3 coder professional jobs found

Description The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc.  KNOWLEDGE & SKILLS: Concise and effective verbal and written communication skills  Ability to interface with claims...

📍 Wilmington, DE  🕓   Full-Time on-site | Healthcare Administration | Revenue Cycle Management About D’Souza & Associates For over 35 years,   D’Souza & Associates   has helped physicians and healthcare practices across the U.S. get paid accurately and on time. We’re a technology-driven medical billing and revenue cycle management firm that believes in precision, accountability, and continuous improvement. We combine human expertise with smart automation to simplify healthcare operations — and we’re looking for detail-oriented, motivated professionals to grow with us. What You’ll Do Enter and review patient, insurance, and billing data for accuracy Research and resolve claim issues and denials through payer communication and analysis Track claims and payments to ensure timely reimbursement Collaborate with internal teams and physician offices to clarify billing details Prepare and summarize reports on claim and payment activity Handle...