Medical Coding Auditor

Location: Long Beach, CA/Surrounding areas (Remote, must be withing 50 miles of Long Beach or Woodland Hills, CA incase of any onsite needs) Hours: 8-5 PST Start Date: ASAP Client Overview A leading nonprofit health plan serving millions of members across commercial, Medicare, Medicaid, and individual market programs. The organization is committed to improving healthcare quality, affordability, and access through innovative care delivery models, population health initiatives, and regulatory compliance excellence. This role supports enterprise-wide risk adjustment, medical record review, and government audit activities that help ensure accurate documentation, coding integrity, and compliance with federal and state requirements. Job Description Seeking two experienced Senior Medical Review Coders to support high-priority government audit and medical record review initiatives. Responsibilities include retrospective and prospective medical record reviews, coding validation, abstraction, provider outreach, and audit support across Medicare Advantage (MA), ACA, and Medi-Cal programs. Key Responsibilities Review and abstract medical records for coding and audit projects Support government audit initiatives including RADV and other regulatory reviews Perform retrospective and prospective coding reviews Validate diagnosis coding and documentation accuracy Request and follow up on medical records from providers Conduct provider outreach and resolve documentation issues Utilize coding guidelines and regulatory requirements to ensure compliance Collaborate with internal audit, coding, and quality teams Skill Set Requirements 10+ years of medical coding/review experience Active coding certification (CPC, CCS, CRC, RHIT, RHIA, or equivalent) Extensive experience with: Medi-Cal programs Medical record abstraction and review Strong knowledge of ICD-10-CM coding guidelines Microsoft Office Suite Medical record retrieval and documentation systems Experience with Facets preferred (training available) Experience using fax systems such as RightFax preferred Nice to Haves Prospective and retrospective review experience Provider outreach and medical record retrieval Health plan or managed care environment Education/Certification(s)/License(s) Active coding certification (CPC, CCS, CRC, RHIT, RHIA, or equivalent) #J-18808-Ljbffr