223 nurse coder jobs found

Medical Review Nurse Coder (Home Health) The Catholic Health Home Care Medical Review Nurse Coder is responsible for ensuring the accuracy, completeness, and regulatory compliance of home health clinical documentation prior to billing. This role reviews OASIS assessments, patient charts, Face-to-Face (F2F) encounters, physician orders, and Plans of Care to support Medicare Conditions of Participation, payer requirements, and timely reimbursement. This role is essential to maintaining regulatory compliance, ensuring accurate reimbursement, and supporting high-quality, timely patient care in the home health setting. Key Responsibilities Review OASIS assessments for accuracy, completeness, and compliance Audit patient records to ensure documentation supports billed services Validate Face-to-Face (F2F) encounters for regulatory compliance Review Plans of Care for accuracy, timeliness, and physician signatures Ensure proper clinical coding and case-mix accuracy...

TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care. This role will apply coding and clinical principles based on industry standards and...

A healthcare technology firm is seeking a Nurse Coder DRG Auditor to validate coding accuracy and medical necessity of inpatient claims. The role involves applying industry standards and guidelines to perform DRG validations while collaborating within a team. Successful candidates will have an active RN license, relevant coding certifications, and experience in clinical practice. A competitive salary of $85,000 to $90,000 is offered, along with a comprehensive benefits package. #J-18808-Ljbffr

PERMA FAIR is seeking a Member Experience Clinical Coder & Medical Biller in Camden, New Jersey. This role involves reviewing and validating medical claims, ensuring coding accuracy, and maintaining compliance with medical coding standards. Candidates should have a nursing degree, an active nursing license, and at least 2 years of experience in the medical field. A competitive salary ranging from $115,000 to $150,000 is offered along with comprehensive benefits including medical insurance and a 401(K) plan. #J-18808-Ljbffr

Registered Nurse & Certified Professional Coder- State of Alabama It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Gainwell is currently seeking a Registered Nurse licensed in the state of Alabama who is also a Certified Professional Coder (CPC), or actively working toward CPC certification (must be certified within 12 months of employment). This is a critical role that combines clinical expertise with claims-processing accuracy. Job Functions Process complex claims...

Description: Are you interested in building a career with other TOP PERFORMERS? Effingham Health System is committed to providing exceptional care and services in an environment that supports professional growth, diversity, and inclusion. Every team member's experience and work-life balance are a priority in our organization. EHS culture encourages and supports individuals in pursuing their career goals and well-being by providing work-life balance, flexible scheduling, career development, and all the benefits and perks you need for yourself and your family. New Grads are welcome to apply. Benefits Retirement plans 403 (b) and 457 Health insurance Dental Insurance Vision insurance Prescription Drug Plan Hospital Discount Flexible spending account Paid time off Extended Days off (Sick time) Employee assistance program Strive365 Wellness Program Basic Life insurance (Employer Paid) Voluntary Life insurance/Accident/Critical Illness Disability (LTD and STD) Tuition...

Overview Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Benefits for Full and Part-time Employees We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay 100% of the DENTAL monthly premiums for Employee Only coverage. We provide an...

Ready to help us transform healthcare? Bring your true colors to blue. The Role The Clinical Appeals Nurse Reviewer facilitates, coordinates, and responds to provider appeals for denied services utilizing extensive clinical, regulatory, business, and coding knowledge. Collaborates with the Physician Review Units, Medical & Payment Policy Departments, Provider Service, Member Service and Claims Area to research and resolve provider claims appeals. The Team As an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and business expert for claims appeals. This role works collaboratively with Provider Service, Claims, Network Management, Physician Review, and Medical and Payment Policy teams. Key Responsibilities: Review appeals utilizing sound clinical judgement, medical policy, payment policy guidelines, pricing files, contractual obligations, and billing practices, all to appropriately adjudicate provider and facility claims...

Ankura Health Care Disputes, Compliance and Investigations Practice Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also...

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research...

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research...

QA Nurse / Coder (RN) As a QA Nurse / Coder, you will ensure the accuracy, completeness, and regulatory compliance of Home Health documentationparticularly OASIS assessments, the Home Health Plan of Care (485), and face-to-face encounter noteswhile properly sequencing diagnoses according to federal/state standards and agency policy. Core responsibilities include: Review OASIS forms and Plans of Care for appropriateness, completeness, and compliance. Assign and sequence ICD?10 codes in line with current home health coding guidelines. Ensure consistency and compliance of face-to-face encounter documentation with OASIS and care plans. Conduct additional clinical record audits and OASIS reviews as assigned. Stay current on Medicare reimbursement policies, home health regulations, and compliance requirements. Maintain relevant certifications (HCS?D, HCS?O or COS?C). Participate in quality assurance and performance-improvement efforts. Coordinate with physicians, facilities,...

Position Summary The Member Experience Clinical Coder & Medical Biller serves as a key contributor to internal medical billing review, payment integrity, and claims adjudication. Responsible for reviewing, validating, and repricing claims on behalf of payers, providers, and claim audit partners to support accurate reimbursement and strengthen payment integrity for our self‑insured clients. Translate medical diagnoses, procedures and services into standardized coding while ensuring compliance with established guidelines and reimbursement methodologies. Collaborate closely with providers, Third-Party Administrators (TPAs), and other stakeholders to identify coding discrepancies, provide analysis, and communicate findings that drive informed decision‑making and optimal claim outcomes. Key Responsibilities Medical Coding & Documentation Review Receive, analyze, and verify patient medical records for accuracy, ensuring all required information is present for proper billing and...

Coding Compliance & Education Coordinator A Day in the Life of the Coding Compliance & Education Coordinator: You'll be diving into clinical documentation and coding records, performing detailed audits to ensure every code is accurate, complete, and compliant with regulatory standards. You'll analyze patterns, identify discrepancies, and provide actionable feedback that supports optimal reimbursement and quality reporting. You'll assist with developing and delivering training sessions for coding staff, clinical providers, and other stakeholders. You'll serve as the go-to expert for ICD-10-CM, ICD-10-PCS, CPT, and sequencing guidelines, helping teams stay current with evolving standards. You'll work closely with the Coding Manager and other leaders, ensuring coding practices align with organizational goals. Whether you're refining audit processes, answering complex coding questions, or creating educational materials, your work directly impacts compliance, revenue...

Newport News, Virginia Overview Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. What You Will Do Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits for documentation opportunities and queries clinical staff to fill in any gaps to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation. Contacts and works with physicians as needed for clarification of details to ensure correct coding. Accurately utilizes the ICD‑10‑CM...

Medical Coding Specialist Summary/Objective: Obtain accurate reimbursement for healthcare claims. Essential Functions Reviews and resolves all assigned charges thoroughly based on coding guidelines, chart documentation and related charges in billing system. Audits task manager work files with charges reviewed by Claims Manager that were found to have coding errors/omissions. When appropriate communicates approved coding changes and/or questions to Physician's and their office staff. Also alerts providers of missing or late charges. Alerts management to coding trends discovered while working daily charges/edits. Stays informed and up to date on coding issues by attending seminars. Possesses a comprehensive understanding of carrier specific State of Florida billing guidelines. Consistently stays within the department production goal set for your area Requirements Required Education and Experience: High School Graduate or Equivalent. Must be a certified coder either...

Job Description Responsible for supervising the work of staff who review, interpret, code and abstract medical records information according to standard classification systems; performs the most advanced medical records coding and abstraction duties; performs data quality reviews and prepares complex reports as required; and performs other related duties as assigned. Principal Accountabilities include promoting Coding Audit department goals by selecting, motivating, and training capable team members, leading the activities of assigned Coding Audit team members by communicating and providing guidance toward achieving department objectives, assisting in analyzing common operational definition of metrics and assisting in the development of regional reports to monitor individual hospitals in one database and developing processes to integrate clinical department managers in correction and resubmission of medical records, assisting with the development of tools to track performance...

Job Title Newport News, Virginia This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Hours: Labor Pool (as needed) Overview Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. What You Will Do Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits for documentation opportunities and queries clinical staff to fill in any gaps to clarify confusing, incomplete or conflicting information and...

Our client is seeking an experienced Quality Assurance Coder/Auditor in Phoenix, AZ on a Hybrid basis. This opportunity will transition from a 6-month contract to direct hire position while being trained as a replacement by a seasoned employee. The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Schedule : 40 hours a week (plus any additional hours as requested or as needed to meet business requirements). Hybrid : 1 day a week in office setting, remainder of week is remote Key Responsibilities: • Comprehensive understanding of HCC Coding rules, regulations and methodology • Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct...

Nursing Supervisor (RN) Medical Surgical Urology/Genitourinary Full Time Days Bring your passion to Texas Health so we are Better + Together Work location: Texas Health Dallas, 8200 Walnut Hill Lane, Dallas Texas, 75231 Work hours: Full Time Days (7A-7P) Medical Surgical Department Highlights 24-Bed Urology Inpatient Medical-Surgical Unit Self-scheduling with rotating weekend requirements Working with a Multi-Disciplinary Team Work with patients and provide life-saving care The opportunity to work with a diverse patient population What You Need Associate Degree in Nursing required; BSN preferred. Current RN licensure or compact licensure recognized by the Texas Board of Nursing upon hire required BCLS prior to providing independent patient care and maintained quarterly required ACLS - Advanced Cardiac Life Support 90 Days Req And CPI Crisis Prevention Intervention Training within 90 days of hire 2-year experience as a registered nurse with previous...

Job Description Job Description Certified Home Health Coder & QA Specialist Become a part of the Hope At Home Family! We currently have a position available for a Certified Home Health Coder & QA Specialist. Position Summary: Certified Home Health Coder & QA Specialist is required to have PDGM, Oasis D1 experience, and Kinnser software knowledge. Home Health Coder is responsible for coding using ICD-10 all diagnoses and applicable procedures of skilled service visits. The position is also responsible for reviewing OASIS and abstracting visit data for billing and data collection purposes. Responsibilities: Codes records using ICD-10-CM and coding guidelines. Reviews OASIS. Observes and report unusual patterns in data collection and/or lack of adequate documentation for code assignments. Review documentation and provide ICD-10 coding recommendations based on current coding and Oasis guidelines. Performs other related duties as requested by the Home...

Job Description Principal Accountabilities: 1. Scans by rounding the inpatient units with scanners on wheels daily times. 2. Scanning done in HIM of all outpatient documentation. 3. Indexes, performs quality review and Archives. 4. Preps medical records from all services with a high degree of detail and accuracy. 5. Ensures every page contains a patient ID label and both sides are scanned if needed. 6. Ensures the scanning quality is legible and easily readable for all services. 7. Other related projects as assigned Qualifications Required: 1. HS diploma or equivalent experience 2. Minimum two (2) years' experience in physician coding and billing required 3. CCS preferred 4. EPIC training preferred LEVEL II - 3-5 years of prior experience - HS Diploma or equivalent. Associates/Technical Degree or equivalent combination of education/experience. All legally/reasonably expected certifications needed for function and level. Performs moderately complex assignments that require an...

Primary Responsibilities Sets team direction, resolves problems and provides guidance to members of own team Oversees work activities of medical coders or recovery resolutions representatives Adapts departmental plans and priorities to address business and operational challenges Influences or provides input to forecasting and planning activities Leverages pertinent data to identify and solve a range of problems Examines, assesses, and documents business operations and procedures to ensure data integrity, data security, and process optimization Leverages solid communication skills (verbal, non‑verbal, and written) with a demonstrated ability to communicate ideas clearly and concisely with peers, superiors, subordinates, members, and providers Manages the day‑to‑day activities of staff Sets priorities for the team to ensure task completion and performance goals are met Provides coaching and constructive feedback to team members Employee will be required to complete the...