20 coder ii 5 jobs found

Risk Adjustment Coder II The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborating with multiple departments across the organization. Job Specifications and Core Competencies: Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions, utilizing ICD-10 coding guidelines for Commercial and Medicare risk...

Job Summary JOB SUMMARY The primary purpose of the SPEC, PHYS SVC CODING II is to code physician charges by assigning ICD-10, CPT, HCPCS codes and modifiers from medical record documentation. Must have the ability to utilize multiple resources to support code assignment. Must possess knowledge on how to resolve coding denials and pre-bill coding edits. Productivity and accuracy are measured via internal audits and must be maintained. Level II roles include but are not limited to evaluation and management coding, radiology, and emergency department coding. ESSENTIAL DUTIES AND RESPONSIBILITIES Assign ICD-10, CPT, HCPCS and modifiers codes from documentation Review and appropriately resolve pre-bill edits Review and appropriately resolve coding denials Meet or exceed productivity standards Meet or exceed accuracy rate of 95.5% in monthly internal audits Effectively present coding issues to internal team members, internal clients, or external clients Deliver...

DHR Health - US:TX:McAllen - Days Summary: POSITION SUMMARY: The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the Standards of Ethical Coding as set...

Job Description REMOTE position WebEx video interview will be conducted prior to an offer MUST be able to work 40 hrs/week without issue Applicant must have the necessary equipment for the contract; 2 monitors, keyboard, mouse, web camera. If not, Agency must supply ahead of start date. Knowledge and Expertise: Must demonstrate a solid understanding of Coding Guidelines and CPT Guidelines for E/M (Evaluation and Management). Must be able to answer questions to gauge their coding knowledge. Clinic Coding Experience: Must have experience in clinic coding, including: Office-type procedures Vaccinations E/M leveling Modifiers: Familiarity with modifiers used in the clinic setting is essential. Risk Adjustment Experience: While Risk Adjustment experience is acceptable, the candidate must also possess clinic coding experience as well. Experience in Specialty Areas: The candidate must have experience in at...

RN Field Coder Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The RN Field Coder will be responsible for documentation and coding review of medical records where...

Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk‑adjusting conditions and supporting provider documentation improvement. Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding. Advanced...

Job Number: 180041, Job Title: Risk Adjustment Coder II, Salary: $27.69 - $34.62 JOB SUMMARY The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborating with multiple departments across the organization. JOB SPECIFICATIONS AND CORE COMPETENCIES Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions,...

Community Health Choice, Inc. seeks a Risk Adjustment Coder II in Houston, Texas. The role involves advanced medical record reviews and coding of chronic conditions to ensure correct risk scoring, complying with CMS guidelines and internal policies. The ideal candidate has a Bachelor's degree or equivalent experience, and AHIMA/AAPC certification, along with 3-5 years of experience in risk adjustment coding. Join a team dedicated to improving healthcare quality for over 400,000 members. #J-18808-Ljbffr

Job Summary The RN Field Coder will be responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. The RN Field Coder will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work includes pre-visit, post-visit, and wrap‑around education. In pre‑visit, the coder reviews medical records, outside results, and health plan data for upcoming appointments, flagging key insights for the provider. In post‑visit, the coder reviews the provider note, populates all supported codes (ICD‑10, CPT, CPT‑II, etc.), and assists in claim submission. Wrap‑around education involves periodic review of findings, highlighting documentation opportunities, and ongoing education. The Field Coder is responsible for provider querying and education on documentation guidelines, requires a strong understanding...

Job Summary The RN Field Coder will be responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. The RN Field Coder will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work supported by the RN Field coder will include pre, post and wraparound visit input. Pre-Visit: Reviewing the medical records, outside results and health plan data for upcoming patient appointments and flagging important insights for the provider to review before seeing the patient. Post Visit: Reviewing the provider note, populating all supported codes (ICD-10, CPT, CPT-II, etc.), and assisting submission of encounter for claim processing. Wrap Around Education: Periodic review of findings, highlighting areas of opportunity in documentation and ongoing education. Provider querying and education...

Company Overview Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women Children's Health Insurance Program (CHIP) for the children of low‑income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions. Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare...

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary The RN Field Coder will be responsible for documentation and coding review of...

RN Field Coder Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The RN Field Coder will be responsible for documentation and coding review of medical records where...

RN Field Coder The RN Field Coder will be responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. The RN Field Coder will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work supported by the RN Field coder will include pre, post and wraparound visit input. Pre-Visit: Reviewing the medical records, outside results and health plan data for upcoming patient appointments and flagging important insights for the provider to review before seeing the patient. Post Visit: review the provider note, populate all supported codes (ICD-10, CPT, CPT-II, etc.), and assist submission of encounter for claim processing. Wrap Around Education- periodic review of findings, highlighting areas of opportunity in documentation and ongoing education. The Field Coder will be responsible for...

About Us Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits,...

Associate Director - Medical Science Liaison - Gastroenterology (Dallas TX) Join to apply for the Associate Director - Medical Science Liaison - Gastroenterology (Dallas TX) role at BioSpace Associate Director - Medical Science Liaison - Gastroenterology (Dallas TX) 1 day ago Be among the first 25 applicants Join to apply for the Associate Director - Medical Science Liaison - Gastroenterology (Dallas TX) role at BioSpace At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to our communities through philanthropy and volunteerism. We give our best effort to our work, and we put people first. We’re looking for people who are determined to make life better for people around the world. Organization...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note:...

Job Title This Coder II will be part of the Cath lab team therefore, experience with Cath lab coding highly preferred in addition to the CIRCC certification. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. The Coder II is skilled in three or more types of outpatient, Profee,...

Driscoll Children's Hospital in Corpus Christi, TX is seeking a CBO Certified Coder II. This role involves reviewing medical records and assigning appropriate ICD and CPT codes to outpatient records. The ideal candidate will have 3-5 years of physician coding experience and relevant certifications. The position requires maintaining confidentiality and adhering to compliance guidelines. Join our compassionate team dedicated to innovation and superior patient care. #J-18808-Ljbffr

Integrative Emergency Services, LLC ("IES") is seeking a Coding Specialist with emphasis on auditing surgical services. The Coding Specialist is responsible for accurate professional fee coding and documentation review for assigned surgical service lines (URSA/NTCC/TSN). This role evaluates medical records to ensure proper CPT, HCPCS Level II, and ICD-10-CM code assignment in accordance with payer guidelines and regulatory standards. The Coding Specialist supports documentation integrity, identifies coding compliance risks (including undercoding, overcoding, and unbundling), and contributes to clean claim submission and optimal reimbursement through coding analysis, audits, and special projects. Candidates can work in either a hybrid or remote setting. If remote, must reside in a state IES operates in: AZ, CO, TX, OK, IN, MO, AL, SC, FL IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting...