8 jobs found in Highland Beach

Humana is seeking an experienced Outpatient Behavioral Health Coding Auditor to handle provider disputes in a metrics-driven environment. This remote role supports the Disputes Team in ensuring accuracy, timeliness, and quality of coding dispute outcomes for behavioral health claims. The ideal candidate has 3+ years of BH coding audits, CPT/HCPCS expertise, and strong communication skills, with proficiency in MS Office. Travel to Humana offices may be required occasionally. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy, documentation integrity and compliance across medical and behavioral health records. Required CPC certification, 3+ years of professional coding experience, familiarity with CPT/HCPCS/Revenue codes, CMS 1500/UB04 data elements, and proficiency with Excel/Word. Travel may be required. Full-time with comprehensive benefits. #J-18808-Ljbffr

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed....

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

Introduction This is a position specific recruitment for the Maryland Department of Natural Resources, Audit & Management Review. This recruitment will be used to fill current vacancies for the position and may be used to fill future vacancies in the same classification/function. Future vacancies may also be filled via other recruitments. The resulting eligible list will be maintained for one year. GRADE STD0019 LOCATION OF POSITION Tawes State Office Building, 580 Taylor Avenue, Annapolis, MD 21401 (Anne Arundel County) Main Purpose of Job Conduct and oversee internal and external audits and conduct management studies, reviews and analyses to evaluate program performance. Develop and mentor internal auditors. POSITION DUTIES The Department of Natural Resources, Audit & Management Review, located at 580 Taylor Avenue, Annapolis Maryland, is currently accepting applications for an Internal Audit Supervisor. This position will conduct and supervise audits...

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 you...

Datavant is seeking experienced inpatient coders for a fully remote position. The role requires proficiency in ICD-10-CM and ICD-10-PCS, with a focus on accurate sequencing and abstraction of codes from patient records. You will oversee Level 1 & 2 coders, drive documentation improvement, and maintain high accuracy and productivity benchmarks. The ideal candidate has at least 3 years of inpatient coding experience, AHIMA certifications preferred, and strong communication skills to collaborate #J-18808-Ljbffr

Humana is seeking a Medical Coding Auditor to remotely review outpatient claims and ensure accurate CPT/HCPCS coding against medical records. You will verify codes, analyze documentation, and support quality initiatives while maintaining patient confidentiality. Travel to Humana offices may be required for training. The role emphasizes independent work, strong CPT/HCPCS knowledge, and experience with radiation/infusion coding as part of outpatient services. #J-18808-Ljbffr