31 remote jobs

The Senior Medical Director serves as a pivotal clinical leader within Lyric, providing strategic oversight for the development, validation, and continuous improvement of pre-payment edits to ensure robust payment integrity. In this capacity, the Senior Medical Director partners with executive leadership, clinical teams, and external stakeholders, acting as a trusted advisor on complex clinical scenarios and claims outcomes. As the primary liaison between Lyric and its customers, this role represents the organization in industry forums and payer-provider collaborations, fostering strong relationships and advancing Lyric’s reputation as an industry leader. The Senior Medical Director is also responsible for remaining at the forefront of evolving healthcare trends, regulatory requirements, and advancements in medical practice, ensuring that Lyric’s strategies and solutions consistently reflect best practices and support organizational objectives. Role Responsibilities:...

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...

Position Summary The Certified Medical Biller and Coder is responsible for accurately reviewing medical documentation, assigning appropriate diagnosis and procedure codes, and supporting the billing process to ensure timely and compliant reimbursement. This role plays a critical part in maintaining the integrity of the revenue cycle by ensuring claims are coded correctly, submitted efficiently, and compliant with payer and regulatory guidelines. The position requires strong knowledge of CPT, ICD-10-CM, HCPCS coding systems, payer requirements, and medical billing workflows. Essential Duties and Responsibilities Review provider documentation and assign accurate CPT, ICD-10-CM, and HCPCS codes Ensure coding compliance with Medicare, Medicaid, and commercial payer guidelines Verify documentation supports medical necessity and appropriate coding Apply correct modifiers and place-of-service codes Prepare and review claims prior to submission to ensure...

Essential Functions: Coordinates with Compliance Audit Manager and Sr. Audit Director on any billing compliance investigations. Reviews and audits documentation in the medical records and charges submitted including CPT and ICD-10information to ensure compliance. Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing are being performed in an accurate and timely manner and is supported by documentation. Analyzes billing trends to identify areas of non-compliance and prepares regular reports on audit findings to Compliance Manager. Collaborates with the Compliance Team to develop annual audit work plans. Educates providers when deficiencies in documentation and code selection are identified. Develops corrective action plans and participates in compliance investigations as needed. Performs other duties as...

The Medical Policy Manager is responsible for overseeing all cap thresholds and medical review triggers, ensuring they are routed either for administrative evaluation by the vendor or referred to the state’s Utilization Management (UM) vendors for clinical review. Qualifications Certified Coding Specialist credential issued by the American Health Information Management Association (AHIMA) Minimum of five years’ experience creating and administering medical and/or Utilization Management (UM) policies for state Medicaid programs or Medicare Strong working knowledge of Centers for Medicare & Medicaid Services (CMS) procedure and diagnosis coding, including dental and Current Dental Terminology (CDT) codes Bachelor’s degree in a related discipline

Position Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.  As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the DRG Operations Department leaders, the DRG Reviewer will conduct reviews of inpatient claims for both coding accuracy as well as perform screening referrals for clinical support of coded diagnoses. Responsibilities: Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing. Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides. Collaborates with physician reviewers, as needed. Ability to prioritize and organize workload and complete tasks independently....

Physicians' Choice is currently seeking a highly proficient and seasoned Medical Coding Auditor specializing in Evaluation and Management (E/M) services, with a comprehensive understanding of Emergency Medicine, to join our esteemed team. If you possess extensive expertise in current E/M coding guidelines and have a strong background in auditing, we invite you to apply for this exceptional opportunity. Job Description:  As a Medical Coding Auditor you will play a vital role in ensuring accurate and compliant coding practices within our organization. You will be responsible for conducting detailed audits of medical records, coding documentation, and related billing processes to verify compliance with established coding guidelines, regulatory requirements, and internal policies. Responsibilities: Perform comprehensive audits of medical records, coding documentation, and billing processes. Evaluate the accuracy, completeness, and appropriateness of medical...

Are you an experienced and motivated Medical Biller specializing in Home Infusion Therapy? The ideal candidate would have experience in billing for implanted pain pumps. We are seeking a skilled 1099 contractor with experience in billing for Florida-based home infusion services and in Payer credentialing. This is a remote contract position offering flexibility and competitive compensation. Expericence in Billing  Key Responsibilities: Experience in credentialing and billing with CareCentrix BCBSFL- UB-04 Claim Submission: Efficiently and accurately prepare, review, and submit Home Infusion claims using the UB-04 and EDI Formats as required by payers. Payer Credentialing: assist with credentialing and re-credentialing processes with various commercial and government payers, specific to the state of Florida. A/R Management: Follow up on outstanding claims, denials, and appeals to ensure timely and maximum reimbursement. Compliance:...

Overview Top candidates will have experience with Oncology Coding.   As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA   This position is responsible for abstracting, coding, and interpreting of outpatient clinic and provider services for professional and/or facility billing. This position uses coding knowledge to abstract and record data from medical records and provides support to areas related to documentation and coding. This position codes and charges complex or specialty services and may serve as a resource for other coders. This position is not responsible for...

About the role We run a fast-growing care management program billed under partner clinic TINs across a mixed payer population. We need an expert to tighten CoCM billing yield while keeping documentation audit-proof as we scale from ~24 clinics to 100+. The right candidate will be able to convert this into a full-time role with equity, and grow with the company. Looking to hire ASAP. What you’ll own Design and audit CoCM and CCM billing workflows , including appropriate patient stratification between programs. Define clear, defensible criteria for assigning patients to CoCM vs CCM (and transitions over time). Build “gold standard” documentation templates and checklists for 99492/99493/99494, 99490, 99439 , and related codes as applicable. Design simple, audit-proof time capture and attribution workflows across care team members. Create and run a QA sampling plan with feedback loops for care teams and clinic billers. Partner with...

About the Job The Director of Reimbursement and Market Access is responsible for assisting the Senior Vice President of Reimbursement and Market Access by collaborating with life sciences clients to provide analysis and insight related to coding, reimbursement, practice management, and policy. This individual will leverage internal data sources and professional experience to effectively support clients in developing and implementing reimbursement and market access strategies for their drugs, devices and other healthcare technologies. Duties and Responsibilities Develop and implement coding and reimbursement strategies for new and existing drugs, biologics, medical devices, digital technologies and diagnostic tests Lead client project engagements by serving as the direct point of contact for clients and coordinating with project teams Evaluate drugs and technologies to assess the potential applicability of coding options (HCPCS, CPT, ICD-10-PCS, and ICD-10-CM)...

Job Title:   Accounts Receivable (AR) Specialist Company:   Client First RCM, LLC Location:   In-Office/Remote/Hybrid– Pennsylvania Job Type:   Full-time About Us Client First RCM, LLC is a multi-specialty Revenue Cycle Management company serving providers across multiple states. We specialize in ethical, accurate, and efficient medical billing services with a focus on provider success and patient satisfaction. Job Summary We are seeking a dependable and detail-oriented Accounts Receivable (AR) Specialist to join our in-office team in Pennsylvania. This position plays a key role in managing AR follow-ups, claim resolution, and reimbursement activities across multiple medical specialties. Responsibilities: Follow up on unpaid or underpaid claims via phone, web portals, and written communication Resolve claim denials and rejections using EOBs and remittance advice Submit corrected claims and appeals with appropriate documentation Post...

General Summary:   U.S. Urology Partners, LLC (USUP) and its physician groups are committed to promoting conduct that is responsible, ethically sound, and compliance with applicable law.  USUP’s Compliance Department (CD) fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and reimbursement of health care.  An integral function of USUP’s compliance program is auditing and monitoring compliance with billing, coding, and documentation requirements of its providers.    An CPC, CCS-P, or CPMA is required for this position.     Compliance Audit Services:   Compliance audit initiatives include physician, other providers, and facility documentation audits as well as preparation of guidance documents and tools to assist physicians and staff in appropriate billing, coding, and documentation.  The audit program looks at professional fee billing,...

JOB LOCATION:   Remote (Considering applicants residing in Georgia, Florida, Ohio, North Carolina, South Carolina, West Virginia, Utah, Arizona, and Missouri.) DEPARTMENT:   REVENUE CYCLE MEDICAL GROUP, SGMC Health SCHEDULE:   Full Time, 8 HR Day Shift, 8-5 Abstracts ICD-10 and CPT codes for Diagnosis and Procedures on professional services. Reviews and analyzes medical records verifying and coding the diagnosis, evaluation and management service, minor procedures, or other codes required for the completeness and accuracy of the record. Additionally, will code and/or review principal diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, any applicable supply, medication, and injectable drugs. Maintains communication with Management, Practice Manager, and Provider to ensure timely notification of identified documentation issues. Interact with other team members of the revenue cycle and provider clinics. Responsible for continuing education of...

Ever wanted to help build the organization you always wanted to be a part of? At Norwood we’re forging our own path. We’re a remote-first staffing and consulting company specializing in mid-revenue cycle management within the healthcare industry.  Our team of experts have delivered meaningful improvements to our partners with proven ROI with sustainable outcomes. We have also placed thousands of professionals that support organizations ranging from small, community-based hospitals to the largest healthcare systems in the nation. Our mission? Bringing health to hospitals’ bottom lines. We are looking for a motivated and relationship-driven Client Delivery Lead Consultant, to help manage the growth within Norwood’s Solutions division. The Client Delivery Lead Consultant will play an integral role leading and managing the successful development and delivery of various project types within the mid cycle space. Development and delivery success will including aligning team members with...

Physician Medical Coder Job Listing   PLEASE READ JOB DESCRIPTION    Profee coder to review coding denials and correct/validate CPT, ICD-10, HCPCS and modifiers for physician services.  Our coders will review medical records, research payer policy, and NCDs to make coding corrections and resubmit corrected claims in an accurate and timely manner. We work closely with other team members and management to translate clinical documentation consistently and accurately into ICD-10 and CPT codes with proper sequencing and modifiers. Through these efforts, the individual within this role will identify and report error patterns, resolve errors or issues associated with coding and billing processes, and when necessary, assist in the design and implementation of workflow changes to reduce billing errors.     Job Requirements     At least one active certification is required. Additional certifications a plus. Accepted certifications...

Provider Coding Specialist Are you passionate about quality and committed to excellence? Consider joining our Tidelands Health team. As our region's largest health care provider, we are also one of our area's largest employers. More than 2,500 team members at more than 70 Tidelands Health locations bring our healing mission to life each day. A Brief Overview Under the supervision of the Coding Supervisor, the Provider Coding Specialist is responsible for analyzing and assigning ICD-10-CM diagnostic codes, CPT, and HCPCS codes to professional surgical patient accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Organization policy and procedure. Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes...

AAPC is seeking a highly motivated and dedicated coding professional to join our team as a Contract Coder. This position is a fully remote contract role. The ideal candidate must have at least 5 years of coding experience for physician practices, with various surgical specialties as well as E/M. The position requires one to be resourceful, organized, and extremely driven. The ideal candidate will possess the following: Minimum 5 years of coding experience Extensive coding in multiple specialties including: all primary care specialties, anesthesia, general surgery, dermatology, and orthopedics. Excellent written and verbal communication skills Detail oriented and deadline driven attitude Sound knowledge of medical terminology Strong computer skills (Excel, Word, and internet) Ability to multitask and keep a sense of urgency Excellent customer service skills Strong time management, organization skills, and work ethic Job Duties:...