility Inpatient Surgical and Claims Edit Auditor

Acute Coding Quality Review Auditor (Remote)

Coding Compliance Auditor

Certified Coding and Billing Compliance Specialist

Medical Auditor - Remote

Coding Compliance Analyst III

Billing Compliance Specialist

Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Inpatient / Outpatient Coding Compliance Auditor

Auditor/Biller

Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Senior Compliance Coding Auditor - CPMA

Risk Adjustment Coding Auditor

Inpatient Medical Coding Quality Auditor

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