51 payment integrity coder jobs found

Overview Payment Integrity Nurse Coder RN III role at L.A. Care Health Plan . Responsibilities The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs quality audits to include validation of accuracy and completeness of ICD, Rev...

Payment Integrity Nurse Coder RN III (Job ID: 12330) Location: Los Angeles, 90017 Shift: Full Time Pay Range: $102,183.00 (Min.) – $132,838.00 (Mid.) – $163,492.00 (Max.) Job Description The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise and judgment in the application of medical and reimbursement policies within the claim adjudication process. The role involves medical record review for Payment Integrity and Utilization Management projects, serving as a subject‑matter expert (SME), performing quality audits, validating coding accuracy and completeness, and guiding Payment Integrity initiatives, including concept and cost avoidance development. Additionally, the position trains and mentors Payment Integrity Nurse Coder, RN staff, acting as a resource and mentor for fellow employees. Qualifications At least 8 years of clinical RN experience. At least 3 years of experience in utilization...

A prominent healthcare institution in Los Angeles is seeking a Payment Integrity Nurse Coder RN III to review medical records and provide expertise in claim adjudication. The role requires extensive knowledge of coding and healthcare reimbursement. Ideal candidates will have substantial RN experience in clinical settings and a strong background in utilization management or clinical coding. This position offers a full-time shift and great compensation along with the opportunity to mentor other staff members. #J-18808-Ljbffr

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...

Description Leidos, a global technology leader, is seeking a Combat Coder for our Sentinel program, supporting the United States Air Force in geographically distributed intelligence operations. Combat Coders directly support mission objectives by integrating data sources and interfaces quickly while being embedded with the user base. As a Combat Coder you will engage directly with our customers to build and modify all aspects of full-stack applications. Your contributions will move directly to production systems and get immediate feedback. You will be working with a small elite team of developers that focus on getting things done to support the mission. Join Leidos in our mission to enhance global security and efficiency through technology and innovation. Be part of a team that champions Integrity, Inclusion, Innovation, Agility, Collaboration, and Commitment. If you're ready to drive critical software deliveries, apply now to join Leidos as a Combat Coder for the...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from...

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick, birthday, and vacation time as well as a 410k matching plan. Additional employee paid coverage options available. Job Purpose The Medical Claims Coding Auditor supports the Managed Service Organization (MSO) by performing detailed medical claims reviews to ensure accuracy, compliance, and appropriate reimbursement across Medicare,...

divh2Medical Coder/h2pOur hospital provides high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve./ppThe Medical Coder reviews and assigns diagnostic and procedure codes to patient records for reimbursement and data purposes, in keeping with state and federal regulations. This position must integrate company values into daily practice./ppEssential Functions Include:/pulliAssigns codes using the International Classification of Disease-10th Revision-Clinical Modification (ICD-10-CM)./liliEnsures codes are accurate and sequenced correctly in accordance with government and insurance regulations./liliMaintains a 95% threshold for coding accuracy./liliReceives and reviews patient charts and documents for accuracy. Identifies discrepancies and follows up with the provider on any documentation that is insufficient or...

Job Posting Santa Barbara Cottage Health seeks a HIM Coder II for their Health Information Management department responsible for coding and abstracting diseases and procedures for accurate administrative and clinic data and optimal hospital reimbursement, utilizing coding guidelines as set forth in Coding Clinic for ICD-9-CM and CPT Assistant for CPT/HCPCS. Major accountabilities include: Codes diseases and procedures abstracted from the medical record according to ICD-9-CM and CPT classification systems, utilizing only recognized coding guidelines. Abstracts data for coding utilizing the entire medical record in accordance with approved coding guidelines. QUALIFICATIONS: All job qualifications listed indicate the minimum level necessary to perform this job proficiently. Education: Minimum: Formalized education that provides knowledge and experience in the following areas: 1) Assigning ICD-9-CM and CPT coding classifications in an acute care setting; 2) UHDDS reporting...

divh2Medical Biller Opportunity/h2pWe are seeking a skilled Medical Biller to join our clients healthcare team. The ideal candidate will be responsible for accurately and efficiently processing medical claims and invoices, ensuring timely reimbursement from insurance companies and patients. The Medical Biller will work closely with healthcare providers, insurance companies, and patients to resolve billing discrepancies and ensure compliance with regulatory requirements./ppstrongJob Responsibilities:/strong/pullistrongClaims Processing:/strong Prepare and submit accurate medical claims to insurance companies, Medicare, and Medicaid for reimbursement./lilistrongBilling:/strong Generate and send invoices to patients for services rendered, following up on outstanding balances and resolving billing discrepancies./lilistrongInsurance Verification:/strong Verify patients insurance coverage and eligibility, ensuring all necessary authorizations and referrals are obtained before services...

Job Summary Under direct supervision, the Inpatient Coder is responsible for the accurate coding and abstracting of inpatient cases or services (diagnosis, conditions and procedures) from medical record documentation. Assign codes and modifiers using the appropriate version of ICD-CM, ICD-PCS, CPT and HCPCS as well as other specialty systems as required by diagnostic category. The Inpatient Coder is expected to code and abstract Observation (OBS), Hospital Ambulatory Surgery (HAS), Emergency Department (ED), and complex Hospital Outpatient Visit (CHOY) services when needed. All work must be performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, ICD-PCS, CPT and HCPCS code book, CPT Assistant, NCCI Edits, CMS, OSHPD and Kaiser Permanente organizational and institutional coding guidelines. Essential Responsibilities Coding and...

Vista Community Clinic (VCC) At Vista Community Clinic (VCC), we believe healthcare is more than medicine, it's about hope, community, and impact. For over 50 years, we've been a leader in the community clinic movement, growing from a small volunteer-driven effort in Vista to a nationally recognized network of state-of-the-art clinics across San Diego, Orange, Los Angeles, and Riverside counties. Today VCC has 14 clinics serving over 70,000 patients annually, we continue our mission of delivering exceptional, patient-centered care where it's needed most. As a private, non-profit, multi-specialty outpatient clinic, VCC provides more than healthcare, we provide opportunity. Here your skills are celebrated, your growth is supported and your work makes a difference. We know that our success is a direct result of the exceptional talents and dedication of our employees. Benefits include: Competitive compensation & benefits Medical, dental, vision Company-paid life insurance...

Job Summary: Under direct supervision, the Inpatient Coder is responsible for the accurate coding and abstracting of inpatient cases or services (diagnosis, conditions and procedures) from medical record documentation.  Assign codes and modifiers using the appropriate version of ICD-CM, ICD-PCS, CPT and HCPCS as well as other specialty systems as required by diagnostic category.  The Inpatient Coder is expected to code and abstract Observation (OBS), Hospital Ambulatory Surgery (HAS), Emergency Department (ED), and complex Hospital Outpatient Visit (CHOY) services when needed.     All work must be performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, ICD-PCS, CPT and HCPCS code book, CPT Assistant, NCCI Edits, CMS, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines. Essential Responsibilities:...

divh2AIDS Healthcare Foundation/h2pstrongAMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!/strong/ppDoes the idea of doing something that really makes a difference in peoples lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?/ppstrongIf so, AIDS Healthcare Foundation is the place for you!/strong/ppFounded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them./ppAHFs core values are to be:/pulliPatient-Centered/liliValue Employees/liliRespect for Diversity/liliNimble/liliFight for Whats Right/li/ulpPlease review our Advocacy page for...

Job Posting In accordance with federal & state coding compliance laws, rules, regulations, and guidelines, use current ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically/manually record into the 3M 360 Encompass/Computer-Assisted Coding (CAC), 3M Coding & Reimburse System (3M-CRS), and the coding abstracting system (3M-HDM/ARMS), all diagnoses, and minor invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary Visits: Laboratory; Radiology/Imaging; Clinic Visits; Radiation Oncology; Recurring Visits, etc.). Address OCE/NCCI/Medical Necessity edits within 3M-360/ARMS/CRS and those returned to HIM Coding from Patient Financial Services (PFS). Respond timely to all internal/external coding audit results and any feedback from other revenue cycle stakeholder Depts. Understands PFS coding/billing DNFB/DNFC processes & systems such as Oracle's Soarian Financials...

Inpatient Coder Under direct supervision, the Inpatient Coder is responsible for the accurate coding and abstracting of inpatient cases or services (diagnosis, conditions and procedures) from medical record documentation. Assign codes and modifiers using the appropriate version of ICD-CM, ICD-PCS, CPT and HCPCS as well as other specialty systems as required by diagnostic category. The Inpatient Coder is expected to code and abstract Observation (OBS), Hospital Ambulatory Surgery (HAS), Emergency Department (ED), and complex Hospital Outpatient Visit (CHOY) services when needed. All work must be performed in accordance with the rules, regulations and coding conventions of ICD-CM Official Guidelines for Coding and Reporting, Coding Clinic published by the American Hospital Association, the ICD-CM, ICD-PCS, CPT and HCPCS code book, CPT Assistant, NCCI Edits, CMS, OSHPD and Kaiser Permanentes organizational and institutional coding guidelines. Essential Responsibilities: Coding...

Job Description Job Description Benefits: Competitive salary Paid time off Training & development About ZapZzz: ZapZzz is a specialized sleep apnea treatment program with a mission of improving patients overall health and quality of life by providing advanced, patient-centered solutions for sleep apnea. We are committed to excellence in care, professionalism, and compliance while ensuring patients have access to the treatment they need. We are seeking a dedicated and detail-oriented Medical Biller with experience in sleep apnea billing. The ideal candidate will bring both technical expertise and a proactive approach to managing insurance claims, billing processes, and revenue cycle operations. Position Summary: The Medical Biller will be responsible for accurately preparing, submitting, and managing insurance claims related to sleep apnea treatment and oral appliance therapy. This role requires a thorough understanding of insurance verification, billing...

Inpatient Coding Specialist In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non-Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Perform other coding...

Job Description Job Description Overview AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. AHF’s core values are: Patient-Centered Value Employees Respect for Diversity Nimble Fight for What’s Right Please review our Advocacy page for the latest news on how...

Join to apply for the Claims Edit Coder role at Cedars‑Sinai . Job Description Bring your whole self to exceptional care. Cedars‑Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals 2024‑25" rankings, and it's all thanks to our team of 14,000+ remarkable employees! What you will be doing in this role The Claims Edit Coder (Coder II) operates under the general direction of an audit supervisor and involves responsibilities across various work units, as well as duties specific to the reporting team. In this role, the Coder II reviews ICD‑10‑CM diagnosis coding and Current Procedural Terminology (CPT) procedure code for claim edit fall outs. The position entails conducting modifier review and assignment, handling complex coding edits that necessitate research and resolution, and validating key data elements like the billing physician and date of service. You are expected to abstract coded data accurately and promptly into the applicable system...

Job Summary Under the direction of the Associate Director/Revenue Manager, the Medical Billing Coder aka Professional Fee Coder - Revenue Cycle Analyst will be responsible for front-end billing functions from procedural & diagnosis coding and charge entry to contacting physicians for documentation tracking and updating. Working under direct supervision the incumbent acquires knowledge of revenue cycle coding practices and concepts. Developing proficiency to manage 500 - 1000 code combinations to include Evaluation and Management Services as well as simple to moderately complex testing and procedural code services. The Medical Billing Coder will work to acquire and master all entry-level coding functions including assigning appropriate CPT and Dx codes, associated modifiers, appropriate NCCI edits, resolving coding edits and RFIs as well as basic entry-level revenue cycle duties. Other duties may include assisting other Departments as needed/assigned. As a Medical Billing...

Overview In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac). Record all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in inpatient medical records (e.g., Medicare, non-Medicare, and all complex cases). Meet productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists to acquire or clarify necessary medical record documentation needed to facilitate accurate coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim to assure timely claims drop with appropriate codes. Perform other coding department related duties as assigned by HIM management staff....

Overview Apply remotely. Location: Los Angeles, CA. Time type: Full time. Posted: 3 Days Ago. Job requisition id: REQ20170579. In accordance with federal and state coding compliance laws, rules, regulations, and guidelines, use ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically/manually record into the 3M 360 Encompass/CAC, 3M Coding & Reimburse System (3M-CRS), and the coding abstracting system (3M-HDM/ARMS) all diagnoses and minor invasive and non-invasive procedures documented by physicians in outpatient medical records (OP Ancillary Visits: Laboratory; Radiology/Imaging; Clinic Visits; Radiation Oncology; Recurring Visits, etc.). Address OCE/NCCI/Medical Necessity edits within 3M-360/ARMS/CRS and those returned to HIM Coding from Patient Financial Services (PFS). Respond timely to all internal/external coding audit results and feedback from other revenue cycle stakeholder departments. Understands PFS coding/billing...

Associate Director, Field Medical Director Ophthalmology North America West At Annexon Biosciences we are a biopharmaceutical company advancing a late-stage clinical platform of novel therapies for people living with devastating classical complement-mediated neuroinflammatory diseases of the body, brain, and eye. Our novel scientific approach targets upstream C1q to block the classical complement inflammatory cascade before it starts, and its therapeutic candidates are designed to provide meaningful benefits across multiple autoimmune, neurodegenerative and ophthalmic diseases. With proof-of-concept data in Guillain-Barr syndrome, Huntington's disease and geographic atrophy, we are rigorously advancing our mid-to late-stage clinical trials to bring new potential treatments to patients as quickly as possible. At Annexon, you'll be part of a team committed to making an impact together. We're seeking exceptional talent from all backgrounds to fuel our growth. At Annexon, we're...