1873 jobs found

Position Summary: The CDI Manager oversees and manages the Clinical Documentation Improvement (CDI) Program, taking charge of budgeting, monitoring, and ensuring compliance with healthcare regulatory standards. They uphold ACDIS & AHIMA guidelines and hospital policies, striving for high-quality, accurate medical record documentation through thorough reviews. Proactively seeking clarity from healthcare providers for specific documentation needs, they also continuously educate senior leaders and physicians on documentation guidelines. SKILLS AND CERTIFICATIONS [note: bold skills and certification are required] Previous lead or supervisory experience Familiarity with Utilization Review criteria Knowledge of CMS, Joint Commission, CADP, and other regulatory and compliance requirements CDI Credential (CCDS, CDIP) Electronic Health Record experience: 3M, Epic Minimum 7 years clinical RN experience 5 years’ experience as a CDI Specialist Knowledge of...

As the Operations Manager, you play a crucial role in ensuring the smooth functioning and efficiency of our organization. Your primary responsibility is to provide leadership to your assigned office and oversee its overall performance. You will work closely with the Director of Operations to drive process improvements, implement changes, and evaluate the success of new initiatives. Your role also involves managing employees in compliance with company policies and regulations, from recruitment and training to performance management and issue resolution. Key Responsibilities: Enhance Organizational Effectiveness: Streamline operational systems, processes, and policies to align with our mission. Improve management reporting, information flow, and organizational planning. Boost Operational Efficiency: Enhance the effectiveness and efficiency of operations in your assigned region. Foster collaboration and communication between support and...

HCC Manager - Risk Adjustment Coding and CDI   Full Time Day Shift  8a-5p, Mon-Fri ***Remote Position - Candidates MUST live in the state of SOUTH CAROLINA*** Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #2 in the state and #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina. The 607-bed teaching hospital anchors a health care network that includes five community medical centers and employs more than 8,000 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first   HeartCARE CenterTM  and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an...

Compliance Educator (Cert. Professional Coder) Corporate Compliance   Full Time Day Shift  8:00am - 5:00pm, Mon-Fri Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #2 in the state and #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina. The 607-bed teaching hospital anchors a health care network that includes five community medical centers and employs more than 8,000 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first   HeartCARE CenterTM  and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing...

Physician and Outpatient Medical Coder Job Listing 2 Fully remote positions available. One Profee coder one Facility coder to review coding denials and correct/validate CPT, ICD-10, HCPCS and modifiers for inpatient and outpatient professional and facility services. The coders will ensure that medical records are coded in an accurate and timely manner as well as 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 for multiple specialties including primary care, Ob/gyne, cardiology, ED, gastroenterology and more. 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...

Accurately and completely codes all inpatient or outpatient records   to ensure assigned codes conform to current coding conventions achieving 95% accuracy in code assignment. Performs coding consistent with productivity benchmarks. Consults providers for clarifications and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record. Minimum Education High School graduate or GED equivalent.    Associate or Bachelor degree in Health Information Management (or similar program) from an accredited program preferred. Minimum Work Experience Medical terminology and anatomy and physiology required. Minimum of two (2) years' experience in acute care hospital based ICD-10-CM and ICD-10-PCS coding...

Summary This position is responsible for the timely auditing and coding of professional services based on provider documentation, ensuring that all services are in compliance with the Tulane University Medical Group (TUMG) Guidelines. Responsibilities also include maintaining knowledge base relative to billing functions, internal and external regulations and documentation issues. This individual is required to maintain current knowledge of CMS and Louisiana guidelines that govern reimbursement for professional services. This person must be able to work independently and process large quantities of data. The ability to communicate clearly and professionally with providers, department administrators, and the TUMG staff and respond timely and accurately to inquiries are key elements required of the individual in this position. *** This position offers remote opportunities. Required Knowledge, Skills, and Abilities Proficient computer skills and a working...

Responsibilities :  Responsible for assignment of accurate Evaluation and Management (E&M) codes, ICD diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers and quantities derived from medical record documentation (paper or electronic) for outpatient encounters in a US Government facility. Plays a significant role in coding compliance activities. Knowledge and Skill: Excellent computer/communication skills Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience. Ability to handle multiple projects and appropriately prioritize tasks to meet deadlines Education/Certifications: RHIT, RHIA, CPC, CCS-P Obtain the required CEU requirements to maintain current and proper certifications Experience: Minimum of 3 years in the...

JOB DESCRIPTION CLAIM TECHNICIAN / ADMINISTRATION SUPPORT - FULL TIME The Illinois Life & Health Insurance Guaranty Association Claim Technician and Administration Support complements team members in various ways including the investigation of medical, behavioral, and long-term care health claims and death benefit claims.  This position works in conjunction with the claims team and utilizes policies and procedures to perform adjudication, adjustments and audits of claims, ensuring accuracy of payment details.  This position is the point person to ensure that claim benefit payments are distributed properly and includes such assistance as claims intake, TPN issues, document handling and maintenance of electronic folders and processes, including procurement. To be successful as a Claim Technician / Administration Support , candidates should be professional, polite, and attentive while also being accurate. The Claim Technician/ Administration Support should...

Responsibilities include, but are not limited to, the following: Preparing claims for electronic claims submission through a clearinghouse or direct submission to the insurance payer; Preparing paper claims for submissions via mail; attaching medical records when necessary for claim processing; Retrieving correspondence received from the clearinghouse or insurance company via mail and resolving all rejected claims for resubmission; Updating the billing system with necessary corrections for claims submission; Troubleshooting claims submissions; Maintaining a daily log of all uploaded, sent, and rejected claims; Establishing and maintaining a professional relationship with the clearinghouse and all insurance Electronic Data Interchange (EDI) department personnel and co-workers; Working with the Insurance Specialists to ensure proper filing of claims; Operating, using, and maintaining office equipment as trained. Minimum education and professional...

Seeking Breakthrough Makers Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career. CHOP’s Commitment to Diversity, Equity, and Inclusion CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children. We strongly encourage all candidates of diverse...

JOB SUMMARY Conducts risk-based and ad hoc coding compliance audits of inpatient and outpatient professional fee encounters to validate code assignment is in compliance with official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Understands, interprets, and applies coding guidelines for coding audits. Audits inpatient and outpatient professional fee diagnosis, Evaluation and Management, and procedural code assignments. Reviews claims to validate submitted codes and abstracted data including, but not limited to ICD-10 CM codes, CPT codes, and HCPCS codes which impact reimbursement. Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and...

Job Req ID:   111341 Compliance Auditor We are seeking a  Compliance Auditor   who will provide audit and research support to physicians, advanced practice professionals, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the Sr. Auditors/Trainers, Associate Managers, Associate Director and Director to provide input and assist in the development of any applicable training and education content. Assists in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. The documentation audits are conducted as part of the School of Medicine’s Professional Fee Compliance Program....

The position can be as an IC  or employee Under the direction of Compliance and Coding Management, the Medical Auditor is responsible for performing focused coding quality reviews to validate the integrity of code assignments by Coding Specialists for E/M levels, CPT procedures, modifiers, HCPCS codes and ICD-10 codes according to medical chart documentation. The Auditor will document and report to management relevant coding and provider documentation trends including areas that are high risk for potential compliance concerns. The Auditor is responsible for offering recommendations for improvement to maintain a minimum of 95% coding quality across the department. The Auditor ensures billing optimization and minimizes errors by identifying opportunities during review and audit. The Auditor will assist with special projects as needed. The Auditor is responsible for maintaining current coding regulatory and procedure changes which may affect coding compliance and reimbursement....

AAPC Recruiting Services is working on behalf of organization that has provided patients with unmatched quality care.  This is a stable, private practice that offers personal care and focuses on building relationships with all the patients they serve.  If you are detailed oriented, looking for a fantastic work culture, and like to be flexible...then read on! Currently, they are seeking a certified medical billing professional with the following qualifications: Able to work ON-SITE in the West Palm Beach (Florida) area Has 2+ years of experience in medical coding Has obtained and currently holds either Certified Professional Coder (CPC), Certified Risk Coder (CRC), and/or the Certified Professional Biller (CPB) The responsibilities include: Updates patient data, developing payment plans, and preparing invoices Ensures that patients are billed quickly and accurately  Processes insurance claims, denials, and verifications within the standard monthly billing...

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:...

Looking for a Subcontractor Medical Coding Opportunity?   We have 5 remote contract opportunities working with the Veterans Health Administration- Veterans Affairs:   -        Outpatient Medical Coder -        Inpatient Medical Coder -        Surgery Coders -        Pro Fee Coders -        Auditors   Key Skills and Experience:   -        Required 2 years’ experience in the Veterans Health Administration- Veterans Affairs as a Medical Coder -        Active credential/certification with AAPC or AHIMA   If you meet these qualifications and are looking for part-time work, we want to speak with you and tell you about this great opportunity!

JOB SUMMARY: Hours: Monday - Friday 7am-5pm (Flexible) - Transitioning to hybrid soon  Location: North Phoenix. 1929 W Lone Cactus Dr., Phoenix, AZ 85027  The Eligibility Billing Specialist provides comprehensive advanced billing support to Pathology Billing Services, LLC to enhance the generation of accurate billing of insurance claims and patient statements. All employees are responsible for supporting the company’s goals and mission by following all company policies and procedures.   ESSENTIAL FUNCTIONS: Work assigned client workload in a timely manner. Review and resolve any front-end eligibility edits for clean claim submission(s) (i.e., patient demographics, insurance, etc.) Ability to research and obtain specific insurance plan information such as payor address, clearinghouse data and other field requirements. Maintains productivity and accuracy metrics per department expectations. Complete status...

Organization benefits for position: 100% remote but candidate  must reside in California These are full-time opportunities Full Benefits - Health/Dental/Vision/Life/AD&D/FSA Basic Term Life Insurance and accidental death insurance 401(k) contributions  Client to p rovide Codify Equipment supplied Position – OP Ancillary Physician Coder: CPC or CCS required   CHONC preferred Minimum of  3 years of current experience  in a hospital or physicians office as a medical coder Expert knowledge of ICD10-CM, CPT, and HCPCS EPIC software experience  required Proficient with Microsoft Purpose Statement / Position Summary Under the direction of the Coding Compliance Manager, the Pro-Fee Oncology Physician Coder will play a key role in reviewing and analyzing billing and coding for charge processing, specifically with...

Certified Coder is a nonexempt position responsible for front office and general coding billing duties. Responsible for Coding Audits, Claim, Billing review and compliance.  Performance Requirements Knowledge Knowledge of billing practices and clinic policies and procedures. Knowledge of coding and clinic operating policies.  Knowledge of medical terminology Knowledge of health care insurance claim practices and compliance. Knowledge of computer systems, programs, and applications. Skills Proficient skills in computer programs. Skill in using a calculator. Abilities Ability to understand and interpret policies and regulations. Ability to read and interpret medical charts. Ability to examine documents for accuracy and completeness. Ability to communicate effectively and work with others.   Major Duties and Accountabilities Coordinates with clinical staff to verify charge and/or documentation information as needed...

Summary: Remote Medical Billing Specialists needed to provide best-in-class billing services to our private pediatric practice clients.   Job Tasks: Review claims for accuracy; oversee processing of claims to payers Resolve insurance company payments that are late, underpaid or denied Work closely with providers, practice managers and staff to implement best practice protocols. Responsibilities: Learn and become proficient with the premiere pediatric system in the industry- Physician’s Computer Company (PCC) Billing. Efficiently analyze insurance claims throughout the submission process, insuring claims are accurately coded in a timely fashion, and for optimum reimbursement and compliance. Ensure that all claims reach the payers, and independently resolve any issues (underpayments, denials, etc.) with the claims so they are paid fully and on time. Post payments, organize processing of patient correspondence and...

Summary: This position will support coding operations and compliance as part of the Medical Modernization Program. The coding professional will conduct internal audits; monitor coding practices and documentation deficiencies to identify, develop, deliver training and monitor effectiveness of efforts to ensure improvement to documentation, coding completion, timeliness and accuracy rates for the MTF. Knowledge and Skills: Knowledge of The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-CM), procedural coding, healthcare common procedure coding system (HCPCS)/current procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes to perform the duties described. Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and, Resource Based Relative Value...

Summary: The position will reduce inpatient  facility, ambulatory procedure visit (APV), or professional services coding (PSC) backlog created by workload  surges, manning shortages, or computer system issues. This position will conduct focused audits for coding  compliance or training purposes; develop standardized coding training; deliver coding education/training to  individuals or groups; and identifying/educating on clinical documentation improvement opportunities. Knowledge and Skill: Knowledge of The International Classification of Diseases, Ninth Revision, Clinical Modification (ICDCM), procedural coding, healthcare common procedure coding system (HCPCS)/current  procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and  physiology, pharmacology, and disease processes to perform the duties described. Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related  Groupings...