3 cpc jobs found

The Certified Professional Medical Auditor is responsible for performing comprehensive audits of medical records, coding, and billing to ensure accuracy, compliance with federal and state regulations, and alignment with payer policies. This role helps protect the organization from financial risk, supports accurate reimbursement, and promotes high standards of documentation and clinical integrity. Key Responsibilities Perform prospective and retrospective audits of medical records, coding, and billing across assigned service lines (e.g., outpatient, inpatient, behavioral health, SUD/MH, lab). Verify that documentation supports ICD‑10‑CM, CPT, and HCPCS coding; identify under‑coding, over‑coding, unbundling, and other compliance risks. Review claims for adherence to Medicare/Medicaid, commercial payer, and regulatory guidelines; ensure compliance with NCCI edits and payer‑specific policies. Prepare clear, detailed audit reports summarizing findings,...

Phoenix Behavioral Healthcare, LLC is seeking a highly skilled Executive   Director of Revenue Cycle Management (RCM) to oversee and optimize the full revenue cycle across multiple behavioral health facilities, clinics, laboratories, and E&M service lines. This onsite leadership role manages all aspects of RCM operations—including intake, UR/UM alignment, coding, billing, claims submission, collections, clinical documentation improvement, denial management, appeals, and compliance oversight. Key Responsibilities: Lead, manage, and optimize end-to-end revenue cycle operations for all Phoenix facilities Oversee billing and coding for inpatient, outpatient, lab, and professional services (UB-04 & CMS-1500) Direct UR/UM workflow integration to improve documentation quality and turnaround times Manage and mentor a full RCM support team (billers, coders, auditors, documentation trainers, compliance) Develop standardized...

Professional Coding Provider Educator & Reviewer RWJBarnabas Health Oceanport, NJ Full-Time Day Pay Range: $75,597.00 - $106,780.00 per year Pay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. Job Overview: The Professional Coding Provider Educator/Reviewer is responsible for preparing educational materials and delivering instruction to Medical Group physicians, Advance Practice Providers, and staff across all RWJBH medical centers, as directed by the System Professional Provider Education Coding Manager and Coding Leadership. Education may be provided in response to compliance reviews, physician onboarding, proactive training, or coding and regulatory updates. This role also conducts...