484 payment integrity coder jobs found

Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 12330 Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding...

The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend. As an Inpatient Coder Associate, Payment Integrity at Clover Health, you will play a key role ensuring that Clover is able to continue to build and scale a compliant, efficient and profitable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. You will help drive value for every member by ensuring that Clover's medical claims are paid accurately and recovering overpayments when they are identified. The Associate - Inpatient Coder coordinates the identification of provider DRG denials and upcoding. As an Inpatient Coder, you will: Partner with Clinical, Claims, and Payment Integrity peers to review claims for...

Payment Integrity Nurse Coder RN III The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding...

A healthcare organization is seeking a Coder Trainer I, fully remote, to develop and conduct training programs for the Payment Integrity department. This role involves conducting training needs analyses, developing training programs, and evaluating their effectiveness. Candidates should have a Bachelor's degree and at least 2 years of training experience in a healthcare environment. Competitive salary and a range of benefits including flexible work options are provided. #J-18808-Ljbffr

Overview At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. We are a leading authority in payment integrity solutions. The Outpatient Payment Integrity Coder Auditor is responsible for reviewing outpatient medical claims to ensure coding accuracy, compliance, and appropriate payment in accordance with CMS and payer-specific guidelines. This role supports the development and implementation of payment integrity initiatives by identifying coding and billing inaccuracies, trends, and potential cost savings opportunities across outpatient facility claims. The ideal candidate has advanced knowledge of outpatient coding, APC and EAPG payment methodologies, and clinical documentation requirements, with strong analytical and auditing skills. Responsibilities Perform detailed coding audits on outpatient facility claims to validate appropriate CPT/HCPCS, revenue codes, modifiers, and ICD-10 coding in accordance with CMS, NCCI, and...

WHAT WILL I GET AT ELLIS MEDICINE? Comprehensive and affordable Health, Dental and Vision insurance that starts DAY ONE! Generous paid time off to support a work-life balance, including 6 paid holidays Tuition Reimbursement and professional development opportunities Retirement plan in the form of a 401(3b) with company match after longevity Flexible Spending Account and Dependent Care Account-allowing you to set aside pretax dollars to better care for your health and the health of your loved ones Free yearlong unlimited CDTA Navigator Pass, including Free CDTA bike share program Employee Wellness Program Employee Assistance Program Employer paid Life Insurance WHAT WILL I DO AS A MEDICAL CODER? Basic Function: The Medical Coder is responsible for the revenue cycle activities of specific physician practices of Ellis Medical Group (EMG). This includes, but is not limited to managing the charge entry and charge...

Job Type Full-time Description What We're Looking For Are you a proactive problem-solver who takes pride in delivering meaningful work that makes a lasting impact? We're looking for a driven and detail-oriented professional to join our team as a Billing Coder - FQHC / PPS Specialist. In this role, you'll play a vital part in ensuring financial stability, compliance, and continued mission impact , helping us move forward with purpose and precision. The ideal candidate values continuous learning, leads with a welcoming spirit, takes ownership of their work, and is passionate about supporting people and building stronger communities. We are seeking a highly experienced Billing Coder with deep FQHC expertise for our billing team-particularly in Prospective Payment System (PPS) and Medicare FQHC billing . Essential Job Duties: Serve as a subject-matter expert for PPS and FQHC billing workflows Ensure accurate, compliant coding and claim submission...

Reports to the Manager, Coding & Records. Reviews, codes, and analyzes medical records in order to abstract relevant data from patient medical records into the on-line computer system. Assigns DRGs to Medicare, Medicaid, and other required payors. Determines DRG and APC assignment on outpatient and inpatient records. Maintains productivity and accuracy levels for the assigned job code. MISSION, VALUES and SERVICE GOALS MISSION: We deliver outstanding care, inspire health, and connect with heart. VALUES: Trust. Respect. Integrity. Compassion. SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team. Reviews and analyzes discharged patient medical records to ensure all applicable patient data is available for coding and abstracting by: Checking the diagnosis and procedure to ensure accurate coding and sequencing as specified by established coding principles and guidelines, following AHA, AHIMA, and CMS coding guidelines for outpatient...

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a SIU Coder, to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Learn more about McLaren Health Plan at...

Something special starts here. You can't define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full - with joy, purpose and lifelong health - it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you're looking for at LMH Health. You'll find everything you're looking for at LMH Health: Join a team that cares about the community Tuition reimbursement to support continuing education Professional development and recognition Excellent benefits We're looking for you. Job Description *MUST LIVE IN KS OR MO- MUST BE WITHIN Driving distance of Lawrence KS. I. JOB SUMMARY The Coder I position is responsible for accurate, coding, abstracting, claims filing, documentation review and claims...

Coding Specialist Responsible for reviewing demographic and clinical medical records, assigning appropriate ICD-10-CM/PCS and CPT/HCPCS codes based on provider documentation and current coding guidelines. Works across multiple encounter types, including Observation/Outpatient in a Bed, Emergency Department, Urgent Care, Ambulatory Surgery, and Ancillary. Utilizes both manual and AI-assisted coding platforms to optimize accuracy, compliance, and throughput. Ensures data integrity for quality reporting, population health, and financial reimbursement purposes. Education Minimum: High school diploma or equivalent required. Preferred: Associate degree in Health Information Technology or related field. Certifications Required: Certified Coding Specialist (CCS), Certified Coding Specialist Physician (CCS-P), Certified Inpatient Coder (CIC), or Certified Outpatient Coder (COC) (AHIMA or AAPC). Preferred: Registered Health Information Administrator (RHIA) or Registered Health...

JOB SUMMARY The Health Information Management (HIM) Coder impacts Memorial's Healthcare quality initiatives and reimbursement through the assignment of the most accurate and optimal diagnosis and procedural codes to individual patient health information for data retrieval, analysis, and claims processing. Under the direction of the Health Information Management (HIM) Coding and Clinical Documentation Integrity (CDI) Manager, this position will code and analyze physician documentation contained in health records (electronic, paper or hybrid) to determine the appropriate principal diagnosis, secondary diagnoses, and procedures codes to accurately capture MS-DRG assignment. Use the Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers in accordance with coding rules and regulations. The coding information is used to determine APC's (Ambulatory Payment Classification) for data quantitative analysis,...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from...

Summary Responsible for reviewing demographic and clinical medical records, assigning appropriate ICD-10-CM/PCS and CPT/HCPCS codes based on provider documentation and current coding guidelines. Works across multiple encounter types, including Observation/Outpatient in a Bed, Emergency Department, Urgent Care, Ambulatory Surgery, and Ancillary. Utilizes both manual and AI-assisted coding platforms to optimize accuracy, compliance, and throughput. Ensures data integrity for quality reporting, population health, and financial reimbursement purposes. Education Minimum: High school diploma or equivalent required. Preferred: Associate degree in Health Information Technology or related field. Certifications Required: Certified Coding Specialist (CCS), Certified Coding Specialist Physician (CCS-P), Certified Inpatient Coder (CIC), or Certified Outpatient Coder (COC) (AHIMA or AAPC). Preferred: Registered Health Information Administrator (RHIA) or Registered Health...

Description Leidos, a global technology leader, is seeking a Combat Coder for our Sentinel program, supporting the United States Air Force in geographically distributed intelligence operations. Combat Coders directly support mission objectives by integrating data sources and interfaces quickly while being embedded with the user base. As a Combat Coder you will engage directly with our customers to build and modify all aspects of full‑stack applications. Your contributions will move directly to production systems and get immediate feedback. You will be working with a small elite team of developers that focus on getting things done to support the mission. Join Leidos in our mission to enhance global security and efficiency through technology and innovation. Be part of a team that champions Integrity, Inclusion, Innovation, Agility, Collaboration, and Commitment. If you’re ready to drive critical software deliveries, apply now to join Leidos as a Combat Coder for the...

Description Leidos, a global technology leader, is seeking a Combat Coder for our Sentinel program, supporting the United States Air Force in geographically distributed intelligence operations. Combat Coders directly support mission objectives by integrating data sources and interfaces quickly while being embedded with the user base. As a Combat Coder you will engage directly with our customers to build and modify all aspects of full-stack applications. Your contributions will move directly to production systems and get immediate feedback. You will be working with a small elite team of developers that focus on getting things done to support the mission. Join Leidos in our mission to enhance global security and efficiency through technology and innovation. Be part of a team that champions Integrity, Inclusion, Innovation, Agility, Collaboration, and Commitment. If you're ready to drive critical software deliveries, apply now to join Leidos as a Combat Coder for the...

Description Leidos, a global technology leader, is seeking a Combat Coder for our Sentinel program, supporting the United States Air Force in geographically distributed intelligence operations. Combat Coders directly support mission objectives by integrating data sources and interfaces quickly while being embedded with the user base. As a Combat Coder you will engage directly with our customers to build and modify all aspects of full-stack applications. Your contributions will move directly to production systems and get immediate feedback. You will be working with a small elite team of developers that focus on getting things done to support the mission. Join Leidos in our mission to enhance global security and efficiency through technology and innovation. Be part of a team that champions Integrity, Inclusion, Innovation, Agility, Collaboration, and Commitment. If you're ready to drive critical software deliveries, apply now to join Leidos as a Combat Coder for the...

This is a remote based position. Applicants can be located nationwide Back Medical Coder #2621 United States Apply X Facebook LinkedIn Email Copy Position Description About You You are a person who has Profee Outpatient Coding experience. We need someone who is responsible for assignment of accurate Evaluation and Management (E&M) ICD-10-CM, ICD-10- PCS, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, modifiers and quantities derived from medical record documentation (paper or electronic) for encounters dependent upon record type. Tell us about your experience with Profee Outpatient Coding. Are you a team player and a self-motivator? What is your experience with conducting business in a way that is credit to a company? We are counting on you to manage multiple projects using your problem-solving skills. We are looking for someone UNCOMMON. What is uncommon about you? Are you highly committed? Are you...

This is a remote based position. Applicants can be located nationwide Back Medical Coder #2621 United States Apply X Facebook LinkedIn Email Copy Position Description About You You are a person who has Profee Outpatient Coding experience. We need someone who is responsible for assignment of accurate Evaluation and Management (E&M) ICD-10-CM, ICD-10- PCS, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, modifiers and quantities derived from medical record documentation (paper or electronic) for encounters dependent upon record type. Tell us about your experience with Profee Outpatient Coding. Are you a team player and a self-motivator? What is your experience with conducting business in a way that is credit to a company? We are counting on you to manage multiple projects using your problem-solving skills. We are looking for someone UNCOMMON. What is uncommon about you? Are you highly committed? Are you...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from...

Team Lead Coder Coding Validation The Team Lead Coder Coding Validation position will have responsibility for supervising a team of Coding Validation analysts or coders. Team Leaders ensure that the work of others meets productivity standards, quality and client guidelines. Primary responsibilities include queue management, work distribution, performance and production optimization, audit planning, coder interactions, training of new hires/existing staff, on appeals support while meeting SLA obligations. The Team Lead goal is to ensure the team audits client data on behalf of our clients, generating high quality payment determinations and displays professional skepticism that enhances the work performed in order to achieve success in position. Responsibilities: Oversee onshore/offshore Coder Coding Validation team(s) in reviewing claims and producing well written appeals consistent with high level of integrity and meeting metrics Provides support needed to review quality...

Coding Team Member We know it's not just about finding a job. It's about finding a place where you are respected, valued, and where your work is purposeful and fulfilling. At CHS, our coding team recognizes your individual talents, encourages professional development, and provides opportunity for career advancement. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 14 states, CHS is committed to helping people get well and live healthier. CHS operates 70 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. Job Summary As a member of the 100% US Based HIM Central Services coding team, the Coder IP provides inpatient coding assistance for a set of HIM Central Services-supported CHS...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from...

Coding Team Member We know it's not just about finding a job. It's about finding a place where you are respected, valued, and where your work is purposeful and fulfilling. At CHS, our coding team recognizes your individual talents, encourages professional development, and provides opportunity for career advancement. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 14 states, CHS is committed to helping people get well and live healthier. CHS operates 70 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. Job Summary As a member of the 100% US Based HIM Central Services coding team, the Coder IP provides inpatient coding assistance for a set of HIM Central Services-supported CHS...