14 outpatient complex coder jobs found in Springfield

Description: Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical reviews of high-dollar or highly complex medical records before a claim is finalized for...

About Ensemble Thank you for considering a career at Ensemble!Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!O.N.E Purpose:Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation....

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognise that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving...

Company Description At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better? Job Description Required:3-4 years of coding experience in an acute healthcare settingRHIT, RHIA or CCS credentialed The Outpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation...

Job Summary We are seeking an experienced and certified Medical Coder - Inpatient & Outpatient to join our Health Information Management/Revenue Cycle team.The Medical Coder is responsible for accurately reviewing and coding inpatient and outpatient hospital medical records in accordance with official coding guidelines, CMS requirements, payer regulations, and hospital policies.This position plays an essential role in ensuring coding accuracy, regulatory compliance, timely reimbursement, and the integrity of clinical and financial data.The successful candidate will demonstrate strong knowledge of hospital coding, medical terminology, anatomy and physiology, reimbursement methodologies, and regulatory requirements.Essential Duties and Responsibilities Review inpatient and outpatient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes based on assigned account type. Assign and validate appropriate MS-DRG/APR-DRG, APC, Present on Admission (POA),...

Job TitleClinical Documentation SpecialistJob DescriptionThis position is responsible for reviewing clinical documentation and applying the correct coding and modifiers for clinical services performed in office and/or hospital setting an may include surgical and non-surgical procedural services. This position ensures that the documentation supports the levels or types of service billed, ensures the documentation is compliant with regulatory regulations, provider documentation guidelines, and CPT documentation and CMS coding guidelines.Principal ResponsibilitiesResponsible for reviewing and analyzing documentation present in the medical record for professional services related to clinic, inpatient and/or outpatient services.Verifying and coding of the diagnosis, evaluation and management, procedures or other codes required for the completeness and accuracy of the record.Codes and/or reviews encounters to identify first-listed diagnosis, co-morbidities, complications, therapeutic and...

Inpatient Medical Coder (CCS certified) Assignment Details: 100% REMOTE Position Type: W2 Regular Employment At least 5 years of IP PCS Coding experience, required At least 3 years OP, preferred CCS certificate is required. Schedule: Weekdays, full-time hours Shift: Regular day shift hours System Experience: Cerner | Power Chart | 3M | EPIC Start Date: Immediately To be considered, IP and/or OP assessment test will be required to complete and pass a coding assessment test. Summary IP/OP Coding Specialist demonstrates proficiency in coding all types of inpatient and outpatient accounts. Utilizes International Classification of Disease (ICD-10-CM and PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding. Responsibilities: 1. Examines the complete medical record to accurately determine the principal & secondary diagnoses, procedures, and complications. 2....

Inpatient Medical Coder (CCS certified) Assignment Details: 100% REMOTE Position Type: W2 Regular Employment At least 5 years of IP PCS Coding experience, required At least 3 years OP, preferred CCS certificate is required. Schedule: Weekdays, full-time hours Shift: Regular day shift hours System Experience: Cerner | Power Chart | 3M | EPIC Start Date: Immediately To be considered, IP and/or OP assessment test will be required to complete and pass a coding assessment test. Summary IP/OP Coding Specialist demonstrates proficiency in coding all types of inpatient and outpatient accounts. Utilizes International Classification of Disease (ICD-10-CM and PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding. Responsibilities: 1. Examines the complete medical record to accurately determine the principal & secondary diagnoses, procedures, and complications. 2....

**Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days. **ESSENTIAL RESPONSIBILITIES** + Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. (65%) + Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) + Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) + Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and...

Inpatient Medical Coder (CCS certified) Assignment Details: 100% REMOTE Position Type: W2 Regular Employment At least 5 years of IP PCS Coding experience, required At least 3 years OP, preferred CCS certificate is required. Schedule: Weekdays, full-time hours Shift: Regular day shift hours System Experience: Cerner | Power Chart | 3M | EPIC Start Date: Immediately To be considered, IP and/or OP assessment test will be required to complete and pass a coding assessment test. Summary : IP/OP Coding Specialist demonstrates proficiency in coding all types of inpatient and outpatient accounts. Utilizes International Classification of Disease (ICD-10-CM and PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding. Responsibilities: 1. Examines the complete medical record to accurately determine the principal & secondary...

Inpatient Medical Coder (CCS certified) Assignment Details: 100% REMOTE Position Type: W2 Regular Employment At least 5 years of IP PCS Coding experience, required At least 3 years OP, preferred CCS certificate is required. Schedule: Weekdays, full-time hours Shift: Regular day shift hours System Experience: Cerner | Power Chart | 3M | EPIC Start Date: Immediately To be considered, IP and/or OP assessment test will be required to complete and pass a coding assessment test. Summary : IP/OP Coding Specialist demonstrates proficiency in coding all types of inpatient and outpatient accounts. Utilizes International Classification of Disease (ICD-10-CM and PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding. Responsibilities: 1. Examines the complete medical record to accurately determine the principal & secondary...

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

We are seeking experienced and highly accurate Value-Based Coders to join a project dedicated to in-home health assessments for Medicare Advantage and other value-based programs.This role is 100% remote and ideal for coders who are confident working independently, detail-oriented, and committed to quality and compliance.As a contractor, you'll have the independence to manage your own schedule while contributing to meaningful work that truly makes a difference.As part of the coding team, you will review clinical documentation from in-home visits and assign complete and compliant ICD-10-CM diagnosis codes that reflect the full spectrum of each patient's health.This includes :Risk adjustment (HCC) diagnoses aligned with CMS-HCC and HHS-HCC models.Social Determinants of Health (SDOH) codes.Medication-related Z codes, such as long-term drug therapy and treatment monitoring.All other clinically relevant diagnoses supported by documentation.Your accuracy directly supports the integrity of...