24274 jobs found

Essential Functions: Coordinates with Compliance Manager and Chief Compliance Officer on any billing compliance investigations. Reviews and audits documentation in the medical records and charges submitted including CPT and ICD-10information to ensure compliance. Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing are being performed in an accurate and timely manner and is supported by documentation. Analyzes billing trends to identify areas of non-compliance and prepares regular reports on audit findings to Compliance Manager. Collaborates with the Compliance Team to develop annual audit work plans. Educates providers when deficiencies in documentation and code selection are identified. Develops corrective action plans and participates in compliance investigations as needed. Performs other duties as...

Position Summary Performs coding and documentation quality audits, providing feedback and education to coding and reimbursement specialists, coders, and providers.   Minimum Qualifications ·       High School graduate or equivalency and five years of coding and reimbursement experience of which 1 year may be as a coding auditor. ·       Additional job-specific education may substitute for the experience. ·       Active professional coding certification from an accredited organization, e.g., American Association of Professional Coders (AAPC), American Health Information Management Association (AHIMA). ·       Certification to remain current during term of employment. ·       Knowledge of CPT, ICD-CM, ICD-10, and HCPCS nomenclature.   Position Specific Qualifications •        Billing and coding experience in a multi-specialty group practice and/or academic practice setting is preferred. •        Five...

Riverside University Health System (RUHS)   is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences including physicians and other staff. The ideal candidate will have at least five years of progressive experience in an acute care hospital...

The University of Missouri School of Medicine is seeking an experienced and strategic Supervisor, Coding & Data Management to lead our Professional Coding and Revenue team. This role is critical to ensuring accurate medical coding that directly translates into clinical revenue integrity, regulatory compliance, and operational excellence. If you are a certified coding professional who thrives in leadership, process improvement, and complex reimbursement environments, we invite you to apply. Why Join Us? At the School of Medicine, our coding leadership team plays a vital role in supporting clinical operations, optimizing reimbursement, and maintaining compliance with federal and commercial payer regulations. You will collaborate with physicians, administrators, and revenue cycle professionals in a mission-driven academic healthcare setting. Position Overview The Supervisor, Coding & Data Management is responsible for overseeing coding accuracy, reimbursement...

SCOPE: Under minimal supervision performs periodic, comprehensive coding audits for all assigned regional oncologists (medical, radiation and surgical oncology).   Verifies charge documentation and charge submission processes are in compliance with Federal and State regulations, as well as payer guidelines. Coordinates efforts with manager and front office managers to ensure optimal revenue cycle processes and adherence to compliance and revenue cycle policies and procedures.  Provides effective educational feedback to physicians and staff on findings from audits and updates in Payer billing regulation . ESSENTIAL DUTIES AND RESPONSIBILITIES: Develops Audit and Education Programs Abstracts relevant clinical and demographic information from the medical record to assign current ICD and CPT codes in accordance with coding and reimbursement guidelines. Codes with an accuracy of 97% based on QA internal reviews Performs Evaluation and Management (E&M)...

Are you a detail-driven coding professional who thrives on accuracy, compliance, and making an impact behind the scenes of patient care? If so, we want to hear from you! We are currently hiring Medical Coding Specialists – (certified or non-certified) to join our dynamic and collaborative team supporting University Physicians. This is your opportunity to work in a mission-driven environment where your expertise directly supports quality care and operational excellence. 💼 What You’ll Do Review complex clinical documentation and diagnostic results to accurately assign: ICD-10-CM (diagnoses) CPT codes (procedures) Modifiers for services Ensure maximum reimbursement and regulatory compliance Assist with audits to identify coding issues, denials, and reimbursement opportunities Serve as a liaison between departments and third-party payers Support providers, residents, and staff with documentation and coding guidance Help...

The Medical Policy Manager is responsible for overseeing all cap thresholds and medical review triggers, ensuring they are routed either for administrative evaluation by the vendor or referred to the state’s Utilization Management (UM) vendors for clinical review. Qualifications Certified Coding Specialist credential issued by the American Health Information Management Association (AHIMA) Minimum of five years’ experience creating and administering medical and/or Utilization Management (UM) policies for state Medicaid programs or Medicare Strong working knowledge of Centers for Medicare & Medicaid Services (CMS) procedure and diagnosis coding, including dental and Current Dental Terminology (CDT) codes Bachelor’s degree in a related discipline

Position Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.  As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the DRG Operations Department leaders, the DRG Reviewer will conduct reviews of inpatient claims for both coding accuracy as well as perform screening referrals for clinical support of coded diagnoses. Responsibilities: Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing. Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides. Collaborates with physician reviewers, as needed. Ability to prioritize and organize workload and complete tasks independently....

Billing & Coding Integrity Specialist Full Time (Benefit Eligible) Monday - Friday (No weekends or holidays), 8:00 am - 5:00 pm  This role is an on‑site position and is not eligible for remote work. The Patient Financial Services Department is seeking a full time Billing and Coding Integrity Specialist to join the team. Under the direction of the Director of Patient Financial Services the specialist is responsible for implementing and promoting consistent revenue integrity practices that will improve compliance, accurate billing, and charge capture at the point of service to ensure optimal reimbursement for Keystone Health.  The specialist is responsible for auditing and monitoring appropriate coding guidelines and regulations. Recommending any corrective action and assists with implementing the corrective action.  This position is also responsible for providing billing/coding training and education to providers and staff and maintaining a current...

Physicians' Choice is currently seeking a highly proficient and seasoned Medical Coding Auditor specializing in Evaluation and Management (E/M) services, with a comprehensive understanding of Emergency Medicine, to join our esteemed team. If you possess extensive expertise in current E/M coding guidelines and have a strong background in auditing, we invite you to apply for this exceptional opportunity. Job Description:  As a Medical Coding Auditor you will play a vital role in ensuring accurate and compliant coding practices within our organization. You will be responsible for conducting detailed audits of medical records, coding documentation, and related billing processes to verify compliance with established coding guidelines, regulatory requirements, and internal policies. Responsibilities: Perform comprehensive audits of medical records, coding documentation, and billing processes. Evaluate the accuracy, completeness, and appropriateness of medical...

Are you an experienced and motivated Medical Biller specializing in Home Infusion Therapy? The ideal candidate would have experience in billing for implanted pain pumps. We are seeking a skilled 1099 contractor with experience in billing for Florida-based home infusion services and in Payer credentialing. This is a remote contract position offering flexibility and competitive compensation. Expericence in Billing  Key Responsibilities: Experience in credentialing and billing with CareCentrix BCBSFL- UB-04 Claim Submission: Efficiently and accurately prepare, review, and submit Home Infusion claims using the UB-04 and EDI Formats as required by payers. Payer Credentialing: assist with credentialing and re-credentialing processes with various commercial and government payers, specific to the state of Florida. A/R Management: Follow up on outstanding claims, denials, and appeals to ensure timely and maximum reimbursement. Compliance:...

Billing Specialist Seeking a detail-oriented and dependable Billing Specialist to join our integrated care team in Newton, Kansas. This is a full-time position offering the opportunity to support patient care in a collaborative, mission-driven environment. We value collaboration, open communication, and a positive environment where everyone's input counts. As a vital member of the billing team, you play a critical role in the financial health of the organization and supporting access to care for our patients. We value the unique expertise each team member brings and are committed to supporting ongoing learning and professional development within the organization. What You'll Do Review charges for correct coding prior to claim submission, ensuring compliance with all federal and state regulations. Prepare and submit clean claims timely to insurance companies, electronically, via paper and through insurance portals. Resolve clearinghouse and payer...

Overview Top candidates will have experience with Oncology Coding.   As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA   This position is responsible for abstracting, coding, and interpreting of outpatient clinic and provider services for professional and/or facility billing. This position uses coding knowledge to abstract and record data from medical records and provides support to areas related to documentation and coding. This position codes and charges complex or specialty services and may serve as a resource for other coders. This position is not responsible for...

JOB TITLE: Certified Billing Specialist DEPARTMENT: Business Office LOCATION: Anchorage, AK STATUS: Full-Time, On-Site CERTIFICATION REQUIRED:  Active Certified Professional Biller (CPB) or Certified Coder (CPC) **SIGN ON BONUS: $3,000 (2yr commitment) ** About the Role Alaska Heart & Vascular Institute (AHVI) is seeking an experienced and detail-oriented Billing Specialist  to join our in-office Business Office team in Anchorage. This role is ideal for a billing professional who thrives in a collaborative environment and is looking to deepen their expertise in cardiology billing across outpatient, inpatient, and ambulatory settings. As part of a highly knowledgeable team of coders, billers, and clinical professionals, you’ll play a key role in ensuring accuracy, compliance, and exceptional service in a fast-paced, high-volume environment. SUPERVISION RECEIVED: Reports to Business Office Manager. SUPERVISION EXERCISED: None ESSENTIAL...

About the role We run a fast-growing care management program billed under partner clinic TINs across a mixed payer population. We need an expert to tighten CoCM billing yield while keeping documentation audit-proof as we scale from ~24 clinics to 100+. The right candidate will be able to convert this into a full-time role with equity, and grow with the company. Looking to hire ASAP. What you’ll own Design and audit CoCM and CCM billing workflows , including appropriate patient stratification between programs. Define clear, defensible criteria for assigning patients to CoCM vs CCM (and transitions over time). Build “gold standard” documentation templates and checklists for 99492/99493/99494, 99490, 99439 , and related codes as applicable. Design simple, audit-proof time capture and attribution workflows across care team members. Create and run a QA sampling plan with feedback loops for care teams and clinic billers. Partner with...

Adventist HealthCare seeks to hire an experienced Lead Coding Specialist for our Medical Coding Department who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing. As a Lead Coding Specialist, you will: Conduct reviews to validate I-10-CM diagnosis codes and PCS procedure codes for inpatient bill hold related to PSI, PPC & other reimbursement conventions to be resolved prior to final coded data. Manages daily DNFB and DNFC reports and work queues for un-coded or outstanding records. Under the direction of the coding manager, the coding specialist lead should be proficient in communicating with the coding team. Oversees coding corrections, abstracts elements for HSCRC submissions, and ensures coding compliance with coding standards. Liaison between coding and other departments, managing coding-related tasks and denials. Provides mentoring support to coders on coding...

Job Description Nemours is seeking a Sr. CDM Specialist  in Orlando, FL This position is responsible for: assistance in maintenance of Charge Description Master (CDM) within Nemours hospital revenue producing departments. Works with the CDM/HB Manager to ensure an accurate CDM and Coding process resulting in clean and compliant claims. Acts as liaison and problem solver for CDM issues with Administration, insurance companies, charge capture departments, Health Information Management, Utilization Management, Recovery Auditors, Managed Care, Corporate Compliances, and Central billing Office (CBO).  Responsibilities: Responsible for the coordination of ongoing CDM consistency within revenue producing departments. Includes maintaining accurate descriptions, coding, in-activations, and revenue code assignments.      Demonstrate and incorporate a working knowledge of the hospital's billing and coding software applications as related to coding...

About the Job The Director of Reimbursement and Market Access is responsible for assisting the Senior Vice President of Reimbursement and Market Access by collaborating with life sciences clients to provide analysis and insight related to coding, reimbursement, practice management, and policy. This individual will leverage internal data sources and professional experience to effectively support clients in developing and implementing reimbursement and market access strategies for their drugs, devices and other healthcare technologies. Duties and Responsibilities Develop and implement coding and reimbursement strategies for new and existing drugs, biologics, medical devices, digital technologies and diagnostic tests Lead client project engagements by serving as the direct point of contact for clients and coordinating with project teams Evaluate drugs and technologies to assess the potential applicability of coding options (HCPCS, CPT, ICD-10-PCS, and ICD-10-CM)...

Job Title:   Accounts Receivable (AR) Specialist Company:   Client First RCM, LLC Location:   In-Office/Remote/Hybrid– Pennsylvania Job Type:   Full-time About Us Client First RCM, LLC is a multi-specialty Revenue Cycle Management company serving providers across multiple states. We specialize in ethical, accurate, and efficient medical billing services with a focus on provider success and patient satisfaction. Job Summary We are seeking a dependable and detail-oriented Accounts Receivable (AR) Specialist to join our in-office team in Pennsylvania. This position plays a key role in managing AR follow-ups, claim resolution, and reimbursement activities across multiple medical specialties. Responsibilities: Follow up on unpaid or underpaid claims via phone, web portals, and written communication Resolve claim denials and rejections using EOBs and remittance advice Submit corrected claims and appeals with appropriate documentation Post...

General Summary:   U.S. Urology Partners, LLC (USUP) and its physician groups are committed to promoting conduct that is responsible, ethically sound, and compliance with applicable law.  USUP’s Compliance Department (CD) fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and reimbursement of health care.  An integral function of USUP’s compliance program is auditing and monitoring compliance with billing, coding, and documentation requirements of its providers.    An CPC, CCS-P, or CPMA is required for this position.     Compliance Audit Services:   Compliance audit initiatives include physician, other providers, and facility documentation audits as well as preparation of guidance documents and tools to assist physicians and staff in appropriate billing, coding, and documentation.  The audit program looks at professional fee billing,...

Job Summary Assigns appropriate ICD and CPT codes for reimbursement and statistical purposes. Follows ICD, CPT, CMS, and other regulatory coding guidelines. Abstracts clinical information from medical records for complete and accurate statistical documentation. Minimum Qualifications Minimum Education:   High School Diploma or Equivalent Minimum Years of Experience:   3 Years of Professional Coding Experience Covering Multiple Clinical and/or Surgical Specialties (Combination of Surgical, E/M, or other coding experience as approved by Director), which they Successfully Met Quality and Productivity Standards Substitutable Education & Experience (Optional):   None. Required Certifications/Licensure:   Active AAPC or AHIMA Coding Credential Required Training:   Experience working with CPT, ICD diagnosis coding; Experience with CCI edits; Experience with Medicare LCDs and NCDs; Understanding of state and federal regulations as well as payor...

Coding Operations Manager is responsible for overseeing the medical coding team and ensuring the accurate and efficient coding of patient records for billing, compliance, and reimbursement purposes. Oversee insurance verification department.  Needs skills with operational leadership, compliance oversight, team management, and process improvement within the healthcare revenue cycle. Experience: Equivalent of an Associate’s degree and two to three years of relevant emergency department or general medical coding experience. CPC required, CEDC additionally preferred.  Strong expertise in all professional medical coding, including ICD-10, CPT and HCPCS coding.  Excellent organizational skills and ability to multi-task. This is a hybrid position.  (Two days remote and three days in-house.) JOB RESPONSIBILITIES Oversee day-to-day operations of the medical coding team, ensuring timely and accurate coding and allocation of duties Ensure that all codes (ICD-10, CPT,...

Help safeguard accuracy, integrity, and regulatory compliance across our organization. We are seeking a skilled Compliance & Coding Audit Specialist to support the Corporate Compliance Program through detailed auditing, monitoring, and provider education related to coding, billing, and clinical documentation practices. What You’ll Do Conduct ongoing coding, billing, and documentation audits to ensure compliance with hospital policies and federal and state regulations Interpret medical records and related documentation using advanced coding knowledge to assess accuracy and risk Execute compliance audit assignments with a high degree of independence, confidentiality, and professional judgment Analyze findings, prepare audit documentation, and identify trends or improvement opportunities Present audit results directly to physicians and providers, delivering clear feedback and education on documentation and coding best practices...

JOB LOCATION:   Remote (Considering applicants residing in Georgia, Florida, Ohio, North Carolina, South Carolina, West Virginia, Utah, Arizona, and Missouri.) DEPARTMENT:   REVENUE CYCLE MEDICAL GROUP, SGMC Health SCHEDULE:   Full Time, 8 HR Day Shift, 8-5 Abstracts ICD-10 and CPT codes for Diagnosis and Procedures on professional services. Reviews and analyzes medical records verifying and coding the diagnosis, evaluation and management service, minor procedures, or other codes required for the completeness and accuracy of the record. Additionally, will code and/or review principal diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, any applicable supply, medication, and injectable drugs. Maintains communication with Management, Practice Manager, and Provider to ensure timely notification of identified documentation issues. Interact with other team members of the revenue cycle and provider clinics. Responsible for continuing education of...