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Claims Edit Coder Jobs in California (NOW HIRING)

... codes, follow up on rejected claims, and appeal denials; develop and track written correspondence. * Complete adjustments, check refund request forms, and special transaction forms. * Work with edit ...

AR Follow Up Coord

Los Angeles, CA ยท On-site

$20 - $23/hr

... codes, follow up on rejected claims, and appeal denials; develop and track written correspondence. * Complete adjustments, check refund request forms, and special transaction forms. * Work with edit ...

Apply Early

AR Follow Up Coord

Los Angeles, CA ยท On-site

$20 - $23/hr

... codes, follow up on rejected claims, and appeal denials; develop and track written correspondence. * Complete adjustments, check refund request forms, and special transaction forms. * Work with edit ...

Apply Early

... codes, follow up on rejected claims, and appeal denials; develop and track written correspondence. * Complete adjustments, check refund request forms, and special transaction forms. * Work with edit ...

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Claims Edit Coder information

What are the key skills and qualifications needed to thrive as a Claims Edit Coder, and why are they important?

To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.

What are Claims Edit Coders?

Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.

What is the difference between Claims Edit Coder vs Claims Processing Specialist?

AspectClaims Edit CoderClaims Processing Specialist
CertificationsCertified Coding Associate (CCA), CPCNone required, but certifications can be beneficial
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, healthcare providers, office setting
Primary ResponsibilitiesReview and correct claim data, ensure coding accuracyProcess claims from submission to payment, handle inquiries

Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.

What are some common challenges faced by a Claims Edit Coder, and how can they be addressed?

Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.
What are popular job titles related to Claims Edit Coder jobs in California? For Claims Edit Coder jobs in California, the most frequently searched job titles are:
What job categories do people searching Claims Edit Coder jobs in California look for? The top searched job categories for Claims Edit Coder jobs in California are:
What cities in California are hiring for Claims Edit Coder jobs? Cities in California with the most Claims Edit Coder job openings:
Infographic showing various Claims Edit Coder job openings in California as of June 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution.
BILLING SUPERVISOR II

BILLING SUPERVISOR II

NORTH EAST MEDICAL SERVICES

Daly City, CA โ€ข On-site

$62K - $81K/yr

Full-time

Posted 2 days ago


Job description

The Billing Supervisor II (Front-End Revenue) is the senior supervisory role within the Billing department and supports the Revenue Cycle Manager in leading the front-end revenue cycle to achieve organizational goals. This role directly supervises the medical coding function (Medical Coder and Senior Medical Coder), the provider enrollment and credentialing function (Provider Enrollment Specialist and Senior Provider Enrollment Specialist), and front-end charge-review and claims staff. The position is accountable for charge capture integrity, accurate code assignment, clean-claim submission, and front-end denial prevention, ensuring work entering the revenue cycle is complete, compliant, and timely so as to enhance revenue, accelerate cash flow, and reduce claim denials. The Billing Supervisor II leads evaluation and training of front-end staff, partners with the Billing Supervisor I (Back-End Revenue) to coordinate hand-offs across the revenue cycle, and works with operational, clinical, and EHR departments to drive process improvements, set priorities, and develop innovative solutions. The Billing Supervisor II ranks above Billing Supervisor I; both report to the Revenue Cycle Manager.

ESSENTIAL JOB FUNCTIONS:

  • Demonstrates a thorough and authoritative understanding of Medicare, Medi-Cal, FQHC (Federally Qualified Health Center), state, local programs, and private insurance regulations, and serves as the front-end subject-matter resource.
  • Directly supervises the medical coding function: coordinates and monitors the work of the Medical Coder and Senior Medical Coder, ensures coding and documentation comply with ICD-10, CPT, HCPCS, HCC risk adjustment, and CMS NCD/LCD guidelines, and supports timely resolution of coding-related and medical-necessity claim edits.
  • Directly supervises the provider enrollment and credentialing function: coordinates and monitors the work of the Provider Enrollment Specialist and Senior Provider Enrollment Specialist, and ensures timely and compliant enrollment, re-credentialing, revalidation, CAQH attestations, and SB 137 provider-data maintenance to prevent enrollment-driven billing disruptions.
  • Directs charge review and claim-edit work: oversees front-end claim scrubbing, charge capture validation, and resolution of pre-submission edits to maximize clean-claim rates.
  • Provides direction, monitoring, training, and assistance to front-end team members; establishes priorities, assigns and balances workloads, inspects completed work, and resolves escalated front-end issues.
  • Conducts probationary and annual evaluations for front-end staff (coding, provider enrollment, charge/claims); for senior specialist roles, evaluations are completed in consultation with the Revenue Cycle Manager and informed by compliance metrics, productivity data, and technical input from subject-matter resources.
  • Partners with the Billing Supervisor I (Back-End Revenue) to coordinate clean hand-offs between front-end submission and back-end posting, follow-up, and AR.
  • Uses the Epic Professional Billing and Claims environment for charge, code, and claims-library awareness, and coordinates with the Epic Analyst (who owns system configuration) to report, validate, and resolve front-end application issues.
  • Monitors front-end denial trends, identifies root causes, and implements process improvements; develops policies and procedures and ensures consistent adoption across the front-end functions.
  • Designs and delivers training for new and existing front-end employees on coding, enrollment, charge review, and claims software and workflows.
  • Generates and reviews front-end performance reports (coding accuracy, enrollment status, clean-claim and edit rates) for the Revenue Cycle Manager and Administration.
  • Performs additional duties as assigned by management.
  • Completion of a four-year degree from an accredited university.
  • Must hold at least one Epic Resolute Professional Billing (PB) certification. Epic Resolute Claims and Remittance certification is preferred.
  • Minimum of three years of supervisory experience in a healthcare revenue cycle, billing, coding, or provider enrollment setting, including experience leading or developing staff.
  • At least five years of professional experience in healthcare revenue cycle operations in a complex healthcare or FQHC setting, with front-end (coding, enrollment, charge/claims) exposure.
  • Working knowledge of medical coding (ICD-10, CPT, HCPCS, HCC risk adjustment) and provider enrollment / credentialing processes (CAQH, SB 137, payer revalidation) sufficient to supervise these functions; coding credential (AAPC/AHIMA) or equivalent experience preferred.
  • Excellent analytical and communication skills, with the ability to convey complex information clearly to technical and non-technical audiences.
  • Proficient in computer skills, including billing/coding software and Microsoft Office applications.
  • Ability to write clear and professional business correspondence, policies, and procedures.
  • Strong organizational skills, with the ability to manage and coordinate multiple front-end processes and personnel simultaneously.
  • Committed to maintaining high standards of customer service in a demanding and complex healthcare environment.
  • Demonstrates initiative, resourcefulness, integrity, and timeliness to achieve high levels of customer satisfaction.
  • Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic in all aspects of work.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluency in other languages is an asset.

STATUS:

This is an FLSA Exempt position.

This is not an OSHA high-risk position.