9 claim edit coder jobs found

Job Description Job Description Description: About Primary Health Solutions Our Mission We meet people where they are and partner with them on their journey towards wellness. Our Vision The destination for servant leaders to provide comprehensive and exceptional care. Our Values R – Respect I – Innovation S – Stewardship E – Excellence Billing and Coding Specialist Summary Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. A Day in the Life · Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. · Review incomplete encounters and code based on available documentation in EHR systems. · Know and understand several different...

Overview As a Certified Medical Coder at Vytal Health Partners, you will play a vital role in ensuring the accuracy, integrity, and compliance of medical coding and billing processes. You will review clinical documentation, medical records, and claim information to accurately assign ICD-10-CM, CPT, and HCPCS codes in accordance with current coding guidelines, payer requirements, and regulatory standards. In this role, you will collaborate with billing staff and operational teams to support accurate reimbursement, reduce claim denials, and promote documentation excellence. This position is ideal for a detail-oriented professional who is passionate about healthcare compliance, continuous learning, and making a meaningful impact on patient care and revenue cycle operations. What You Will Do Review medical record documentation and claim information prior to submission to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS codes, supporting appropriate reimbursement and...

SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 hours / Days Hybrid or Remote Join a mission‑driven health plan where precision and expertise protect both members and resources—we’re seeking a certified coder who can identify discrepancies others miss, analyze coding patterns with accuracy, and turn complex clinical data into clear, actionable insights; if you bring deep knowledge of coding standards, a sharp analytical mindset, and a passion for ensuring integrity in healthcare claims, this is your opportunity to make a meaningful impact and strengthen the quality of care delivery. Summary Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met. Makes recommendations to Medical Directors, Compliance, Internal...

Certified Coder Using established policies and procedures; the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series, and emergency room cases) and may be called upon to code highly complex inpatient records (to include trauma, burns, open heart and transplant cases) based on experience and skill set. Responsibilities Coding quality: Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRG's. Interprets health record content to ensure that all diagnoses and procedures coded are supported by physician documentation. Maintains a coding accuracy rating of at least 95% on records assigned. Queries physicians when necessary to ensure documentation supports...

Scope of Position The Associate Director of Outpatient Coding Services performs at an expert level sustaining responsibility for timely and accurate coding of all facility outpatient visits and outpatient coding audits for The Ohio State University Wexner Medical Center (OSUWMC) including James Hospital. This position oversees the operations of denials, claim edits, and charge capture for reimbursement purposes. In this role, the Associate Director of Outpatient Coding Services serves as a liaison and coordinator for special projects regarding the coding of medical records. This position develops and implements policies and procedures to achieve organizational goals; and assists in the development of operational strategy. This position also re-evaluates processes to keep staff engaged and to assist in meeting department and organizational goals for OSUWMC. This position is critical to the financial and legal standing of the hospital for compliance and legal purposes. The director...

Certified Coder, Special Investigations Unit (SIU) (Job ID: 59225) SummaCare - 1200 E Market St, Akron, OH Full‑Time / 40 Hours / Days Hybrid or Remote Join a mission‑driven health plan where precision and expertise protect both members and resources—we’re seeking a certified coder who can identify discrepancies others miss, analyze coding patterns with accuracy, and turn complex clinical data into clear, actionable insights; if you bring deep knowledge of coding standards, a sharp analytical mindset, and a passion for ensuring integrity in healthcare claims, this is your opportunity to make a meaningful impact and strengthen the quality of care delivery. Summary Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met....

GENERAL SUMMARY Works under the supervision of the HIM Manager (Operations & Auditing). The primary function of the HIM Coder - Professional is to code and charge medical office visits for professional claims. Must be able to review and edit charges in Meditech as well as review leveling criteria for E/M charging accuracy, charge for procedures and other billable services provided in the clinic/office setting. Must be able to code ICD-10 diagnoses and CPT codes while ensuring they are assigned correctly and sequenced appropriately. Must apply HCC/risk coding concepts to ensure the appropriate risk score is assigned to each patient. Must understand the basic ICD-10 diagnosis and CPT procedure coding rules and guidelines. Performs other duties as assigned. QUALIFICATIONS Education: High School Diploma or successful completion of an equivalent High School Exam Required Successful completion of the HIM Coder – Professional/HCC competency exam within 6 months of hire required...

Medical Coder III (Level II) We are seeking an experienced and detail-oriented Medical Coder III (Level II) to support coding operations by monitoring, analyzing, and implementing accurate and efficient medical coding processes. This role serves as a coding resource and technical expert for diagnostic and procedural coding systems, ensuring compliance with applicable coding guidelines, regulations, and organizational policies. The ideal candidate will possess strong analytical skills, extensive knowledge of ICD, CPT, and HCPCS coding systems, and experience researching and resolving coding discrepancies while maintaining a high level of accuracy and efficiency. Required Qualifications Candidates must be local. 3-4 years of recent medical coding experience One of the following credentials is required: RHIT (Registered Health Information Technician) RHIA (Registered Health Information Administrator) CCS (Certified Coding Specialist) CCS-P (Certified Coding...

University of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery.Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family.The primary site of inpatient care services is at the University of Toledo Medical Center, but many of our physicians' practice at hospitals and medical offices throughout the region.University of Toledo Physicians offers competitive pay and benefits including:403B, Pension, health and tuition waiver at UT.POSITION SUMMARYThe Certified Coder is responsible for coding ICD diagnosis and CPT facility and professional codes.Assignment may include outpatient clinic visits, diagnostic procedures, outpatient surgeries, observation and inpatient encounters, and emergency room charges for the...