13 jobs found in New Haven

Job Title: Lead Inpatient Coder How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. The Lead Inpatient Coder serves as a key expert in ICD-10-CM, ICD-10-PCS, and DRG assignment, providing specialized knowledge and guidance to the Inpatient Coding team. This role is responsible for addressing complex coding questions, reviewing, and resolving external audit findings, and contributing to coding improvement initiatives. Additionally, the Lead Inpatient Coder plays a critical role in delivering ongoing education and training to the coding team, helping to minimize...

Scheduled Hours 40 Position Summary Position reviews medical record documentation to determine appropriate billing codes and necessary documentation. Job Description Primary Duties & Responsibilities: Reviews the documentation in the record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patients conditions and treatment. Codes evaluation and management to appropriate CPT code and codes diagnosis to appropriate ICD-9 code. Meets with physicians to review documentation, resolve coding and secure signature of all unsigned dates of service, tagging files for follow up. Acts as lead person and assists coders with IBC staff with medical terminology and policy interpretation as required. Assists with efforts to increase physician awareness of documentation requirements. Prepares case reports and initiates follow-up for billing process. Working Conditions: Job Location/Working Conditions Normal...

Job Title: Registered Nurse (Rn) We are seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with state and federal regulations. Key Responsibilities: Analyze claims data, medical records, and provider documentation to identify discrepancies, fraud, or non-compliance. Conduct retrospective case reviews, on-site provider audits, and recipient interviews. Review billing practices for upcoding, duplicate billing, and unbundling of services using ICD-10, CPT, and HCPCS manuals. Prepare reports, case findings, and recommend sanctions when violations are identified. Coordinate and participate in teleconferences, hearings, and legal proceedings with the Office of General Counsel and other agencies. Respond to provider complaints and compliance inquiries via hotline,...

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...

Op Senior Coder 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. Reporting to the Supervisor of Outpatient Coding, the OP Senior Coder is a vital multifaceted role within the Outpatient Coding Department. This position provides support to the Outpatient Coding Department as a OP coding subject matter expert, educator, QA reviewer, and also focuses daily efforts on A/R management and oversight. Additionally, this person works with partner departments to problem solve issues and streamline processes. The OP Senior Coder is also required to mentor other team members and prepare them for the role of OP Senior Coder. The OP Senior Coder possesses a strong level of OP clinical coding expertise, and has the ability to handle multiple priorities....

Behavioral Health Coding Auditor (Consultant) This is a remote position. We are seeking a Certified Medical Coder with deep Behavioral Health expertise to audit current coding practices and outcomes for a healthcare payer organization. The consultant will assess provider-facing coding (CPT, HCPCS, ICD-10) in the Behavioral Health domain, identify issues, and recommend rule definitions and process improvements to optimize accuracy and reimbursement. Experience configuring payer platformsespecially HealthEdge HealthRules or Optum equivalentsis a strong plus. What You'll Do Perform retrospective and prospective audits of Behavioral Health claims and encounters (CPT/HCPCS/ICD-10). Evaluate accuracy, completeness, and adherence to payer and Medicaid guidelines with emphasis on Rhode Island Medicaid policy requirements. Analyze denial trends, under/overpayments, edits, and provider coding patterns; quantify impact and root causes. Draft clear, actionable coding rule definitions...

Description CPA medical Billing a division of GeBBS Health Care company is currently seeking an experienced medical biller to join their team. Connecticut based candidates only. The Medical Biller/Accounts Receivable Specialist is one of the most important components to revenue cycle management as this role play an integral part in getting the doctors paid. This position requires a vast array of different skills that when applied properly deliver a positive result in a timely manner. Responsibilities Research: Work aged accounts on assigned payers prioritizing accounts that are approaching timely filing denial. Devote time weekly to work current rejections 1 to 90 days old. Fix errors and re-bill accordingly. Look up payer eligibility using payer websites or call payers to gather needed information for billing. Update all accounts in the system for that patient and promptly re-bill. Contact guarantors as needed to determine insurance coverage. Drop tickets having no insurance...

Inpatient/DRG Validation Coding Auditor The Inpatient/DRG Validation Coding Auditor performs documentation and coding audits for all acute inpatient services for clients. Identifies coding errors, compliance, and educational opportunities, and optimizes reimbursement by ensuring that the diagnosis/procedure codes and supporting documentation accurately support the services rendered and comply with ethical coding standards/guidelines and regulatory requirements. Performs independent reviews, interprets medical records, and applies in-depth knowledge of coding principles to determine billing/coding/documentation issues and quality concerns. Demonstrates high level of expertise in researching requirements necessary to make compliant recommendations. Has an extensive understanding of reimbursement guidelines, specifically related to DRG (MS, APR, Tricare, etc.) payment systems. Conducts DRG (ex. MS, APR, Tricare) coding and clinical reviews to verify the accuracy of coding, DRG...

Associate Director, Us Medical Review Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. Argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients. The associate director, us medical review will be responsible for overseeing the medical review of promotional materials and leading a dedicated indication sub-team within the us medical review community. This...

Outpatient Coder 1 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. Responsibilities: Reviews medical record documentation to determine appropriate ICD-10-CM codes in accordance with official coding guidelines. Reviews medical record documentation 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. The Inpatient Coder 2 performs activities involving moderate level inpatient coding of medical records as a mechanism for indexing clinical information used for research, utilization, appropriateness of care, compilation of statistics for hospital, regional and government reporting, and accurate reimbursement. This level of coding is expected to completely code cases of moderate complexity with lengths of stay greater than six days and continue to challenge themselves to code more complex cases with longer lengths of stay. They also support the department through a variety of project work and support the department through a variety of project work. EEO/AA/Disability/Veteran...

Patient Support Medical Claims Processing Representative Contract Remote Role Location (Open to Remote US) As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma, medical device and diagnostic companies get their therapies to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product's value to payers, physicians, and patients. A significant part of our business is providing patient support programs on the behalf of our customers. With the right experience, you can help provide support to patients in need of available therapies. IQVIA has the world's largest Commercial Sales & Medical Solutions (CSMS) organization dedicated to the launch and marketing of pharmaceutical and medical products. With a focus on providing talent for patient support, field/inside sales, medical device support, clinical support, and...

Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community- eligible for opportunities through the New Haven Hiring Initiative or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale! Salary Range $68,000.00 - $120,500.00 Overview Coordinate and conduct medical billing audits for the Yale Medicine Administration. Evaluate medical billing, coding and documentation for 18 clinical departments under the direction of the Compliance Officer. Provide training and feedback to physicians and departmental personnel who have responsibilities with billing activities. This opportunity is currently remote (work from home, in or outside CT) for a position located in CT. CPC or similar certification needed within 12-18 months. Required Skills and Abilities Demonstrated knowledge of ICD-10 and CPT-4 coding and billing practices. Ability...