37 clinical data analyst jobs found

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...

Medical Coding Auditor UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. This position requires extensive knowledge and experience with E/M coding. $2,000 Sign-on Bonus Minimum $56,173 - Midpoint $70,217* Salary is determined based on years of total relevant experience. Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes, medical diagnoses and clinical procedures ensuring that accurate medical billing conforms with legal and regulatory requirements. Trains, instructs and provides technical support...

It's rewarding to be on a team of people that truly believe in making an impact!We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.**Job Summary**The ACO Coding Auditor is responsible for reviewing medical records and identifying, collecting, assessing, monitoring, and documenting claims and encountering information as it pertains to Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the Medicare Risk score meets all requirements and act as a consulting MRA advisor to the practices you support. You review practices for both CMS and Commercial ACOs for quality compliance.**Essential Duties & Responsibilities*** Performs on-site and remote clinical validation audits and interpretation of medical documentation to capture all Medicare Risk codes in coordination with the physician.* Provides guidance and consultation to practice team members to drive improved MRA coding...

Pro Fee Coder Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). The Pro Fee Coder will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement. Coder I may validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals. The Coder I performs documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coder I may...

Job Description Job Description Hybrid-Sunrise, Florida Position Summary: The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities: Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud...

Pro Fee Coder Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). The Pro Fee Coder will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement. Coder I may validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals. The Coder I performs documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coder I may...

Banner Health Coding Educator Our Coding Educators play a critical role at Banner Health. Join our team of forward-looking Physician Coding Educators who support our Physician Practices and Profee Coding Teams. In this role, you will provide valuable coaching to our Physician Coding team, as well as our Providers. Experience in advanced E/M Coding, and wide range of Production Coding experience within different specialties is a must, as well as current certification in Coding through AHIMA or AAPC (as seen in the qualifications below). Location: Remote Shift: Full time, Exempt position, Monday-Friday Ideal Candidate: 3 years recent experience in Profee EM coding within wide range of specialties (clearly reflected in your attached resume); Bachelors Degree or equivalent; Must be currently certified through AAPC or Ahima, as defined in minimum qualifications below. Please upload a copy or provide certification number in your questionnaire. The hours are flexible with the...

Job Title: Registered Nurse (Rn) We are seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with state and federal regulations. Key Responsibilities: Analyze claims data, medical records, and provider documentation to identify discrepancies, fraud, or non-compliance. Conduct retrospective case reviews, on-site provider audits, and recipient interviews. Review billing practices for upcoding, duplicate billing, and unbundling of services using ICD-10, CPT, and HCPCS manuals. Prepare reports, case findings, and recommend sanctions when violations are identified. Coordinate and participate in teleconferences, hearings, and legal proceedings with the Office of General Counsel and other agencies. Respond to provider complaints and compliance inquiries via hotline,...

Medical Records Technician (Coder Inpatient/Outpatient) MRTs are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. These coding practitioners analyze and abstract patients health records and assign alphanumeric codes for each diagnosis and procedure. ** This is an on site position, you must live within or be willing to relocate within a commutable distance of the duty location. ** Duties of the Medical Records Technician (Coder) In/Outpatient include, but not limited to: Assigns codes to documented patient care encounters (outpatient and/or inpatient professional services) covering the full range of health care services provided by the VAMC. Selects and assigns codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common...

Coding Specialist At Memorial, we are dedicated to improving the health, well-being and, most of all, the quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital...

Job Title :Registered Nurse (Rn)We are seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers.This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with state and federal regulations.Key Responsibilities :Analyze claims data, medical records, and provider documentation to identify discrepancies, fraud, or non-compliance.Conduct retrospective case reviews, on-site provider audits, and recipient interviews.Review billing practices for upcoding, duplicate billing, and unbundling of services using ICD-10, CPT, and HCPCS manuals.Prepare reports, case findings, and recommend sanctions when violations are identified.Coordinate and participate in teleconferences, hearings, and legal proceedings with the Office of General Counsel and other agencies.Respond to provider complaints and compliance inquiries via hotline, email, and official...

divh2Coding Specialist/h2pResponsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment./ppstrongMinimum Qualifications:/strong/pp1. Graduate of Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience./pp2. Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), COC (Certified Outpatient Coder), CCS...

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet. The Department of UHealth Laboratories- IHL is currently seeking a Full-Time Sr. Medical Biller to work onsite in Miami. The incumbent in this position will process billing information in appropriate system and assists supervising staff in maintaining quality control of data by identifying potential problems and offering and implementing solutions. CORE JOB FUNCTIONS Assists management with the training of new staff. Runs reports weekly on accounts and monitors to keep the contents at a minimum. Verifies all claims and ensures edits are collected and released in a timely fashion. Reports edits by billing area to managing staff on a monthly basis. Verifies that all controls are followed so that no...

Overview Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families...

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence.For 25 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2024-2025 & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.What truly sets us apart is our people.At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond...

Job Description About the Role: We are seeking a highly skilled and experienced Senior Inpatient HIM Coder to join our dynamic healthcare information management team. This role is crucial in bridging the gap between clinical data and technology, as we aim to develop cutting-edge AI solutions for medical coding and billing processes. The successful candidate will play a pivotal role in providing valuable insights and expertise to enhance our product development efforts. Requirements and Qualifications: A minimum of 3 years of hands-on experience as an acute HIM inpatient medical coder in a hospital environment. Proficiency in identifying and extracting ICD-10-CM, ICD-10-PCS, HCPCS/CPT codes, and associated modifiers from patient records. In-depth understanding of supporting evidence requirements for accurate coding. Practical experience using grouper software for MS-DRG and APR-DRG assignment. Strong communication skills to interact...

Become a part of our caring community and help us put health first 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. 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...

Job Requirements ** Candidate to be considered must reside in the state of Florida. This is a work from home opportunity with majority being remote work** Position Summary To be fully engaged in providing timely, complete, and accurate data collection for quality clinical analysis and revenue enhancement. PRIMARY ACCOUNTABILITES 1. Uphold regulatory compliance by assigning and sequencing accurate ICD 10 and CPT 4 codes to reference lab, ancillary, emergency room, endoscopy, ambulatory surgery, observation, and other outpatient records as per coding guidelines demonstrating behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities. 2. Validate accuracy of codes assigned by the computer assisted coding software, recognizing inappropriate application of clinical coding rules/guidelines, and revising the codes assigned based upon expert subject matter knowledge and provider...

Job Description The Inpatient Medical Coder II is responsible for coding and applying ICD-10-CM and PCS codes as applicable to code medical records for Brooks Rehabilitation Hospital. Reviews data from the medical record to determine or confirm codes. Performs analysis of physician documentation and provides feedback for improvement. Collaborates with internal and external resources to obtain additional documentation to support the services provided, documentation and codes billed. Responsibilities: Reviews medical record to correctly apply and/or validate ICD-10-CM IRF-PAI codes. Supports timely, accurate and complete documentation of clinical information, facilitating modifications to clinical documentation to support services rendered and reimbursement received. Maintains knowledge of coding rules and regulations by staying current on issues regarding medical coding, compliance and reimbursement. Ability to accurately assign the IGC, etiologic diagnosis, and...

Current Coding certificate AAPC (CPC, CEMC, COC, CIC) or AHIMA (CCS, CCS-P) 3+ Years working in the health insurance field. Evaluation and Management (E&M) & GMC Coding - MUST have 3+years of experience Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration. Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted. Conduct detailed coding audits to validate...

Miami, FL | Full-Time Health Information Management Summary HIM Inpatient Coder 1 is responsible for reviewing the clinical documentation contained in the in-patient health records to accurately assign and sequence ICD-9 diagnostic and ICD-9 procedure codes to inpatient records for use in reimbursement and data collection. Responsibilities Has the knowledge and experience to code In-patient medical records using ICD-9 and/or ICD-10 code set. Ensures all accounts are coded correctly, which will provide an accurate MS-DRG or APR-DRG for appropriate reimbursement. Ensures all accounts are coded within 4 days of the patient's discharge date, meeting productivity standards according to AHIMA Guidelines depending on record type. Verifies patient information to identify any discrepancies and ensures that all codes and any other abstracted information is applied to the appropriate patient's encounter. While reviewing the record for coding purposes, serves as a...

Summary MRTs are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. These coding practitioners analyze and abstract patients. health records and assign alphanumeric codes for each diagnosis and procedure. Duties Help ** *THIS IS AN ON SITE POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** Duties of the Medical Records Technician (Coder) In/Outpatient include, but not limited to: Assigns codes to documented patient care encounters (outpatient and/or inpatient professional services) covering the full range of health care services provided by the VAMC. Selects and assigns codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System...