10 jobs found in Pittsburgh

Three Rivers Orthopedics is seeking a Certified Specialty Coder to support 11 orthopedic surgeons specializing in areas including spine and foot/ankle at 200 Delafield Road, Suite 1040, Pittsburgh, PA 15215. This full-time position runs Monday-Friday, 8:00 AM-4:30 PM, with flexible hours and work from home option. Responsibilities: Utilize advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements. Monitor billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices; prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation. Perform all coding functions, based on staffing needs and/or department requirements. Refer problem accounts to appropriate coding or management personnel for resolution. Maintain daily...

Purpose: All responsibilities of coder trainee, coder I, II plus the following: Monitors and responds to accounts on Pre-Bill edit and error reports. Assists with training other coders as requested. Performs PHC4 coding corrections; provides feedback to coders who made errors. Monitors the Daily Cirius Error report to ensure that there are 0 accounts exceeding the expected completion timeframe. Review and respond to the Pre-Bill Edit report issues to ensure timely billing. Assists with special projects as requested. Responsibilities: Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care and assign appropriate codes. Review appropriate documents in the patients' charts to accurately assign a diagnosis and/or procedure. Ensure the diagnoses and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG/APC/ASC or payment tier under the Prospective Payment system or DSM IV...

Job Description Job Description Description: About e4health At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do: Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth. Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day. WE GROW: We believe in win/win outcomes—when our customers win, we win. GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions. Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our...

Job Description Job Description Description: About e4health At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do: Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth. Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day. WE GROW: We believe in win/win outcomes—when our customers win, we win. GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions. Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our...

Purpose: Same responsibilities as Coder II. Responsible for assigning PQRS codes and assists in the development of templates and processes to obtain the appropriate documentation. Provide feedback to the physicians on coding, documentation, edit and denial issues. Responsibilities: Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification and provide education to physicians to accurately complete the coding process. Refer problem accounts to appropriate coding or management personnel for resolution. Make forward progress within the training period toward meeting coding accuracy standards of the departments within the first year of employment. Meet appropriate coding productivity standards within the time frame established by management staff. Provides training on code selection for new and existing staff. Investigate and resolve reimbursement issues, including...

Discover. Achieve. Succeed. #BeHere A minimum of three years of experience as an inpatient coder at an academic facility is preferred. Bachelor's degree in HIM or equivalent is preferred. Pay is expected to be between: (expressed as hourly) $24.05 - $38.48. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.

Job Title Purpose: Same responsibilities as a Coder I. Review all pertinent physician, nursing and ancillary documentation in the medical record. Depending on type of service and place of service, determine level of acuity, procedure(s) performed, billable supplies and diagnosis to substantiate medical necessity. Review and sequence all codes to maximize reimbursement and address any potential bundling issues. Apply modifiers as needed. LMRP/CCI edit and coding denial resolution. Responsibilities: Utilize computer applications and resources essential to completing the coding process efficiently. Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff. Refer problem accounts to appropriate coding or management personnel for resolution. Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the...

Clinical Coding Auditor & Trainer Location: Remote (U.S.) Must be willing to travel to New York twice annually Position Type: Full Time The Clinical Coding Auditor & Trainer is responsible for conducting clinical documentation and coding audits to ensure compliance with federal regulations, payer requirements, and company policies. This position focuses on DRG validation, inpatient...

Purpose: OUTPATIENT & INPATIENT CODING OUTPATIENT: Coding diagnosis & procedure codes ICD9 & CPT codes and charging for injections, infusions, hydrations, and observation hours. INPATIENT: Codes all inpatient accounts, diagnoses, and procedures. Responsibilities: Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD-9-CM, CPT and DSM IV codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc). Utilize the ACEP acuity level guidelines for assigning the correct acuity level for ED coding, or hospital specific acuity level module as needed. Adhere to internal department policies and procedures to ensure efficient work processes. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing...

ABA Billing Specialist Key Responsibilities: Submit accurate and timely claims for ABA services to private insurance, Medicaid, and other payers Verify insurance eligibility and benefits for new and existing clients Track and follow up on unpaid or denied claims; initiate appeals as needed Manage authorizations, re-authorizations, and documentation requirements for ongoing services Reconcile payments, post EOBs, and generate client invoices as needed Maintain compliance with HIPAA, payer guidelines, and ABA-specific billing codes (e.g., CPT 97151, 97153, 97155) Collaborate with BCBAs, administrative staff, and families to resolve billing issues and ensure smooth revenue cycle operations Requirements: 2+ years of medical billing experience, with a strong focus on ABA or behavioral health services Proficiency in billing software and clearinghouses (e.g., CentralReach, Office Ally, Kareo, SimplePractice) In-depth knowledge of ABA billing codes, modifiers, and...