8735 jobs found

Duties include performing audits of health status by performing primary source validation comparison of medical record documentation to the corresponding paid claim to ensure all risk adjusted diagnosis in the medical record and on the claim align and originate from a valid source.  Core duties and responsibilities include the following: Performs quality reviews on records to validate coding according to the International Classification of Diseases Manual (ICD-10) for diagnoses and coding guidelines. Review medical records to validate diagnosis on the claim are supported by the medical record documentation Review medical records to ensure all relevant diagnosis for a date of service were documented by the provider on the corresponding claim. Works individually and/or within a team to validate the health status which determines the risk score and HCC for health plan members including: Service Code Accuracy (CPT/HCPCS) Diagnosis Codes Accuracy for codes...

APPLY TODAY!!!! FULL-TIME DENIAL FOLLOW UP SPECIALIST   Our Company: Revco Solutions provides best-in-class Revenue Cycle management to Hospital and Physician Service clients.   Position Description:  The Denial Follow Up Specialist handles inbound and outbound calls with insurances and follow up on accounts within a timely manner working towards a one touch resolution.   Duties & Responsibilities: Handle and resolve assigned group of accounts Resolve and recover lost revenue from these denials Investigate the issues and attempt to overturn the denial to get the claims paid   Requirements: 2+ years of previous experience working with commercial or other third-party insurance claims, medical billing/follow-up An understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice Physician and facility, insurance follow-up and denial experience Must have Certified...

About the Role: The Accounts Receivable Specialist (“Specialist”) is an integral member of Community Reach Center’s Finance (“Division”) Division. The Specialist is responsible complete billing process including timely and accurate review of the billing and reporting including data analysis and follow-up and records payments to Consumer/Patient accounts and maintains accounts receivable records. Additionally, the Specialist will have other duties and responsibilities as determined from time to time by the Accounts Receivable Manager. Essential Functions:  Conducts agency business and engages both internal and external customers in a professional and collaborative manner. Accurately post payments to account including apply notations to account for communication. Responsible for follow-up, appeals and denials of claims. Complete insurance eligibility and benefit verification. Regularly work aging and unbilled reports for payment. Reviews all intake and...

JOB SUMMARY: CDI Specialists will collaborate extensively with physicians, nursing staff, other patient caregivers, and medical records coding staff to improve the quality, specificity, accuracy and completeness of the documentation of care provided and coded. CDI Specialist will review medical records for opportunities for diagnosis clarification and validity as it pertains to DRG assignment, severity of illness, risk of mortality, and case mix data as well as timely, accurate and complete documentation of clinical information used for measuring and reporting physician and facility outcomes. These goals will be accomplished by chart review and query placement when appropriate following AHIMA guidelines and CorroHealth policies and procedures. This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES:  Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended...

JOB SUMMARY: Coding Specialists are an important part of the Team at CorroHealth. Will be Coding Professional Fee charts in several specialties for clinics. Specialties needed: Trauma, Neurology/Neurosurgery, Interventional Radiology, Hospitalist, and Orthopedic This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES:  Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. This is a remote position Must live in the US. Specialties needed: Trauma,   Neurology/Neurosurgery,   and Interventional Radiology Team Member must be able to work...

This in on-site role  Job Summary The Billing Specialist II plays a key role in ensuring the success of the revenue cycle by managing billing functions, resolving denials, and supporting process improvements. This position serves as a resource for training, special projects, and complex billing issues, with a strong focus on accuracy, compliance, and timely claims resolution. Key Responsibilities: Duties include, but are not limited to: ·         Identify, research, and resolve complex claims, including payer-rejected and denied claims . ·         Investigate denial reasons and develop strategies to reduce future occurrences . ·         Prioritize and resolve items in billing and manager hold buckets . ·         Verify insurance coverage and eligibility, update patient records with accurate information . ·         Manage accounts receivable and follow up on outstanding balances . ·         Collaborate with...

About the role:                                                        The Audit and Coding Specialist (“Audit and Coding Specialist”) is an integral member of Community Reach Center’s Quality Improvement (“QI”) Division. The Audit and Coding Specialist is responsible for managing all aspects of assigned projects, reviewing compliance standards to maintain quality assurance functions, and support risk management activities for the agency. Additionally, the Audit and Coding Specialist will have other duties and responsibilities as determined from time to time by the Utilization Manager. Essential Functions:  Designs and implements internal compliance audits, regularly monitoring accuracy and adherence to documentation requirements in collaboration with Utilization Manager to support continuous quality improvement and compliance as identified in the Quality Management Plan (QMP). Conducts audits as determined by the Manager or Director. Oversees...

Cardiology and Vascular Billing Specialist Location: Port Richey, FL Position Overview We are seeking a detail-oriented   Cardiology and Vascular Authorization and Billing Specialist   to join our team in Port Richey, FL. This role is responsible for ensuring timely insurance approvals (prior authorizations) for cardiac procedures and vein treatments, while managing accurate billing, coding (ICD-10, CPT), and reimbursement processes. The ideal candidate will prevent denials by verifying benefits, providing clinical documentation to payers, and coordinating with clinical staff for peer-to-peer reviews. Key Responsibilities Prior Authorization Acquisition:   Obtain authorization for appointments, tests, and complex vascular/cardiovascular procedures by reviewing clinical documentation and understanding payor guidelines. Clinical Collaboration:   Partner with physicians to gather medical necessity documentation for insurance reviews. Billing & Coding:...

Join Our Team We are seeking a detail-oriented and experienced   Medical Billing and Coding Specialist   to join our growing team. This role is ideal for a motivated professional who thrives in a fast-paced, team-oriented environment while maintaining the ability to work independently. This is an onsite position located in Linden, NJ. This position has the ability to go remote after six months. If you enjoy solving complex billing challenges, analyzing denial trends, and contributing to process improvements, this is a great opportunity to advance your career. What You’ll Do As a key member of our revenue cycle team, you will take ownership of complex billing processes and serve as a resource for coding and payer-related issues. Core Responsibilities: Review, code, and submit provider/practice claims with accuracy and timeliness Independently manage assigned work queues to ensure proper charge capture Investigate and resolve complex claim denials and...

Director of Operations/Revenue Cycle Manager Millstone Healthcare Full-Time | In Person/Leadership Role | Physical Medicine Practice About Millstone Healthcare Millstone Healthcare is a growing multi-disciplinary physical medicine practice with over $3 million in annual revenue and a team of 35+ employees dedicated to delivering exceptional patient care. We specialize in Federal Workers Compensation, Personal Injury, & Aesthetics.  Our collaborative environment brings together providers and staff focused on improving patient outcomes while creating an efficient, positive experience for every patient we serve. We are seeking an experienced, highly organized, and results-driven  Director of Operations/Revenue Cycle Manager  to oversee the daily operations of our practice and help lead our next phase of growth. Position Summary The Director of Operations/Revenue Cycle Manager will be responsible for the overall administrative and operational...

Summary The Experienced Medical Billing Specialist provides best-in-class full RCM billing services for our private pediatric practice clients. 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 statements. Answer phone inquiries from...

SCOPE/GENERAL PURPOSE OF JOB:   The Coding Specialist is responsible for abstracting all E/M, CPT, HCPCS, ICD-10-CM, modifier, and units from the medical record documentation.  Other responsibilities include accurately entering data into coding/billing software and/or Excel reports.  Performing accurate coding using applicable guidelines and facility protocols and communicating with staff and/or providers as needed.  Provide written feedback of coding results as needed in the form of comments, summary of findings, and recommendations.  Ensure compliance with federal and state laws, regulations and standards related to health information and coding principles.       ESSENTIAL DUTIES AND RESPONSIBILITIES:   Assign ICD-10 CM and CPT codes with modifiers for services provided in the facility environment (Ancillary, ED, Evaluation and Management, Observations, Outpatient surgeries, and/or Professional fee coding) depending on the specific...

Bring your coding expertise to SSM Health in a role where education, quality, and compliance come together. As a Coding Educator, you’ll partner with providers and coders, lead training initiatives, and influence documentation and coding practices that support accuracy, consistency, and revenue integrity across the organization. PRIMARY RESPONSIBILITIES Drives optimal clinical and financial outcomes through thorough assessment of provider documentation and coding competency, identification of improvement opportunities. Develops and delivers training and education of all coding processes. Stays abreast of regulatory changes and works with leadership to ensure compliance and revenue integrity. Act as subject matter expert for providers and coders while providing guidance and clarification on issues which present in their daily account processing. Establishes and coordinates internal quality review processes and corresponding training for providers and coders....

Account Specialist II Locations: Fort Worth, TX Time type: Full time Job requisition id: JR-114239 Location: Calmont Operations Building Department: CBO/Patient Financial Services Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: Under the leadership of Patient Financial Services (PFS) management, the Account Specialist II is responsible for accounts receivable through claim follow up, cash collection, and denial management for services rendered by Cook Children's Medical Center (CCMC). This position requires extensive knowledge of Federal, State, and payor regulations, reimbursement methodologies, and communication with third party payers to facilitate timely and accurate reimbursement. Perform root cause analysis and resolution of denial and variance records. Triage and resolve payor denials. Review and adjudicate insurance credit balances. Qualifications: High School Diploma or...

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Risk Adjustment Coding Specialists are an important part of the Team at Virtix Health. The HCC Coding Team Member will review medical records to abstract ICD-10 codes, specifically those that map to HCCs, RxHCCs, and ESRD models. Coders will follow Medicare guidelines, ICD-10-CM guidelines as well as client specific requirements. Equipment provided along with Encoder software with access to AHA Coding Clinic This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES:...

Lead Coding. Drive Revenue Integrity. Shape Provider Performance.  El Camino Health is seeking a highly experienced HIM Professional Billing Coding Manager to lead coding operations across its medical network. This is a critical leadership role directly tied to revenue cycle performance, compliance, and provider documentation excellence. If you bring deep expertise in professional billing (PB) coding, auditing, and provider education , this is your opportunity to make a meaningful impact within a respected, nonprofit health system. About El Camino Health El Camino Health is an integrated, nonprofit health system known for delivering high-quality, patient-centered care across its communities. With a strong commitment to innovation, compliance, and clinical excellence, the organization plays a vital role in driving healthcare outcomes and access across the region. This position is onsite in Mountain View, CA 2 days a week, with 3 days available for remote work....

Join a dynamic team committed to supporting our employees and our community. Our Vision: Improving lives through compassionate and innovative healthcare. Schedule: Days - Variable, 40/hrs a week Base Wage: $37.72 to $50.59 Location: SRH Business Center, Mount Vernon, WA - Remote hybrid available Sign-On Bonus: $1,000.00 Apply online at www.skagitregionalhealth.org/careers Job Summary Responsible for the accurate coding and abstracting of inpatient and outpatient diagnoses and procedures into codes using an international classification of diseases. The Certified Coder will ensure that records are coded in an accurate and timely manner as well as work closely with physicians and documentation nurses or specialists to consistently and accurately translate clinical documentation and medical records into ICD-10, HCPCS, CPT, Modifiers and assign Ambulatory Payment Classifications (APC) and/or Diagnosis-Related Group (DRG) codes. To ensure success...

This is a remote position Scope of Position   Coding Services assigns diagnosis and procedural codes for hospital outpatient (facility) medical records to support accurate reimbursement and data collection across the entire Ohio State Health System, including University Hospital, East Hospital, and The James Cancer Hospital. This position does not include professional-fee (pro-fee) coding . ICD-10-CM and CPT diagnosis and procedure codes are applied to all hospital outpatients treated within The Ohio State Health System when services are not captured through the charge description master. Medical record abstract data is assigned based on a review of documentation for accuracy within IHIS during the coding process. Position Summary   The position is responsible for coding medical records and other documents at the conclusion of the patient’s visit. A senior medical records coding specialist requires the skill set to code multiple work types for...

Sierra7 is look for experienced Medical Coding professionals to join our team! If you have recent VA coding experience and want a flexible, part-time opportunity, we’d love to hear from you. Open Positions: Outpatient Medical Coder Inpatient Medical Coder Profee Medical Coder Outpatient Medical Coder Auditor Inpatient Medical Coding Trainer Outpatient Medical Coding Trainer Requirements: Recent medical coding experience with the VA Proficiency in WebVIRR (VIRR) Strong attention to detail and coding accuracy Able to work a minimum of 20-25 hours per week.  If you're seeking a flexible, part-time role supporting veterans through your coding expertise, this is your chance to make an impact. Apply today and join the Sierra7 team!

As a onsite Medical Billing Specialist at On With Life, you can be a part of something greater. This position is responsible for generating and submitting claims for our various programs in a timely manner and managing the accounts receivable. The goal is to generate clean claims for payments to allow persons served, families and clinicians more time to focus on treatment and recovery. Hours for the Medical Billing Specialist are primarily between 8am and 4:30pm, Monday-Friday, approximately 40 per week. No holidays or weekends are required, but some earlier or later hours may periodically be needed. We do annual raises based on budget capacity, and you also have the opportunity for a discretionary bonus at your anniversary. Starting wage of $20/hour for applicants with a minimum two years medical billing experience or a Medical Billing Certificate.   This position is eligible for subsidized medical and dental insurance, vision insurance, free life and long-term disability...

Champion Accurate Coding. Win Appeals. Make an Impact. Primarily Remote | Monthly Onsite   Love the challenge of proving you’re right? This role is for coders who don’t just assign codes — they defend them. You’ll be part of a team that ensures providers are paid accurately for the care they deliver. When a payer says no, you build the case that turns it into yes. Your coding expertise, clinical insight, and persistence directly impact reimbursement and provider success.   What makes this role exciting You’ll advocate for correct payment, not just code charts Your work directly reverses denials and underpayments You’ll collaborate with physicians, payers, and fellow coding experts Every appeal you win is a tangible victory   What you’ll do Review medical records to validate accurate ICD‑10, CPT, and HCPCS coding Identify documentation or coding issues that impact reimbursement Build, submit, and follow payer...

SCOPE OF WORK: AGS Health is seeking an Profee Interventional Radiology and Diagnostic Radiology Coding Specialist who will be responsible for coding all requested IVR medical records using the most accurate and appropriate ICD-10-CM, CPT, modifiers, and APC assignment, while meeting specified productivity and accuracy standards. The coding specialist will also be responsible for abstracting key data required from the medical information consistent with UHDDS requirements and other regulatory coding guidelines.     JOBS-TO-BE-DONE ( JTBDs): Codes all requested Profee IVR records using the most accurate and appropriate ICD-10-CM, modifiers, and APC assignment in accordance with coding guidelines. Abstracts, codes, and assigns necessary demographic and clinical data elements required. Writes appropriate, non-leading queries. Maintains quality and productivity according to client requirements. ·           KEY SELECTION CRITERIA:...

OUR COMPANY AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health systems, physician groups, and academic medical centers in the U.S. With expert insight into modern revenue cycle practices, the company pairs cutting-edge technology with college-educated, trained RCM experts to help clients optimize workflows, maintain compliance, prevent revenue leakage, and achieve a high-performance revenue cycle. AGS Health employs more than 13,000 team members globally and partners with more than 150 clients across a variety of care settings, specialties, and billing systems. For more details, please visit http://www.agshealth.com You can also visit us at https://www.linkedin.com/company/ags-health   Job Description AGS Health is seeking a highly motivated and dedicated coding...

AGS Health is seeking an Inpatient Coding Specialist who will be responsible for coding all requested inpatient medical records using the most accurate and appropriate ICD-10-CM/PCS and DRG assignment, while meeting specified productivity and accuracy standards. The coding specialist will also be responsible for abstracting key data required from the medical information consistent with UHDDS requirements and other regulatory coding guidelines. JOBS-TO-BE-DONE ( JTBDs): Codes all requested Inpatient records using the most accurate and appropriate ICD-10-CM/PCS and DRG assignment in accordance with coding guidelines. Abstracts, codes, and assigns necessary demographic and clinical data elements required. Writes appropriate, non-leading queries. Maintains quality and productivity according to client requirements.   KEY SELECTION CRITERIA: Candidate qualifications :  Certified through AHIMA or AAPC (CCS, CPC, or CIC) Minimum 2 years inpatient...