171 nurse coder jobs found

Risk Adjustment Nurse/Coder AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! Full-time permanent position (40 hours) Standard working hours: 8am to 4:30pm EST, M-F This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories...

Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 12330 Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding...

A healthcare solutions provider is seeking a DRG Quality Auditor to perform quality assurance audits for clinical and coding staff. Responsibilities include reviewing medical records, validating DRG assignments, and ensuring compliance with coding guidelines. The ideal candidate should have an active RN license, coding certification, and extensive clinical experience. This remote position offers flexible hours and requires a strong knowledge of DRG reimbursement methodologies. #J-18808-Ljbffr

Registered Nurse - Utilization Management/Coder 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 provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as 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. Bienvivir is currently accepting applications for the following position: Registered Nurse - Utilization Management / Coder The...

Job Description 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 provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as 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 who work 30 or more hours per week: We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay...

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...

Job Type Full-time 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...

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...

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. Credentialed coder (CPC, CCS) required. . The TeamAs 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...

Ready to help us transform healthcare? Bring your true colors to blue. Job Profile: Appeals Nurse Reviewer Job Code: HCM101 Business Title: Appeals Nurse Reviewer Reports To: Patricia Corsini RN, BSN 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,...

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,...

Get notified about new Coder jobs in United States. Coders - AI Training (Freelance, Remote) CDI RN – Clinical Documentation Specialist Registered Nurse HIM Coder (Part Time, 17 hours/week, Remote) In Patient Coder (Remote) | Health Information & Record Management | Full Time REMOTE Coder I - Ancillary, Routine Outpatient CDI RN – Clinical Documentation Specialist Registered Nurse In Patient Coder (Remote) | Health Information & Record Management | Full Time Medical Coder - IMMEDIATE OPENING - Remote Position (UT, SC, AZ, TX, KY, WY, ID, GA, AR) - Full-Time Medical Coder (Inpatient Rehab) - Remote REMOTE Coder I - Ancillary, Routine Outpatient #J-18808-Ljbffr

Coder Coffee Regional Medical Center Position Summary Under general supervision and according to established procedures, assigns diagnostic codes to medical record information. Codes charts under the ICD-9-CM and HCPCS System for statistical and DRG assignment purposes. Abstracts required data into hospital abstracting system. The outcome of information gathered is used to determine the hospital database and reimbursement of hospital claims. Responsible for timely review of patient records in order to identify an appropriate selection of codes which will accurately reflect the reason for admission, extent of care received, and level of severity of illness. Overview The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the...

Job Description Job Description Advanced Medical GI (AMGI) is a comprehensive gastroenterology practice serving the needs of patients in the Northern Virginia and DC suburbs. We specialize in the diagnosis, treatment, and management of diseases and conditions affecting the digestive system. Dr. Richard Blosser and his team of physician assistants and nurse practitioners are medical specialists who have received advanced training in gastroenterology, which involves the study of the digestive tract, including the esophagus, stomach, small intestine, colon, rectum, liver, gallbladder, and pancreas. We have provided care for over thirty years in the Northern Virginia region Overview We are seeking a dedicated biller/coder to join our healthcare team. The ideal candidate will play a crucial role in ensuring the smooth operation of our medical office by providing exceptional billing and collections support. Responsibilities Review and process billing and coding information...

Trauma Coder Analyst Baltimore, MD SINAI HOSPITAL SURGERY Part-time - Day shift - Hours Vary ALLIED HEALTH 95715 Summary Who We Are: LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to "improve the health of people in the communities we serve." Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care. Candidates must reside in MD, DC, PA, VA or WVA About the Role Responsible for the collection, capture and analysis of all data pertinent to the proper function of the Trauma Division. Key Responsibilities On a daily basis, identifies all new trauma patients and prepares a daily trauma census. Assists Trauma Nurse Coordinator in identification of patients to be included in the Trauma Registry and assignment of trauma case number according to MIEMSS criteria. Abstract all relevant data...

\"A New Approach to an Age-Old Need\" - Pathway Geriatrics is a nurse practitioner-owned medical startup headquartered in Redmond, WA, currently serving Greater Seattle. We provide in-home primary care services for homebound older adults. Said differently, we bring our medical services to our clients, who often can't leave their homes to get the specialized care they need. The Basics We are looking for an experienced (5+ years) Medical Billing Specialist to join our team. You can expect to work from home 2 days a week and from our office in Redmond, WA, the rest of the time. Typical business hours are 9:00 AM to 5:00 PM, Monday - Friday. Compensation The position will pay $60,000 - $75,000 annually, depending on your skills and experience. We may also offer additional discretionary bonus opportunities based on personal and company performance. The Job Details Your Day-to-day Responsibilities Will Include Managing Medical claims (submission, denials, rejections & appeals)...

Job Description Job Description COMPANY OVERVIEW Michigan Kidney Consultants (MKC), P.C. is Southeast Michigan’s largest board-certified nephrology group. Our physicians and nurse practitioners are dedicated to providing the latest, most advanced diagnostics and treatments available for kidney disease and end-stage renal failure. MKC offers appointments in eight locations in greater Detroit, Michigan, including Troy, Royal Oak, Southfield, Novi, Pontiac, Clarkston, Rochester Hills and Sterling Heights. All of our physicians are board certified in the sub-specialty of nephrology as well as internal medicine. A nephrologist is a physician who has been educated and trained in kidney disease, kidney transplantation, and dialysis therapy.   POSITION OVERVIEW The Billing Manager is responsible for the day-to-day billing department operations. This person should be skilled in all aspects of billing processes and serve as the point-person for all escalations. The billing...

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 reports 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 Health Supervision. Must be...

Job Description Job Title: Medical Billing & Coding Specialist Company: Pinnacle Wound Management Employment Type: Full-Time Location: This is an on-site location in Miami, FL About Us: At Pinnacle Wound Management, we are dedicated to improving the lives of patients through high-quality wound care delivered by expert physicians, nurse practitioners, and physician assistants. As a growing leader in this specialized healthcare field, we're looking for a detail-oriented and proactive Medical Billing & Coding Specialist to join our administrative team and ensure accurate, timely, and compliant billing operations. Position Overview: The Medical Billing and Coding Specialist will be responsible for reviewing clinical documentation, assigning appropriate diagnostic and procedural codes, and submitting claims to insurance companies. This role plays a vital part in our revenue cycle and overall patient experience. Key Responsibilities:...

Job Description Job Description About Company: As one of the largest primary care practices in Southwest Georgia, Albany Area Primary Health Care (AAPHC) provides health care services to more than 54,000 patients and nearly 217,000 office visits per year. AAPHC is also one of the largest Community Health Centers in our region! To learn more about Community Health Centers, and how this benefits Southwest Georgia. At AAPHC, we strive to provide comprehensive, coordinated, and continuous care to all who access our services. Did you know that all qualifying medical offices operated by AAPHC are recognized as a Level III Patient Centered Medical Home (PCMH) by the National Center for Quality Assurance (NCQA)? NCQA offers three levels of PCMH recognition with Level III being the highest level. As a Level III PCMH, AAPHC is committed to continuously raising the quality of care within our practices, while also lowering our patients health care costs. Our health care teams are...

Overview Department:Pediatric/Adult Medical Surgical Schedule: Nights, 7p-7a, 12-hour shifts Facility: Central Maine Medical Center Location: Lewiston, ME 04240 Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoastal Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. Responsibilities We are looking for a RN Supervisor for our Pediatric and Adult Med Surg unit at Central Maine Medical Center! The Clinical Nursing Supervisor supports administrative responsibility for the...

Job Summary Are you dedicated to advancing compliance in healthcare? Join our dynamic team as a Lead Compliance Auditor. Your expertise will be vital in protecting our health plans from regulatory and contractual discrepancies. Your role will significantly contribute to the detection and management of compliance risks, ensuring the integrity and safety of Molina Healthcare. Essential Job Duties Lead and conduct thorough pre-delegation and annual audits to guarantee adherence to all regulatory and accreditation standards. Examine delegate policies, procedures, and case files meticulously, ensuring high-quality service delivery. Work closely with delegate leadership to evaluate risks and create effective solutions together. Leverage your analytical skills to identify systemic issues and collaborate with other departments to mitigate risks. Analyze audit outcomes, determine root causes, and develop comprehensive corrective action plans (CAPs). Prepare and manage...

Salary Range: ####/hour - ####/hour (based on education and experience) ***THIS IS A REMOTE POSITION, HOWEVER, CANDIDATE MUST BE CURRENTLY LOCATED IN OKLAHOMA OR WILLING TO RELOCATE.*** 18% Permanent Placement Fee Requirement description : The RI Coder at Norman Regional Health System, as a component of the Documentation Integrity Department, works to provide timely and compliant coding for all patient encounters. They strive to tell the story of the patient's experience through the use of accurate and specific code assignment allowing regulatory agencies and payers the ability to accurately determine the services provided. The Documentation Integrity department is comprised of coding, clinical documentation improvement, and denials professionals who work together daily to ensure the most optimal and accurate picture is presented for the patients and communities they serve via the diagnosis and procedural coding, appropriate patient admission status and denial appeal...