CareerHealth® powered by AAPC

PURPOSE OF THE JOB:  Oversees, leads, plans, manages, and supervises the day‑to‑day operations of the Health Information Management Services (HIMS) department and staff. Develops departmental goals, operating budgets, policies, and procedures aligned with BBAHC policies and applicable legal and governmental regulations. Serves as the organization’s designated Privacy Officer. ESSENTIAL FUNCTIONS Collaborates with senior leadership to establish annual, monthly, and weekly operational goals and executes detailed plans in accordance with HIMS best practices, legal and regulatory requirements, and professional standards. Demonstrates comprehensive knowledge of information privacy laws, access, and release‑of‑information requirements, including but not limited to 42 CFR Part 2, HIPAA, and HITECH. Maintains advanced knowledge of medical terminology, anatomy, coding guidelines, ICD‑10‑CM, CPT‑4, HCPCS, patient care documentation standards, and auditing principles. Aligns...

JOB PURPOSE: Responsible for supervising, evaluating, and consistently improving the day-to-day operations of Medical Practice. This role is responsible for accurate and timely billing of insurance claims and patient statements across multiple sites, implements accurate medical coding policies, and enhances operational processes. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing diagnosis data submission processes, presenting performance results to leadership, and supporting HCC/RAF optimization strategies. The role will also oversee the training of Medical Practice Assistants, Physician and IDT disciplines in ICD-9/ICD-10 guidelines. JOB RESPONSIBILITIES: Responsible to deliver accurate and timely billing of insurance claims and patient statements for all...

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary: We are seeking a talented individual for a Clinical DRG Auditor who is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the...

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)...