11 jobs found in Harrisburg

Job Opportunity Position Overview: We are seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with state and federal regulations. Key Responsibilities: Analyze claims data, medical records, and provider documentation to identify discrepancies, fraud, or non-compliance. Conduct retrospective case reviews, on-site provider audits, and recipient interviews. Review billing practices for upcoding, duplicate billing, and unbundling of services using ICD-10, CPT, and HCPCS manuals. Prepare reports, case findings, and recommend sanctions when violations are identified. Coordinate and participate in teleconferences, hearings, and legal proceedings with the Office of General Counsel and other agencies. Respond to provider complaints and compliance inquiries via...

A-Line staffing is hiring a Medical Billing Specialist in Harrisburg, PA. The Medical Billing Specialist would be working for a Fortune 500 Biomedical company. If interested APPLY NOW for IMMEDIATE consideration!! Medical Billing Specialist Job Details Pay Range: $22-$25/hour (based on experience) Location: Harrisburg, PA 17120 (100% Onsite to start with potential to convert to hybrid setup) Shift: Monday – Friday 8am-4pm with a 30-min lunch (37.5 hours per week) Education: High School Diploma or equivalent required. Medical Billing Specialist Responsibilities · Analyze Medical Assistance billing inquiries to determine claim accuracy and proper payment. · Investigate denied claims, identify causes, and explain denial reasons to providers based on Pennsylvania regulations and MA billing guidelines. · Review Remittance Advice statements and explain payment details, including adjustments and take-backs. · Provide proactive customer service to providers and recipients via inquiry...

Become a part of our caring community The Evaluation & Management Auditor (Medical Coding Auditor) is responsible for the accurate and compliant review of Evaluation and Management services, including complex professional inpatient encounters, minor procedures, emergency room services, consultation services, and annual wellness visits. The ideal candidate will have a strong background in professional fee coding and auditing, expertise in industry-standard encoders, and familiarity with multiple coding resources. This role ensures correct documentation, coding, and billing in accordance with regulatory guidelines, payer policies, and Humana's internal standards. The Medical Coding Auditor Evaluation & Management will report to the Manager, Medical Coding. WORK STYLE: Remote/Work at home WORK HOURS: Associates will work on EST, regardless of where the associate resides. All associates must start between 6AM-9AM EST, Monday - Friday as a dedicated schedule. Work...

Clerical Support Supervisor Penn State Health - Hershey Medical Center Location: US:PA: Harrisburg Work Type: Full Time FTE: 1.00 Shift: Day Hours: 8:00a-5:00p Monday-Friday Recruiter Contact: Lindsay E. Erdman Summary Of Position: Provides direct supervision of practice site clerical support staff to provide optimal clinical operations. Responsible for clerical supervision and management including; cost effective management of office supplies, high integrity adherence with organizational policies surrounding quality of patient registration, point of service cash collections and cash control, scheduling, and other clerical support functions, patient satisfaction with clerical staff experience, and clerical staff employee engagement. Abides by, and upholds in performance of direct reports, all related local, state, federal and accrediting body rules and regulations; promotes an exceptional patient experience, by providing customer service support and guidance to staff, and...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources...

Become a part of our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. We're looking for experienced and credentialed outpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the...

3/11/26 At TE, you will unleash your potential working with people from diverse backgrounds and industries to create a safer, sustainable and more connected world. Job Description: Day-to-Day Job Overview Develop new and revise existing firmware Full Software Development Lifecycle according to DO-178 Gitlab pipelines for test automation Generate deliverables and documentation This is a fully remote position. Job Requirements SW Architecture Design, Planning and Documentation Programming Arm Cortex microcontrollers Programming 16-bit PIC microcontrollers Serial communications protocols (RS485, SPI, I2C, 1553, ARINC 429 & 825, CAN) Non-volatile Memory, EEPROM Emulation, ROM, storage of configuration constants Cybersecurity requirements including boot protection, image verification, NVM CI/CD using GitLab DO-178 development expertise MISRA-C linting Writing and utilizing bootloaders Excellent debugging methodology and tools (JTAG, SWD) Selection of MCUs for new products...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days; all the while consistently meeting 92%-95% quality requirements. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (60%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (5%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing...