18 claims edit coder jobs found

Job Description Bring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals 2024-25" rankings, and it's all thanks to our team of 14,000+ remarkable employees! What you will be doing in this role: The Claims Edit Coder (Coder II) operated under the general direction of an audit supervisor and involves responsibilities across various work units, as well as duties specific to the reporting team. In this role, the Coder II reviews ICD-10-CM diagnosis coding and Current Procedural Terminology (CPT) procedure code for claim edit fall outs. The position entails conducting modifier review and assignment, handling complex coding edits that necessitate research and resolution, and validating key data elements like the billing physician and date of service. You are expected to abstract coded data accurately and promptly into the applicable system using relevant applications such as EPIC (CS-Link), EPIC HB...

Description In this role, you will assist with coding reviews, charge corrections, and staff education.Youwill optimize reimbursement by ensuring correct infusion, injection, and procedure coding.You will be responsible for clinic billing and coding questions and assisting with charge review work queue edit corrections.Youwill assist the Revenue Integrity Specialist Manager with conducting comprehensive analysis of monitoring claims to ensure timely and appropriate reimbursements and will work with Authorizations Pharmacists on medical necessity reviews when needed. You will also assist with treatment cash quotes, the Copayment Assistance Team, free drug assistance, and other assigned duties. Salary range: $40.04/hr - $52.83/hr Qualifications Required: Minimum of 2 years active Certified Professional Coder (CPC).Successfully completes required education courses to maintain current coding certification. Knowledge of oncology CPT and ICD-10 codes and medical office...

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview Assigned codes to patient symptoms, diagnosis, operations, and treatments to process reimbursements; knowledge and expertise in reviewing and adjudicating coding services procedures and diagnoses on medical claims. Completes accuracy and timely entry of ICD-9-CM, HCPCS procedure codes and CPT codes into the NextGen system. Minimum...

Description In this role, you will assist with coding reviews, charge corrections, and staff education. You will optimize reimbursement by ensuring correct infusion, injection, and procedure coding. You will be responsible for clinic billing and coding questions and assisting with charge review work queue edit corrections. You will assist the Revenue Integrity Specialist Manager with conducting comprehensive analysis of monitoring claims to ensure timely and appropriate reimbursements and will work with Authorizations Pharmacists on medical necessity reviews when needed. You will also assist with treatment cash quotes, the Copayment Assistance Team, free drug assistance, and other assigned duties. Salary range: $40.04/hr - $52.83/hr Qualifications Required: Minimum of 2 years active Certified Professional Coder (CPC). Successfully completes required education courses to maintain current coding certification. Knowledge of oncology CPT and ICD-10 codes and medical...

Job Posting In accordance with federal coding compliance regulations and guidelines, use current ICD-10-CM, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary/Clinic Visits, and an assorted outpatient surgeries: GI Lab, Heart Cath Lab, Pain Management surgery, and Invasive Radiology, etc.). Address OCE/NCCI edits within 3M-CRS and those returned from the Business Office. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Performs other coding department related duties as assigned by HIM management staff. Essential Duties + Ambulatory Surgery coding of all...

Medical Billing Specialist Job Objective: A brief overview of the position. Reviews E&M and simple visit charges submitted by providers in assigned work queue(s) to validate Level of Service, place of service, new verses established, and modifier review to ensure valid creation of claim. Reviews and enters manual charges submitted by providers for external services. Reviews and resolves simple NCCI, LCD and MUE edits. Reports to Billing Manager Supervises None Ages of Patients None Blood Borne Pathogens Minimal/No Potential Qualifications Education Required: High School Diploma or GED Preferred: Currently enrolled in a coding certification program or holding an Apprentice Certificate in coding- CPC or CCS Preferred: General College Studies Preferred: One year coding certificate or courses in Medical Terminology, Anatomy and Physiology and extensive training or experience in coding Licensure/Certification Required: Within 18 months complete a coding certification...

Job Title: Medical Biller II Salary: $25hr-$28hr DOE Location: Tustin, CA Openings: 1 Position Purpose: The Medical Billing Specialist II supports the revenue cycle team by independently performing a broad range of billing functions with moderate complexity. This role is responsible for accurate insurance verification, charge entry, claim submission, payment posting, and resolution of routine denials to ensure compliance with payer requirements and timely reimbursement. Core Duties and responsibilities, include but are not limited to: Insurance & Eligibility Verification Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO). Research and resolve discrepancies in patient coverage or eligibility. Document eligibility outcomes in the EHR/PM system. Charge Entry & Coding Support Perform charge entry and apply CPT, ICD-10, and HCPCS codes. Review encounter forms for accuracy; flag missing or incorrect...

Job Description Codes and abstracts conditions, diseases, reason for encounters, social determinants of health and outpatient procedures to report accurate administrative and clinical data, utilizing approved coding guidelines as set forth in Official Coding Guidelines, ICD Book, Coding Clinic for ICD-CM/PCS, AHA Coding Clinic for HCPCS and CPT Book. Responsibilities This is not an exhaustive statement of duties, responsibilities, or requirements. Employees will be required to perform any job, with related instruction given by their supervisor, subject to reasonable accommodation. Codes and abstracts diseases, procedures from the medical record according to ICD-CM and CPT classification systems, utilizing only recognized coding guidelines. Abstracts data elements for state regulatory agencies as needed. (45%) Validates coding to assure proper APC assignment . (30%) Participates in quality improvement activities by identifying specific cases and pertinent data as...

Medical Billing Specialist Job Objective: A brief overview of the position. Reviews E&M and simple visit charges submitted by providers in assigned work queue(s) to validate Level of Service, place of service, new verses established, and modifier review to ensure valid creation of claim. Reviews and enters manual charges submitted by providers for external services. Reviews and resolves simple NCCI, LCD and MUE edits. Reports to Billing Manager Supervises None Ages of Patients None Blood Borne Pathogens Minimal/No Potential Qualifications Education Required: High School Diploma or GED Preferred: Currently enrolled in a coding certification program or holding an Apprentice Certificate in coding- CPC or CCS Preferred: General College Studies Preferred: One year coding certificate or courses in Medical Terminology, Anatomy and Physiology and extensive training or experience in coding Licensure/Certification Required: Within 18 months complete a coding...

Our Client, a Healthcare company, is looking for a Specialty Physician Coder for their Fountain Valley, CA location. Responsibilities: Achievement of productivity standards as established by management. Achievement of quality standards as established by management. In adherence with standard work, analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS codes to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines, including the ability to review and natively code surgical operative and/or procedure reports. In adherence with standard work, follow established workflow for working claim denials in the Follow-Up work queues and identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons,...

Position Overview This role is responsible for accurately assigning codes to physician diagnoses and procedures, ensuring compliance with the latest medical billing and reimbursement policies. The specialist reviews medical records to identify all appropriate coding, adhering to CMS guidelines and current reimbursement standards. Duties include generating invoices for insurance and patient billing, managing paperwork, handling insurance claims, and performing collections. Collaboration with clinical teams and patients is essential to ensure precise and complete charge preparation for each visit. Key Responsibilities Maintain a safe and clean work environment, following unit safety and infection control protocols. Coding: Utilize electronic health records (EHR) to support claim coding. Assign ICD-10-CM, CPT-4, and HCPCS codes for surgeries based on current guidelines. Review physician notes for accuracy and completeness. Communicate with physicians to clarify...

The Certified Medical Coder is responsible for accurate, compliant, and timely coding of professional and facility pain management services, with a strong emphasis on Workers' Compensation and Functional Rehabilitation Programs (FRP). This role supports interventional pain evaluation and management, rehabilitation services, and ancillary procedures, while ensuring compliance with state-specific WC rules, payer-specific billing guidelines, and other payer requirements. Performs review of all coding related holds for Boomerang Health Care (BHC) to ensure consistency in documentation needed to meet compliance guidelines for appropriate and effective reimbursement. *This is a remote role. What you will do: Assign accurate CPT, HCPCS, and ICD-10 codes for all services performed at BHC facilities. Apply appropriate modifier usage based on payer and service requirements. Ensure documentation supports medical necessity, procedural complexity, and level of services. Apply...

SUMMARY: This position is responsible for supporting the Professional Medical Billing team by posting payments, capturing/working denials, and working outstanding accounts receivable (A/R) balances and other assigned duties as needed. They will be responsible for assisting in analysis and resolutions of clinic reimbursement issues, clinical statistics, recommending CDM updates for clinic services and assisting Management with other billing responsibilities as assigned. ESSENTIAL FUNCTIONS : Perform posting charges and completion of claims to payers on time Review transmitted claim via clearing house, working rejected claims as needed Review patient bills for accuracy and completeness, and obtain any missing information Prepare, review, and transmit claims using billing software, including electronic and paper claim processing Follow up on unpaid claims within a standard billing cycle timeframe Check each insurance payment for accuracy and compliance with...

This is a casual position which is subject to renewal on 10/24/2025. JOB SUMMARY: Under the general direction of the Supervisor, Professional Billing & Coding and Director, Professional Billing & Coding, this position operates from within the Revenue Cycle Center to address coding issues related to professional billing claims. The incumbent is responsible for reviewing provider charges to ensure accuracy, reduce claim errors & denials while maintaining compliance with CCI & other payer specific coding Edits (McKesson). The incumbent is responsible for reviewing professional surgical coding performed by departmental Professional Services Coders to ensure accuracy. The incumbent will be responsible for identifying trends of incorrect coding & compiling examples. They will develop training guidelines & presentations of coding recommendations based on these identified trends & will meet with physician providers to train & educate. The incumbent...

POSITION Specialty Physician Coder Position Type: Temporary Schedule : M-F, 8:00 am - 4:30 pm Assignment Length: Approximately 3-Months, possibly longer. DESCRIPTION Under the direction of the Coding Compliance Manager, the Specialty Physician Coder plays a critical role in reviewing and analyzing specialty physician coding and billing to support accurate charge capture and compliant reimbursement. This position is responsible for coding office, inpatient, outpatient, and surgical/procedural services with a focus on surgical breast oncology (including plastic reconstructive breast surgery) and Hematology/Oncology. The coder will identify coding trends, irregularities, and opportunities for improvement while collaborating closely with providers and revenue cycle partners. Essential Duties & Responsibilities Review and abstract medical records to capture all billable professional charges Assign accurate ICD-10-CM, CPT, and HCPCS codes for inpatient,...

Job Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Serves as a subject matter expert in hospital and professional coding and interacts with other teams and departments across the organization such as patient financial services, revenue integrity (charge description master) team, provider teams and/or compliance on a routine basis. Performs coding for cardiac/IVR procedures and maintains required quality and productivity standards while remaining compliant with third party, state and federal regulations. Reviews and resolves medical necessity edits that may...

Job Description Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company’s Workplace of the Year. We provide an outstanding benefit package that includes healthcare, paid time off and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals. What Will I be Doing in this Role? Under the general direction of the HID Audit Supervisor, the role operates as a Coding Auditor and shall:  Monitor coding compliance through prebill and retrospective reviews or audits of ICD and/or CPT codes assigned by coding staff. Monitor coding compliance by performing focused audits on high-risk areas identified by the Office of Inspector General (OIG) and the Centers of Medicare and Medicaid Services (CMS)....

Job Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Codes for cancer center encounters and maintains required quality and productivity standards while remaining compliant with third party, state and federal regulations. Reviews and resolves medical necessity edits that may apply for any outpatient surgical encounters, applying hospital and professional modifiers to CPT codes and processes any errors associated with the revenue cycle process. Assists in the design and implementation of workflow changes to reduce coding and billing...