Top 14 Coding specialist Jobs in Monterey Ca

Appeals & Grievance Specalist
Wollborg Michelson Recruiting —California
- $55.00 - $57.80 an hour
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
- Health insurance
- Vision insurance
Quick Apply
2d
Medical Coder
Cypress Healthcare Partners —Monterey, CA
- $21.74 - $29.22 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Organizational skills
Quick Apply
Trauma Registrar
Natividad Medical Center —Salinas, CA
- $7,186.92 - $9,815.87 a month
- Weekends as needed
- Anatomy knowledge
- Hospital
- Customer service
Accounts Research Specialist
Cypress Healthcare Partners —Monterey, CA
- $17.25 - $23.18 an hour
- Full-time
- Research
- Mid-level
- High school diploma or GED
Quick Apply
Interventional Radiology Coding Specialist
MSN Healthcare Solutions —United States
- $26 - $32 an hour
- Full-time
- Remote
- Background check
- Anatomy knowledge
- Microsoft Excel
- Health savings account
- Health insurance
Quick Apply
14d

More jobs to discover

Find similar jobs that you might be interested in.

Medical Coder
Cypress Healthcare Partners —Monterey, CA
Excellent customer service and phone etiquette skills. Furthermore, responsible for posting and reconciling charges and communicating with provider/staff of…
$21.74 - $29.22 an hour
Quick Apply
Certified Outpatient Coder (COC) - AI Trainer
DataAnnotation —California
You can work on your own schedule, on your own computer, from the comfort of your own home. A current or in progress medical degree.
From $20 an hour
Quick Apply

Show more similar jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Medical Coder 3
Iannarino Fullen Group —Columbus, OH
Knowledge of:* (1)ICD diagnostic codes for medical diagnoses, assignments, groupings & medical treatment, (2)agency statutes, rules, policies & procedures, (3)…
$24.75 an hour
Quick Apply
6d
Medical Coder
Medical Recruitment Strategies —Columbus, OH
CCS, CCS-P, or CPC certification. The candidate will act as a technical resource and assist in analyzing policies, monitoring coding accuracy, and maintaining…
Up to $23.30 an hour
Quick Apply
1d

Show more jobs in cities nearby

I want to receive the latest job alert for coding specialist in monterey ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

coding specialist jobs near monterey ca

Appeals & Grievance Specalist

Wollborg Michelson Recruiting -
California

Quick Apply

Job Details

Full-time | Contract
$55.00 - $57.80 an hour
2 days ago

Benefits

Health insurance
Vision insurance

Qualifications

Appeals
Nursing
Medicare
RN License
Managed care organization experience
Spreadsheets
Documentation tools
Pre-authorization review for utilization management
Utilization management
Attention to detail
Bachelor of Science in Nursing
Microsoft Teams
SharePoint
Milliman Care Guidelines (MCG Health)
Productivity software
Clinical documentation standards
Associate's degree
Associate Degree in Nursing
Nursing
Post-acute care experience

Full Job Description

Appeals and Grievance Specialist

Remote

Must Reside in CA

Temporary to Hire

Job Summary

The Appeals and Grievance RN reviews and processes member-generated pre-service and post-service appeals and grievances. This role is responsible for concurrent review of medical records and documentation, determining appropriate outcomes, and ensuring members have quality access to provider care. The RN collaborates with medical directors, coordinators, and leadership to provide clear, well-rationalized determinations and identify any necessary follow-up actions.

Responsibilities

Review and process clinical appeals related to pre-service and post-service concerns and complaints from members.
Conduct accurate, timely first-level reviews in accordance with organizational and regulatory standards.
Utilize National Coverage Determination (NCD), Local Coverage Determination (LCD), Milliman Care Guidelines, and other nationally recognized clinical guidelines such as NCCN and ACOG.
Evaluate appeals for benefit coverage, medical necessity, coding accuracy, and compliance with medical policies.
Collaborate with medical directors, coordinators, and leadership to ensure consistent and compliant decision-making.
Document clinical rationales and determinations clearly and concisely.
Identify and communicate any trends, discrepancies, or issues related to clinical determinations or documentation.

Requirements

Registered Nurse (RN) license in good standing.
Associate Degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) preferred.
Minimum 2 years of managed care experience, including familiarity with MCG, LCD, and NCD.
Minimum 2 years of acute or sub-acute clinical experience.
Knowledge of commercial and Medicare health coverage benefits and review processes.
Experience with prior authorization, pre-service, and post-service review.
Proficiency with Excel, Microsoft Office, PDF tools, shared drives, Teams, and SharePoint.

Skills

Strong knowledge of managed care principles and utilization review processes.
Ability to interpret and apply clinical guidelines and coverage determinations.
Excellent written and verbal communication skills for clear clinical rationales.
High attention to detail in reviewing medical records and documentation.
Proficient computer and data entry skills across multiple platforms and systems.
Strong critical thinking and clinical assessment abilities.

Summary Qualification

Strong understanding of regulatory requirements related to health insurance (e.g., NCQA, CMS, DMHC, DHCS).
Demonstrated ability to work effectively in a fast-paced, changing environment.
Ability to work both independently and collaboratively within a team.
Strong clinical assessment skills and sound professional judgment.
Ability to recognize discrepancies and inaccuracies in medical determinations and clinical documentation.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

Pay: $55.00 - $57.80 per hour

Benefits:

Health insurance
Vision insurance

Work Location: Remote

Quick Apply

Refine Your Search

coding specialist jobs in monterey ca

Appeals & Grievance Specalist

Medical Coder

Trauma Registrar

Accounts Research Specialist

Interventional Radiology Coding Specialist

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for coding specialist in monterey ca

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected