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Medical Coding Compliance Jobs in California (NOW HIRING)

Community Health System

Coding Compliance Auditor

Fresno, CA · On-site

$44.52 - $56.65/hr

The Coding Compliance Auditor is a member of the Compliance Office and contributes to the Community ... Experience performing medical record and billing audits/reviews, including clinical documentation ...

Aquent

Coding Specialist

Sacramento, CA · On-site +1

$38.29 - $41.07/hr

Knowledge of regulatory body requirements and coding compliance issues. * Demonstrated ability to review, analyze, and abstract complex information from medical documentation. * Exceptional critical ...

sdaihc

Finance_Certified_Coder

San Diego, CA · Remote

$24 - $32.75/hr

... compliant medical coding practices across the organization in compliance with HRSA Section 330, Medi-Cal, and Medicare requirements. The Certified Coder bridges clinical documentation and billing by ...

sdaihc

Finance_Certified_Coder

San Diego, CA · Remote

$24 - $32.75/hr

... compliant medical coding practices across the organization in compliance with HRSA Section 330, Medi-Cal, and Medicare requirements. The Certified Coder bridges clinical documentation and billing by ...

Humana

Inpatient Medical Coding Auditor

Sacramento, CA · On-site

Will be an experienced medical coding auditor with in-depth experience in inpatient coding audits ... Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate ...

New

APS

Medical Coder

Modesto, CA · On-site

$19.50 - $26/hr

Ensure coding documentation is complete and compliant * Maintain accuracy and strong follow-through on all assigned work Qualifications * Minimum 1 year of medical coding experience required

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Medical Coding Compliance information

What are the key skills and qualifications needed to thrive in medical coding compliance, and why are they important?

To thrive in Medical Coding Compliance, you need a thorough understanding of medical coding systems (such as ICD-10, CPT, and HCPCS), healthcare regulations, and compliance standards, often backed by certifications like CPC, CCS, or CHC. Proficiency with electronic health record (EHR) systems, coding software, and compliance auditing tools is typically required. Attention to detail, analytical thinking, and effective communication are essential soft skills for identifying discrepancies and educating staff. These skills ensure accurate coding, reduce legal risks, and maintain organizational compliance with healthcare regulations.

What does a medical coding compliance specialist do?

A medical coding compliance specialist ensures that healthcare providers accurately code medical procedures and diagnoses according to industry standards and regulations. They review coding practices, monitor compliance with legal requirements, and implement policies to prevent fraud and errors, often using coding software and staying updated on coding guidelines.

What is the difference between Medical Coding Compliance vs Medical Coding Specialist?

AspectMedical Coding ComplianceMedical Coding Specialist
CertificationsCPMA, CPC, CCSCPC, CCS
Work EnvironmentCompliance departments, healthcare organizationsMedical offices, hospitals, clinics
Primary FocusEnsuring coding accuracy and regulatory adherenceAssigning codes to medical procedures and diagnoses
Employer & Industry UsageHealthcare compliance and auditing firms, hospitalsHealthcare providers, billing companies

Medical Coding Compliance professionals focus on ensuring that coding practices adhere to regulations and standards, often working in compliance or auditing roles. Medical Coding Specialists primarily assign codes to medical records for billing and documentation. While both roles require similar certifications, their responsibilities and work environments differ significantly.

What are some common challenges faced in a medical coding compliance role, and how can they be addressed?

Medical Coding Compliance professionals often encounter challenges such as staying updated with frequent changes to coding regulations, ensuring consistent adherence to compliance standards across departments, and accurately interpreting complex clinical documentation. To address these, it’s crucial to participate in ongoing education, maintain close communication with healthcare providers, and utilize robust auditing tools. Collaborating with compliance officers and regularly attending training sessions can also help reinforce best practices and minimize errors.

What is medical coding compliance?

Medical coding compliance refers to the process of ensuring that medical coding practices adhere to federal, state, and organizational regulations and guidelines. This involves accurately translating medical diagnoses, procedures, and services into standardized codes for billing and documentation purposes. Compliance helps prevent fraud, reduce billing errors, and ensures that healthcare providers receive appropriate reimbursement while avoiding legal penalties. Professionals in this field stay updated on changing regulations, conduct audits, and provide training to staff to maintain high standards of accuracy and integrity.
What are popular job titles related to Medical Coding Compliance jobs in California? For Medical Coding Compliance jobs in California, the most frequently searched job titles are:
What job categories do people searching Medical Coding Compliance jobs in California look for? The top searched job categories for Medical Coding Compliance jobs in California are:
What cities in California are hiring for Medical Coding Compliance jobs? Cities in California with the most Medical Coding Compliance job openings:
Medical Coding Compliance jobs near you
Infographic showing various Medical Coding Compliance job openings in California as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution.

Risk Adjustment Compliance Coding Specialist, Consultant

Blue Shield of CA

Oakland, CA • On-site

Other

Posted 6 days ago

Job description

Your Role

The Risk Adjustment Compliance Coding Specialist (Consultant) helps to ensure organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medi-Cal (Medicaid), and Medicare Advantage lines of business. Specifically, the role helps to ensure the accuracy, completeness, and integrity of medical coding for risk adjustment programs. This specialist reviews clinical documentation and medical records to verify that all diagnoses and procedures are properly captured and coded in accordance with regulatory standards. By doing so, the specialist helps healthcare organizations meet compliance requirements for federal and state risk adjustment initiatives by supporting appropriate reimbursement, accurate risk stratification, and quality improvement efforts.

Your Knowledge and Experience

  • Requires a bachelor's degree or equivalent experience. A degree in Health Information Management, Nursing, Health Administration, or a related clinical field is preferred
  • Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential is required.
  • Requires a minimum of 6 years of experience in compliance audit, risk adjustment coding, medical coding, compliance auditing, or similar roles in a healthcare setting. Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred
  • Requires deep familiarity with compliance risk assessments and audits
  • Requires direct experience supporting or responding to CMS RADV audits, internal coding compliance audits, or OIG related reviews is strongly preferred.
  • Requires advanced proficiency in ICD-10-CM coding, electronic health record (EHR) systems, coding audit tools, and Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). Experience with risk adjustment analytics software is a plus
  • Requires an in-depth understanding of risk adjustment models (CMS-HCC, HHS-HCC), Official Coding Guidelines, payer policies, and regulatory requirements (CMS, HHS, OIG, DHCS)
  • Requires exceptional analytical and critical thinking abilities, meticulous attention to detail, strong organizational and time management skills, and the capacity to interpret and summarize complex clinical documentation
  • Requires ability to work collaboratively in a team, perform duties with minimal supervision, multi-task, and to deliver a quality work product in a highly regulated, demanding, and constantly changing corporate environment
  • Requires outstanding written and verbal communication skills

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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