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Healthcare Administration Medical Records Medical Billing and Coding Healthcare Compliance

Medical Records Reviewer​/CDI Health Plan Inc

Job in Pasadena, Los Angeles County, California, 91122, USA
Listing for: Imperial Health Plan of California, Inc.
Contract position
Listed on 2025-12-14
Job specializations:
  • Healthcare
    Healthcare Administration, Medical Records, Medical Billing and Coding, Healthcare Compliance
Job Description & How to Apply Below
Position: Medical Records Reviewer/ CDI  Health Plan  Inc

Medical Records Reviewer/ CDI (Pasadena) job at Imperial Health Plan of California, Inc.. Pasadena, CA.

CDI specialist on site in Pasadena, CA!

Performs clinical documentation validation.

ESSENTIAL JOB FUNCTIONS:
  • Applies working knowledge of ICD-10 CM & PCS, MS-DRG reimbursement methodology, and Standard of Care in daily medical records reviews.
  • Conducts daily coding reviews of inpatient and outpatient medical records to ensure appropriate billing practices.
  • Analyzes and interprets clinical documentation of diagnoses reported by providers.
  • Formulates accurate clinical review outcomes for reimbursement purpose.
  • Act as a contact person to answer medical review questions submitted by staff or providers.
  • Maintains up to date with regulatory changes related to documentation and coding.
  • Maintains regular and consistent attendance.
  • Adheres to Compliance Plan and HIPAA regulations.
  • Perform coding verification, DRG and clinical validation in accordance with medical standards and CMS guidelines and regulations.
    • EXPERIENCE:
    • Medical Background (MA, LVN, RN, PA, NP, DNP, MD, CDI Specialist, etc.) (Required).
    • One (1) year of experience as a concurrent or retrospective documentation specialist in an inpatient acute care facility using the United States Inpatient Prospective Payment System (IPPS). (Desired).
    • Min 1 year experience performing medical review for private, federal or state contracts (Desired).
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