8 jobs found in Grants

Coding Auditor AllCare Health | Quality Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members. This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes. Essential Duties Ensures the accuracy and...

Coding AuditorAllCare Health | Quality Department | Grants Pass, OregonSummary of the PositionThe Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members.This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes.Essential DutiesEnsures the accuracy and correlation of diagnosis codes, dates of service, medical record documentation, and other information used to support risk adjustment.Identifies, analyzes, and communicates trends related to coding accuracy and documentation quality.Develops and supports intervention...

Options for Southern Oregon in Grants Pass, OR, is seeking a Medical Billing Specialist to support our billing team with patient payments and insurance claims in behavioral health services. You will enter data into the EHR, manage claims, and work with insurance providers to resolve denials, ensuring timely, accurate reimbursements while maintaining confidentiality and meeting deadlines. Strong organizational skills and knowledge of Oregon billing requirements are essential, with prior #J-18808-Ljbffr

Coder IIAccurate assignment of ICD-10-CM/PCS, CPT-4 codes, HCPCS and Modifiers to the highest level of specificity as supported by documentation in the medical record in compliance with governmental regulations and hospital policies. Review of the quality of data and documentation and facilitate improvement. Responsible for reviewing medical records/assigned charges as necessary, for accuracy.Essential Functions:Understands and is able to apply inpatient, emergency room, observation, day surgery and clinic/outpatient coding guidelines depending upon the patient type being coded.This position is able to fill in when other coders are out of office.Codes RFV (Reason for visit), which are the patient's own words on why they are presenting for services.Codes as the principal diagnosis "The condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care", adhering to Cibola General Hospital's Coding, Abstracting, Data...

Medical Billing SpecialistThe Medical Billing Specialist assists the billing department to accurately manage patient payments and insurance claims. The specialist submits claims and/or encounters for clinical services to insurance companies, and other payers, to ensure proper reimbursement. Adheres to claim submission deadlines, posts payments and enters data into the electronic health record (EHR). Utilizes medical terminology, CPT coding, ICD coding, and HCPCS in relation to behavioral health services to process claims through the EHR. Performs quality assurance reviews to ensure clean claims are submitted. Maintains working knowledge of the State of Oregon's diagnosis requirements for billing behavioral health services under the Oregon Health Plan and the payment structure, to properly bill for services. Responsibilities are shared among individuals; one person will not have full responsibility for every duty.Enters required billing data into the EHR.Creates and generates...

Certified Claims Call Center Processor I at AllCare Health with the Claims department in Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options. Summary of the Position The Certified Claims Call Center Processor I serves as a primary point of contact for provider offices and their authorized representatives, responding to inbound calls and electronic inquiries regarding professional and facility claims processing and adjudication. This role combines customer service and certified claims processing responsibilities by independently resolving provider inquiries, researching claim issues, and adjudicating professional claims in accordance with company policy, contract language, coding guidelines, and applicable regulatory requirements....

Claims Processing Supervisor AllCare Health | Claims Department We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Claims Processing Supervisor ensures that internal and external departmental performance requirements are consistently met. This role oversees the day-to-day activities of the Claims Processing team, assigns work and coordinates efficient workflows to meet contractual and operational requirements, and serves as a hands-on resource for staff regarding training, questions, and claims processing best practices. Essential Duties Provides one-on-one support and initial training for new hires and facilitates monthly mandatory training sessions for Claims Processing staff. Establishes and maintains a professional, supportive, and provider...

Coding Auditor AllCare Health | Quality Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members. This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes. Essential Duties Ensures the accuracy and...