147 jobs found in Boston, MA

Become a part of our caring community and help us put health first 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 Durable Medical Equipment (DME) auditing and is part of the PPI Coding Disputes Team with Humana. The Disputes Auditor - DME Outpatient Coding 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 DME coding disputes and expertise in...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Senior auditor responsible for clinical or physician compliance topics. Assigned the most complex clinical/documentation/coding/billing reviews. Provides guidance to other auditors within AHN on audit approach and analysis. Responsible for creating and overseeing orientation of auditors. Leads all hospital or physician audits/investigations, auditing support and responses related to external audit activity. ESSENTIAL RESPONSIBILITIES: Establishes and implements orientation for all members of the AHN audit compliance team. Evaluates the progress of team members including review of reports and audit activities. Works with senior management responsible for AHN-wide case management/physician programs to develop processes that meet Medicare and 3rd party payor requirements. Provides guidance to staff auditors on audit topics and reports. (20%) Conducts educational sessions for...

About Nucs AI Nucs AI is revolutionizing cancer care through cutting-edge AI and medical imaging technology. Founded in 2024 by a multidisciplinary team of oncologists, AI researchers, and healthcare innovators, we're tackling one of medicine's most pressing challenges: the growing demand for accurate, timely cancer diagnostics in the face of rising scan volumes and limited radiologist capacity. We sit at the intersection of diagnostics and treatment planning-building AI-powered tools at the convergence of medical imaging, radioligand therapy, and artificial intelligence. Starting with prostate cancer and expanding across oncology, we partner with world-leading medical institutions and pharmaceutical companies across the US, Europe, and Australia to bring precision oncology into everyday clinical practice. Our mission is to enhance diagnostic precision and expand access to expert-level cancer care, improving patient outcomes worldwide. We're venture-backed, early-stage,...

Overview The HealthCare Authorization, Insurance Verification, and Medical Billing Specialist is responsible for supporting the full revenue cycle functions related to client eligibility, authorization acquisition, and medical billing. This includes securing insurance authorizations, verifying eligibility, performing detailed billing reviews, assisting with claims processing, documenting all activities, and coordinating closely with internal staff, payers, and managed care entities to ensure accurate and timely reimbursement. This includes ensuring all activities are performed in accordance with OIG compliance guidance, payer requirements, and internal controls designed to prevent fraud, waste, and abuse. Maintains accurate, complete, and timely documentation to support billing and reimbursement. Participates in audits, monitoring activities, and corrective action plans as required. Details Schedule: 40 hours, Monday–Friday, 8:00 a.m.–4:30 p.m. Pays: $48,000 - $60,0000 annually...

A healthcare data collaboration firm is seeking experienced inpatient coders to join their fully remote team. The ideal candidate will have at least 3 years of inpatient coding experience, knowledge of ICD-10-CM/PCS coding, and strong attention to detail. Responsibilities include accurately coding patient records and maintaining high accuracy rates. This position offers up to $5,000 in sign-on bonuses, comprehensive training, and a flexible schedule, fostering a supportive work culture. #J-18808-Ljbffr

Clinical Educator Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Clinical Educator Full time, 4x10 shifts Reporting to the Medical Laboratory Science Program Director, the Clinical Educator serves as a primary educator for hospital-based Medical Laboratory Science and related education programs within the Department of Pathology. This role supports a growing and evolving hospital-based education infrastructure and contributes to instructional excellence, program development, and workforce pipeline initiatives. 70% - Instruction & Education:...

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...

About the Role Join our client as a full-time Urology & Urogynecology Coder ! This onsite role offers a hands‑on opportunity to code clinical visits and surgical procedures while engaging with the full revenue cycle—from verifying coverage to obtaining prior authorizations. Location Hanover, MA 02339 (free onsite parking) Schedule Monday–Friday, 8:00 AM–6:00 PM EST (Must make schedule between this time frame) Type Contract‑to‑Hire Responsibilities Code urology and urogynecology clinical visits and surgical procedures Handle full-service revenue cycle tasks: insurance verification, prior authorizations, patient communication Collaborate with physicians, clinics, and insurance companies Maintain detailed, accurate documentation using Athena and Urochart (transition to AthenaOne in 2026) General urology: kidney stones, prostate cancer, prostatitis, hematuria, testicular pain, bladder/vaginal infections Qualifications CPC or CPC-A certification required Revenue cycle...

Description The Coding Specialist reports to the Coding Manager and is responsible for correct coding of professional services and upholding compliance standards. Responsibilities Perform coding and related duties using established Professional Billing Office and Coding Services policies in an accurate and timely manner. Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ICD-9/ICD-10, HCPCS II, and modifiers based on documentation and payor requirements. Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report coding problems. Maintain current knowledge of coding, compliance and reimbursement procedures. Review current literature, newsletters, payor policy updates and coding manuals. Resolve coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue. Function as a resource to Professional Billing Office...

A leading healthcare institution in Boston seeks a Coding Specialist to ensure accurate coding of services and uphold compliance standards. Responsibilities include performing coding duties, resolving denials, and maintaining coding procedures. Candidates must possess a high school diploma, complete a Coding Certificate, and have strong communication skills. Familiarity with medical terminology and coding certifications from recognized bodies are preferred. This is a full-time position located in Charlestown with a day shift. #J-18808-Ljbffr

A healthcare organization is seeking a Certified Risk Coder in Boston. This role involves retrospective and prospective risk coding reviews, ensuring accurate documentation and risk adjustment for outpatient practices. The ideal candidate will have experience in risk adjustment and medical billing, proficient knowledge in EHR systems, and a CRC Certification. Join a fast-paced, innovative team requiring strong communication and customer service skills with an emphasis on quality assurance. #J-18808-Ljbffr

Job Description: The HIM Hospital Inpatient & Same Day Surgery Coding Analyst deciphers and interprets provider documentation in the health record and assigns diagnostic information using ICD-10-CM/PCS and CPT codes for a complex range of acute care services for Intermountain Health. The caregiver provides specific coding expertise in the various fields of NCCI edits, Drugs and Biologicals, Revenue Codes, Current Procedural Terminology (CPT) codes, ICD-10 & CPT codes, DRGs, anatomy and physiology, pharmacology. The analyst also performs audits, provides feedback, and advanced training to clinical teams and physicians on ICD-10 and CPT coding best practices. Essential Functions Reviews and analyzes inpatient medical records for completeness, accuracy, and compliance for Same Day Surgery, Observation and Inpatient acute services at Intermountain Health. Performs coding at an advanced level of complexity for inpatient hospitals including governmental and/or...

Essential Duties and Responsibilities: - Abstract and code clinical data. - Audit medical records to ensure compliance with the organization's coding procedures and standards. - Accurately enter coded data in a system and validate data entered. - Research correct coding practices, clearly document and share findings with others. - Review denials and recommend billing corrections. - Train staff members on the coding process. Minimum Requirements - High School diploma or equivalent with 0 - 2 years of experience. - Additional clinical licensure may be required based on project. - Must be a Certified Medical Coder, Certified Professional Coder, or a Certified Coding Specialist. - Knowledge of Medical Billing and Coding Systems such as CPT and HCPCS is essential. - Ability to work a schedule between the hours of 8:00am - 5:00pm EST Monday - Friday required. Additional Skills and Experience: - Familiarity with retrospective payment reimbursement highly preferred....

Become a part of our caring community and help us put health first Code Edit Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The Medical Coding Coordinator performs advanced administrative, operational, and customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. Where you Come In The Medical Coding Coordinator extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures,...

Department Description: The Critical Care Auditor/ Coder position will be working directly with the Department of Anesthesia, Critical Care and Pain Medicine and will have the opportunity to work remotely following an initial onsite training period. The incumbent will be required from time-to-time to attend billing onsite staff meetings and meetings with the physicians they support. AFS, LLC is located in Needham Heights, Massachusetts. Job Location: Virtual Job Summary: Performs professional certified coding and provides administrative and project support to the department. Analyzes surgical-medical documentation, provides the individual surgeon/physician with the application of appropriate ICD-10/CPT/HCPCS descriptor codes including the appropriate use of modifiers to ensure compliance for reimbursement. Essential Responsibilities: Analyzes evaluation and management, including critical care, procedures and other notes and documents to determine the scope and complexity of...

Urology & Urogynecology Coder (CPC/CPC-A) - Onsite - Hanover, MA About the Role: Join our client as a full-time Urology & Urogynecology Coder ! This onsite role offers a hands-on opportunity to code clinical visits and surgical procedures while engaging with the full revenue cycle-from verifying coverage to obtaining prior authorizations. Location: Hanover, MA 02339 (free onsite parking) Schedule: Monday-Friday, 8:00 AM-6:00 PM EST (Must make schedule between this time frame) Type: Contract-to-Hire Responsibilities: Code urology and urogynecology clinical visits and surgical procedures Handle full-service revenue cycle tasks: insurance verification, prior authorizations, patient communication Collaborate with physicians, clinics, and insurance companies Maintain detailed, accurate documentation using Athena and Urochart (transition to AthenaOne in 2026) Patient/Chart Types: General urology: kidney stones, prostate cancer, prostatitis, hematuria, testicular pain,...

Datavant is a cutting-edge data collaboration platform transforming healthcare. Our mission is to enhance the security, accessibility, and actionability of health data, benefiting a variety of organizations across the healthcare sector, including providers, health plans, researchers, and life sciences companies. By leveraging health data, we are shaping the future of patient care and health outcomes. By joining Datavant, you will become part of a driven, collaborative team dedicated to making impactful changes in the healthcare landscape. We are seeking experienced outpatient coders to be key members of our team. The ideal candidate will have meticulous attention to detail and a solid understanding of medical terminology. This role is fully remote with a flexible schedule, enabling you to contribute to the healthcare revolution from home! Preferred: Experienced PRN Outpatient Coder with a minimum of 3 years in SDS and Observation coding. Key Responsibilities: Review...

Join Datavant, the trusted data collaboration platform for healthcare. Our mission is to make health data secure, accessible, and actionable. We provide vital data solutions for healthcare providers, health plans, researchers, and life sciences companies. From assisting with individual patient requests to advancing AI in healthcare, our team is dedicated to shaping the future of health data. By becoming a Datavanter, you will be part of a dynamic and collaborative team committed to transformative change in the healthcare landscape. What We’re Looking For We are seeking experienced and certified inpatient coders to join our team. The ideal candidate will have exceptional attention to detail and a solid understanding of medical terminology. This fully remote position offers a flexible schedule, allowing you to influence the future of healthcare from wherever you work best! Key Responsibilities: Assign diagnostic and procedural codes using ICD-10-CM and ICD-10-PCS...

A regional health insurance provider is seeking a Coder to manage responsibilities related to chart abstraction and coding quality audits. This remote position requires a strong understanding of ICD-10-CM coding, with a commitment to maintaining high accuracy. Candidates should have at least 5 years of coding experience, including 3 years specifically in Risk Adjustment coding, and hold relevant coding certifications. The role offers competitive salaries and comprehensive benefits. #J-18808-Ljbffr

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary The Coder manages the day to day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic database and or excel spread sheets. The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medical record Our Investment In You Full-time remote work Competitive salaries Excellent benefits Responsibilities Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. Ability to code government and state models. This includes code...

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Clinical Educator Full time, 4x10 shifts Reporting to the Medical Laboratory Science Program Director, the Clinical Educator serves as a primary educator for hospital-based Medical Laboratory Science and related education programs within the Department of Pathology. This role supports a growing and evolving hospital-based education infrastructure and contributes to instructional excellence, program development, and workforce pipeline...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

POSITION SUMMARY : Conducts CPT and ICD-10 coding reviews by detailed examination of each line item in the physician medical record and charge session. Performs chart audits to ensure correct coding and charge capture have been applied appropriately. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers. Position: Physician Practice Coder - Remote Department: BUMG Corporate PBO General Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: Coding support Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures. Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems. Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing. Sequences diagnoses, procedures and...

This is a remote based position. Applicants can be located nationwide Back Outpatient Coding Auditor #2675 United States Apply X Facebook LinkedIn Email Copy Position Description About You You are a person who is passionate about performing quality reviews and audits of the assigned staff. We need someone who ensures standards are met in accordance with department and organization policy. In the role of Outpatient Coding Auditor, you will demonstrate skills in organization, prioritization, professionalism and coaching others. Tell us about your experience with Outpatient Coding Auditing. Are you a team player and a self-motivator? 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 team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you. About The Position Advanced knowledge...