25 associate coder jobs found

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

Become a part of our caring community Become a part of our caring community and help us put health first. Role Overview The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, you will be assigned a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards,...

Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA! Hours: Monday - Friday, 8:00AM -5:00PM, dayshift. This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration. Overview Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record...

Join Our Caring Community Become a part of our caring community and help us put health first. The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS...

Inpatient Coder II Newport News, Virginia Hiring Range: $27.30 - $37.58/Hourly. Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Overview: The Inpatient Coder II is responsible for analyzing the medical record to assign International Classification of Diseases (ICD) Clinical Modification (CM) diagnoses and Procedure Coding System (PCS) procedure codes to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines. Works in collaboration with the Clinical Documentation Improvement (CDI) team to ensure accurate Diagnosis Related Group (DRG) assignment and works closely with management to resolve problems and meet deadlines. What You Will Do: Assigns International Classification of Diseases...

Job Description Job Description Description: Vital Health and Integrative Care is seeking an experienced Medical Biller and Medical Coder to join our growing outpatient psychiatry practice. This is an in-office position responsible for managing the complete medical billing cycle, insurance claims, coding accuracy, payment posting, denial management, and insurance follow-up. The ideal candidate has experience billing for psychiatry and behavioral health services and is knowledgeable in CPT, ICD-10, and payer requirements. Requirements: Minimum of 2 years of medical billing and coding experience in a physician's office or outpatient setting. At least 1 year of psychiatry or behavioral health billing experience required. Knowledge of CPT, ICD-10-CM, and HCPCS coding. Experience with commercial insurance, Medicare, Medicaid, and Tricare claims. Proficient in the complete revenue cycle , including charge entry, claims submission, payment posting, denial management,...

***To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia*** The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility)...

Become a part of our caring community and help us put health first. The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO‑contracted independent providers. The role is the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value‑based care initiatives. You will analyze trends, triage, and answer questions in real‑time, research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, you will be assigned a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify...

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...

## Risk Adjustment CoderApplyremote type: Hybridlocations: SMG Administrationtime type: Full timeposted on: Posted Todayjob requisition id: JR-103351**City/State**Virginia Beach, VA**Work Shift**First (Days)**Overview:**# **Overview**Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training,...

Sentara Health Plans in Virginia Beach, VA is seeking a Risk Adjustment Coder to perform compliance activities related to CMS/HHS risk adjustment and RADV audits. You will review professional and facility coding to ensure accurate HCC capture and support vendor and internal audits. The role requires an Associate degree or 4 years of coding experience, knowledge of ICD-10-CM guidelines, and CRC certification within two years. #J-18808-Ljbffr

Job Title Risk Coder Location Virginia Beach, VA Work Shift First (Days) Job Description Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs...

House Supervisor St. Francis Medical Center The Facility Nursing Supervisor is responsible for maintaining continuity of patient care in the absence of the unit nurse managers/directors in all areas of the hospital. Essential Functions: Supervises and coordinates activities of hospital personnel to maintain the continuity of a safe and efficient standard of care. Makes patient care assignments according to staff ability and patient needs. Evaluates care given by others under his/her direction. Makes appropriate changes and provides feedback to other personnel. Maintains accountability for own care and care delegated to others. Adheres to ethical and legal standards. Seeks assistance from appropriate resources, when needed. Visits the nursing units to oversee nursing care and evaluate condition of patients. Evaluates the census and acuity level of patients per unit and collaborates with ROC (Resource Optimization Center) and other department leaders for patient care...

Inpatient Coder (Remote) Full-time Work From Home Must have CCS, RHIA, or RHIT certification Job Summary As a Coding Integrity Specialist III WORK FROM HOME, you will review and evaluate hospital inpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM and ICD-10-PCS codes. A CIS III performs coding and/or code/DRG validation across multiple entities by applying all appropriate coding guidelines and criteria for code selections. Job Qualifications Assign, sequence, validate, and/or edit codes/DRGs and abstracted data (e.g., physician, discharge disposition, query tracking) for inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCS Maintain or exceed established accuracy standards Maintain or exceed established productivity standards Utilize the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGs Undergraduate (Associate's or Bachelor's)...

House Supervisor Maryview Medical Center The Facility Nursing Supervisor is responsible for maintaining continuity of patient care in the absence of the unit nurse managers/directors in all areas of the hospital. Essential Functions: Supervises and coordinates activities of hospital personnel to maintain the continuity of a safe and efficient standard of care. Makes patient care assignments according to staff ability and patient needs. Evaluates care given by others under his/her direction. Makes appropriate changes and provides feedback to other personnel. Maintains accountability for own care and care delegated to others. Adheres to ethical and legal standards. Seeks assistance from appropriate resources, when needed. Visits the nursing units to oversee nursing care and evaluate condition of patients. Evaluates the census and acuity level of patients per unit and collaborates with ROC (Resource Optimization Center) and other department leaders for patient care...

Description Job Title: Medical Billing Specialist Location: Falls Church Office (travel to the Fairfax office may be required occasionally) Reports to: Billing Manager Schedule: 8:00am - 4:30pm (occasional late evenings and weekends might be needed) FLSA Status: non-exempt Job Summary: The Office Visit Charger is responsible for accurately processing charges for patient visits and/or contact lenses, ensuring compliance with billing regulations, and maintaining accurate patient records. This role is crucial in supporting our commitment to providing excellent service to our patients while ensuring efficient operation of the office. Essential Responsibilities: Charge Processing Verify insurance information and eligibility for each patient visit to ensure proper billing. Submit insurance claims Accurately enter and process charges for all patient visits, including examinations, treatments, contact lenses, and other services provided. Review and...

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Patient Safety DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in...

Memorial Regional Medical Center Bon Secours As a faith-based and patient-focused organization, Bon Secours exists to enhance the health and well-being of all people in mind, body and spirit through exceptional patient care. Success in this goal requires a culture of compassion, collaboration, excellence and respect. Bon Secours seeks people that are committed to our values of compassion, human dignity, integrity, service and stewardship to create an environment where associates want to work and help communities thrive. House Supervisor – Memorial Regional Medical Center Job Summary: The Facility Nursing Supervisor is responsible for maintaining continuity of patient care in the absence of the unit nurse managers/directors in all areas of the hospital. Essential Functions: · Supervises and coordinates activities of hospital personnel to maintain the continuity of a safe and efficient standard of care. · Makes patient care assignments according to...

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified Inpatient Medical Coding Auditor 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. The goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following: Review inpatient medical records and claims to ensure accurate coding and reimbursement Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes Audit coding quality and...

Become a part of our caring community The Inpatient Medical Coding Auditor 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. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

​ **Bon Secours** **About Us** As a faith-based and patient-focused organization, Bon Secours exists to enhance the health and well-being of all people in mind, body and spirit through exceptional patient care. Success in this goal requires a culture of compassion, collaboration, excellence and respect. Bon Secours seeks people that are committed to our values of compassion, human dignity, integrity, service and stewardship to create an environment where associates want to work and help communities thrive. **House Supervisor** **- Maryview Medical Center** **Job Summary:** The Facility Nursing Supervisor is responsible for maintaining continuity of patient care in the absence of the unit nurse managers/directors in all areas of the hospital. **Essential Functions:** + Supervises and coordinates activities of hospital personnel to maintain the continuity of a safe and efficient standard of care. + Makes patient care assignments according to staff ability and patient needs....

Position: Medical Billing Specialist Location: Remote / On-site Department: Revenue Cycle Management Overview CMCI is seeking a detail-oriented and experienced Medical Billing Specialist to oversee claims processing, revenue cycle management, and contribute valuable insights to develop AI-powered tools that enhance medical billing workflows. The ideal candidate will have expertise in medical coding, claims submission, payer interactions, and denial management, ensuring optimized billing practices for maximum reimbursement and minimal claim rejections. Why Join CMCI? Opportunity to work with cutting-edge AI-driven billing solutions that optimize RCM efficiency. Work in a collaborative environment with healthcare and AI professionals. Competitive salary, benefits, and professional development opportunities. Key Responsibilities Claims Processing & Submission: Accurately process, review, and submit medical claims. Verify CPT, ICD-10, and HCPCS codes to ensure claims...

Job Summary The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical validity of reported diagnoses and procedures. This role evaluates coding accuracy, DRG assignment, reimbursement impact, and regulatory compliance in accordance with official coding guidelines, CMS regulations, payer policies, and organizational standards. The reviewer retrieves, analyzes, and documents medical record information to support appropriate reimbursement, documentation integrity, and audit outcomes for hospital inpatient services. Responsibilities Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and CPT-4 coding conventions. Review inpatient medical records to validate the accuracy and appropriateness of reported primary and secondary diagnoses and procedures using ICD-10-CM/PCS guidelines. Evaluate diagnosis and procedure sequencing to ensure...

24 hours per week - weekend only shifts. Primary Function/General Purpose Of Position The Facility Nursing House Supervisor is responsible for maintaining continuity of patient care in the absence of the unit nurse managers/directors in all areas of the hospital. Essential Job Functions Supervises and coordinates activities of hospital personnel to maintain the continuity of a safe and efficient standard of care. Makes patient care assignments according to staff ability and patient needs. Evaluates care given by others under his/her direction. Makes appropriate changes and provides feedback to other personnel. Maintains accountability for own care and care delegated to others. Adheres to ethical and legal standards. Seeks assistance from appropriate resources, when needed. Visits the nursing units to oversee nursing care and evaluate condition of patients. Evaluates the census and acuity level of patients per unit and collaborates with ROC (Resource Optimization Center)...