14 creative coder jobs found

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, andlife sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven andhighly collaborative team that is passionate about creating transformative change in healthcare. We're looking for experienced and credentialed outpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the future of...

Sr. Recovery Resolution Analyst This position is remote in Massachusetts. You will have the flexibility to work remotely as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Sr. Recovery Resolution Analyst will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the...

Medical Biller The Medical Biller serves as the department expert in regards to all billing that is processed for the assigned area. The Medical Biller resolves unsettled items and assists in the recovery of underpayments and denials relative to patients' accounts and third party payers. Works with billing staff to ensure informational data is accurate and timely, optimizing revenue and maximum cash flow benefit to the clinics. Duties also may include: ensuring charge entry and coding is correct, verifying insurance coverage, managing Workques of charges, edits and follow up in Epic. Manages consent forms for services billed to Masshealth. Department: OB-GYN Administration Schedule: Full Time Essential Responsibilities / Duties: Responds to billing company requests for additional information; includes correcting missing/invalid modifiers, diagnosis codes, or other elements to enable submission of billing to payers through Epic Workques. Performs follow-up with insurance...

Become a part of our caring community The 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 Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Job Description About the role: The Associate Director, Medical Review, will serve as a functional expert in the area of Medical Review for their assigned region and products and ensure alignment and integration of process and technology efficiencies in medical review activities across disease areas for Global Medical Affairs Oncology (GMAO). The individual in this role must excel in providing advanced medical and scientific review of commercial and medical affairs materials (both promotional and non‑promotional) to support the review processes. They will perform timely, accurate, and detailed scientific/medical reviews of both non‑promotional and promotional materials for the US and global markets in accordance with established policies and regulatory guidelines to meet customer needs, ensuring accurate, balanced medical/scientific messaging. The role also includes partnering with the Head of Medical Review to deliver high‑quality, balanced, and timely medical and scientific...

Sr Med Bill Examiner - CJ10DN We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future. We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future. Successful candidates will be responsible for performing Medical Bill review and investigation of medical invoices to determine reimbursement based on applicable workers compensation statues and/or regulations including: -Analyzing of bill for proper assignment of detailed medical coding information -Interpreting workers compensation rules for repricing -Entering/correcting data of medical...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We’re Looking For We’re looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

Outpatient Clinical Documentation Specialist The Risk Adjustment CDS will provide clinically based prospective concurrent and retrospective reviews of medical records for WellSense of members enrolled in value-based agreements to evaluate risk adjustment capture based on clinical documentation. The Risk Adjustment CDS will review risk adjustment gap lists for members including suspect conditions and perform chart reviews to determine clinical validity of open gaps. The Risk Adjustment CDS will utilize Physician documentation queries to communicate clinical indicators to Physicians/Other Qualified Health Care Providers in preparation for up-coming visits and/or in identifying patients that need to be seen for a visit. The goal of the risk adjustment reviews includes facilitation of appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality. Specific reviews are both determined internally and by requirements/requests...

Medical Biller The Medical Biller serves as the department expert in regards to all billing that is processed for the assigned area. The Medical Biller resolves unsettled items and assists in the recovery of underpayments and denials relative to patients' accounts and third party payers. Works with billing staff to ensure informational data is accurate and timely, optimizing revenue and maximum cash flow benefit to the clinics. Duties also may include: ensuring charge entry and coding is correct, verifying insurance coverage, managing Workques of charges, edits and follow up in Epic. Manages consent forms for services billed to Masshealth. Department: OB-GYN Administration Schedule: Full Time Essential Responsibilities / Duties: Responds to billing company requests for additional information; includes correcting missing/invalid modifiers, diagnosis codes, or other elements to enable submission of billing to payers through Epic Workques. Performs follow-up with...

Outpatient Clinical Documentation Specialist The Risk Adjustment CDS will provide clinically based prospective concurrent and retrospective reviews of medical records for WellSense of members enrolled in value-based agreements to evaluate risk adjustment capture based on clinical documentation. The Risk Adjustment CDS will review risk adjustment gap lists for members including suspect conditions and perform chart reviews to determine clinical validity of open gaps. The Risk Adjustment CDS will utilize Physician documentation queries to communicate clinical indicators to Physicians/Other Qualified Health Care Providers in preparation for up-coming visits and/or in identifying patients that need to be seen for a visit. The goal of the risk adjustment reviews includes facilitation of appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality. Specific reviews are both determined internally and by requirements/requests...

HIMS Coder Salary Min $23.90 Salary Max $42.49 Pay Basis Hourly Compensation is determined based on experience and applicable certifications. Description Medical HIMS Coder Full-Time career opportunity Valued for your Expertise in HIMS Coding Are you a skilled Health Information Management Systems (HIMS) Coder seeking a career that aligns with your passion and values? Join our team where we believe in careers close to home and heart. Your role is vital in ensuring accurate coding of medical records, maintaining data integrity, and supporting healthcare efficiency. Translating medical information into standardized codes, you'll contribute to quality patient care. As a HIMS Coder, responsibilities include precise coding based on ICD-10-CM and CMS 13 group codes and maintaining compliance with regulatory guidelines and company policies. If you're eager to make a meaningful impact, explore this exciting opportunity with us where your expertise meets personal values. A Glimpse into...

Sr Medical Coding Specialist At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! Job Summary The Senior Medical Coding Specialist provides analysis of the highest dollar and most complex claims by applying research, coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, the incumbent will perform reviews to identify variations from...

Department Description:The Critical Care Auditor/ Coder position will be working directly with the Department of Anesthesia, Critical Care and Pain Medicine and will have the opportunity to work remotely following an initial onsite training period. The incumbent will be required from time-to-time to attend billing onsite staff meetings and meetings with the physicians they support. AFS, LLC is located in Needham Heights, Massachusetts. Job Location:Virtual Job Summary:Performs professional certified coding and provides administrative and project support to the department. Analyzes surgical-medical documentation, provides the individual surgeon/physician with the application of appropriate ICD-10/CPT/HCPCS descriptor codes including the appropriate use of modifiers to ensure compliance for reimbursement. Essential Responsibilities:Analyzes evaluation and management, including critical care, procedures and other notes and documents to determine the scope and complexity of the...

Billing Compliance Curriculum Development Specialist Dana-Farber Cancer Institute Boston, MA Full Time The Billing Compliance Curriculum Development Specialist is responsible for the design, development, implementation, and evaluation of enterprise-wide billing compliance education programs at Dana-Farber Cancer Institute (DFCI). This role serves as a subject-matter expert in professional and technical billing compliance, with a strong emphasis on oncology services, regulatory requirements, and risk-based education strategies. The position partners closely with Billing Compliance leadership, Revenue Cycle, HIM, Clinical Operations, and Compliance to ensure education is standardized, scalable, evidence-based, and aligned with CMS, OIG, NCCI, payer guidance, and institutional risk priorities. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united...