20 payment integrity coder jobs found

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...

Position Overview The Inpatient-Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines. Scope of Role & Responsibilities Identifies trends and inconsistencies in provider documentation and coding practices. Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy. Develops curriculum to improve provider coding practices. Educates providers and their practice staff in coding guidelines. Works in collaboration with other departments, develop plans...

Inpatient-Outpatient Coder Job Ref: TE0031 Category: Claims Department: CLAIMS Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $76,000.00 - $86,661.00 Position Overview The Inpatient-Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines. Scope of Role & Responsibilities Identifies trends and inconsistencies in provider documentation and coding practices. Audits and reviews medical records to determine if...

Outpatient Coder 3 To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 3 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in three (3) complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks, resolving claim edits, handling individual coding workload, working stop bills/DNBs, conducting QA reviews and sending queries, as needed, to clinical staff. Mentors Coder 1 and Coder 2 coders, and participates in cross-training initiatives such as the coder buddy program and learning circle initiatives. Acts as an expert coding...

divh2Hospital Outpatient Coder/h2pUnder direct supervision, the Hospital Outpatient Coder is responsible for the accurate coding and abstracting of diagnoses, conditions and procedures from medical record documentation for Hospital Ambulatory Surgery (HAS), Home Health/Hospice (if applicable), Observation (OBS) and Hospital Complex Outpatient Visit (CHOY) including capture of codes for outpatient services that require monitored anesthesia and conscious sedation. Working from appropriate documentation, assign the appropriate codes and modifiers with ICD-CM, CPT and HCPCS Level II codes. All work must be performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines./ppEssential Responsibilities:/pulliReview...

Outpatient Coder 2 To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 2 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in two complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks, resolving claim edits, handling individual coding workload, working stop bills (if assigned), and sending queries, as needed, to clinical staff. Responsibilities: Reviews medical record documentation to determine appropriate ICD-10-CM codes in accordance with official coding guidelines. Reviews medical record documentation and...

Reports To: Revenue Cycle Director FLSA Classification: Full-Time, Non-exempt, Hourly $24.68-30.00 The working environment is a hospital setting with exposure to patients, residents, and families; sharps, infectious diseases, biological and chemical hazards; machinery and equipment; and potentially extreme temperatures and noise levels. Employees are required to follow all safety practices and protocols at all times. Essential Functions: Abstract pertinent information from patient records; assign ICD-10-CM, ICD-10-PCS, CPT, or HCPCS codes. - Perform coding for all Rural Health Clinic, Outpatient Specialty Clinic, inpatient/observation procedures and stays, emergency room visits, and ambulatory surgeries. Drop both professional and facility fees for all cases, orthopedics, general surgery, outpatient IV infusions, laboratory, radiology, physical therapy, and behavioral health. Other department specialties added as they come on. - Follow up with physicians when code...

Title: Inpatient/Outpatient Coder - Certified Reporting Relationship: Health Information Manager General Summary of Responsibilities: The employee is responsible for analyzing medical records in order to code and abstract medical information for inpatient/outpatient encounters both medical and surgical using correct codes from ICD-9-CM, and/or ICD-10-CM Diagnosis AND Procedure/PCS AND CPT coding guidelines to be submitted for financial reimbursement as required for the Uniform Bill and for the DRG (Diagnosis Related Group). All Coding Guidelines are to be utilized and adhered to. Assign appropriate CPT codes and modifiers as well as CPT anesthesia codes. Assign codes using the 3M encoder with finalization/releasing of records in EMR system. Knowledge of using encoder as well as ICD-9-CM; ICD-10-CM and ICD-10-PCS and CPT coding books. Correctly sort the records after coding for doctors boxes for final signatures or refer to Electronic Medical Records Technicians for...

DHR Health - US:TX:McAllen - Days Summary: POSITION SUMMARY: The Outpatient coder is responsible for timely review of the medical record for correct coding and sequencing of diagnoses and procedures using ICD-10-CM/PCS and CPT/HCPCS classification systems for hospital and/or professional services in accordance with coding rules and regulations. Resolves billing edits according to NCCI and/or payer specific guidelines. Identifies and reports error patterns. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA). POSITION EDUCATION/ QUALIFICATIONS : • Coding credential from an accredited coding organization required • Credentials from AHIMA, AAPC preferred • Good written and verbal communication skills required. JOB KNOWLEDGE/EXPERIENCE : • Extensive experience in medical coding, medical terminology, and anatomy and physiology required; • 3 year of coding experience preferred • Proficiency in...

Job Requirements ** Candidate to be considered must reside in the state of Florida. This is a work from home opportunity with majority being remote work** Position Summary To be fully engaged in providing timely, complete, and accurate data collection for quality clinical analysis and revenue enhancement. PRIMARY ACCOUNTABILITES 1. Uphold regulatory compliance by assigning and sequencing accurate ICD 10 and CPT 4 codes to reference lab, ancillary, emergency room, endoscopy, ambulatory surgery, observation, and other outpatient records as per coding guidelines demonstrating behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities. 2. Validate accuracy of codes assigned by the computer assisted coding software, recognizing inappropriate application of clinical coding rules/guidelines, and revising the codes assigned based upon expert subject matter knowledge and provider...

Now Hiring: Medical Necessity Specialist Join the Health Information Management Team at Cottage Hospital! Are you detail-oriented, organized, and passionate about ensuring accurate medical coding and documentation? Cottage Hospital is seeking a Medical Necessity Specialist to support our Ancillary services, including lab and radiology, by ensuring proper coding, reducing documentation errors, and helping improve diagnostic accuracy across the organization. If you're looking for a role that blends healthcare, compliance, and provider education, apply today and help us strengthen the integrity of patient care and revenue cycle processes! Job Summary: The Medical Necessity Specialist plays a vital role in promoting accurate and compliant medical coding for Ancillary services. This position focuses on ensuring medical diagnoses support ordered procedures, identifying trends in documentation errors, and collaborating with providers to improve coding accuracy and...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 1 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in one complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks , resolving claim edits, handling individual coding workload, working stop bills (if assigned), and sending queries, as needed, to clinical staff. EEO/AA/Disability/Veteran Responsibilities 1. Reviews medical record documentation to determine appropriate ICD-10-CM codes in accordance with official coding guidelines. 2. Reviews...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 2 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in two complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks , resolving claim edits, handling individual coding workload, working stop bills (if assigned), and sending queries, as needed, to clinical staff. EEO/AA/Disability/Veteran Responsibilities 1. Reviews medical record documentation to determine appropriate ICD-10-CM codes in accordance with official coding guidelines. 2. Reviews medical...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 3 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in three (3) complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks, resolving claim edits, handling individual coding workload, working stop bills/DNBs, conducting QA reviews and sending queries, as needed, to clinical staff. Mentors Coder 1 and Coder 2 coders, and participates in cross-training initiatives such as the coder buddy program and learning circle initiatives. Acts as an expert coding resource...

Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. Position Summary: Reviews and validates outpatient and professional clinical documentation and diagnostic results. Extracts data and assigns alpha numeric codes for billing, internal and external statistical reporting,...

W ork where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. Position Summary: Reviews and validates outpatient and professional clinical documentation and diagnostic results. Extracts data and assigns alpha numeric codes for billing, internal and external statistical...

Job Summary: Under direct supervision, the Hospital Outpatient Coder is responsible for the accurate coding and abstracting of diagnoses, conditions and procedures from medical record documentation for Hospital Ambulatory Surgery (HAS), Home Health/Hospice (if applicable), Observation (OBS) and Hospital complex Outpatient Visit (CHOY) including capture of codes for outpatient services that require monitored anesthesia and conscious sedation. Working from appropriate documentation, assign the appropriate codes and modifiers with ICD-CM, CPT and HCPCS Level II codes. All work must be performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, CPT and HCPCS code book, CPT Assistant, NCCI Edits, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines. Essential Responsibilities: Review Medical Records to...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 3 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in three (3) complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks, resolving claim edits, handling individual coding workload, working stop bills/DNBs, conducting QA reviews and sending queries, as needed, to clinical staff. Mentors Coder 1 and Coder 2 coders, and participates in cross-training initiatives such as the coder buddy program and learning circle initiatives. Acts as an expert coding resource...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 2 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in two complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks , resolving claim edits, handling individual coding workload, working stop bills (if assigned), and sending queries, as needed, to clinical staff. EEO/AA/Disability/Veteran Responsibilities 1. Reviews medical record documentation to determine appropriate ICD-10-CM codes in accordance with official coding guidelines. 2. Reviews...

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the general direction of the OP Coding Supervisor, the Outpatient Coder 3 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in three (3) complex outpatient coding service lines. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks, resolving claim edits, handling individual coding workload, working stop bills/DNBs, conducting QA reviews and sending queries, as needed, to clinical staff. Mentors Coder 1 and Coder 2 coders, and participates in cross-training initiatives such as the coder buddy program and learning circle initiatives. Acts as an expert coding resource to...