22 regulatory analyst coder jobs found

Registered Nurse - Utilization Management/Coder RN 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...

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...

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. General Purpose of Job: Ensures that coding compliance initiatives are met with all record types. Reviews and analyzes medical records and abstracted data submitted by the coding staff to determine the accuracy of code assignment and adequacy of clinical documentation according to regulatory requirements. Performs frequent internal reviews and education maintenance long-term to ensure accuracy in the ever-changing environment of coding, documentation, quality initiatives, and impact to reimbursement. Can code, train, and educate on all types of outpatient medical records to provide timely coverage in all coding areas helping to ensure accuracy, stability, and efficiency in our revenue cycle. Code several different specialties, help train new coders, review records for provider audits, assist with...

Coder/Specialty Medical Bill Reviewer The remote Coder/Specialty Medical Bill Reviewer is responsible for reviewing, auditing, and data entry of medical bills for multiple states and lines of business within both Worker's Compensation and Commercial Health arenas. This would include analysis for the fee schedule or usual and customary application, as well as PPO interface, while meeting contractual client requirements. Essential Job Functions: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts Analysis and review of 1 or more assigned states having fee schedules Utilize Fee Schedules, Online Documents, Client instructions, and other training material to properly review medical bills Review medical bills for compensability and relatedness to injury Reprice medical bills to Workers' Compensation Fee Schedule and PPO Network Research usual and customary/fee schedule...

Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk‑adjusting conditions and supporting provider documentation improvement. Responsibilities Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding....

HIM/Medical Records Coding Specialist Opportunity West Oaks Hospital has provided psychiatric care to the Houston area and surrounding communities for over four decades. Our 176-bed acute care facility is fully accredited and includes a 16-bed residential treatment center for adult chemical dependency. We offer a broad range of behavioral health programs for children, adolescents, and adults. Treatment is offered at multiple levels of care including inpatient, partial hospitalization, and intensive outpatient. We are available 24 hours a day, seven days a week to assist you and answer your questions about treatment options and insurance coverage. The hospital is easily accessible off the Southwest Freeway near the Galleria. West Oaks Hospital is seeking a dynamic and talented HIM/Medical Records Coding Specialist to join our team of compassionate, dedicated professionals. The HIM/Medical Records Coding Specialist will be responsible for assigning diagnostic and procedures codes...

Senior Clinical Coding Specialist The University of Texas MD Anderson Cancer Center is seeking a Senior Clinical Coding Specialist to join its Revenue Operations and Coding team. The Senior Clinical Coding Specialist plays a critical role in ensuring accurate and compliant coding of patient encounters, supporting timely billing and reimbursement processes, and maintaining the integrity of clinical data across systems. This position works remotely and collaborates closely with coding professionals, leadership, and clinical partners. The Senior Clinical Coding Specialist at UT MD Anderson is responsible for reviewing medical records, assigning appropriate clinical codes, and supporting departmental goals for accuracy, compliance, and operational efficiency. UT MD Anderson Cancer Center is a leading institution focused on cancer care, research, education, and prevention. The ideal candidate brings strong expertise in clinical coding practices, including CPT, ICD-10, and regulatory...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based on documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

About Our CompanyWe’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com,...

Job Description Job Description Certified Professional Coder Medical Billing Department Exceed Healthcare Why join Exceed Healthcare? At Exceed Healthcare, our mission is simple: improving lives through innovation . We are redefining healthcare by delivering cutting-edge medical services, expanding access through seamless virtual care, and always putting patients at the center of everything we do. Our vision is to lead the future of healthcare by exceeding expectations through technology, strategic insight, and a deep commitment to excellence. We value integrity, respect, accountability, and collaboration. We foster a diverse and inclusive culture where courage and resiliency thrive—and where every team member plays a vital role in making an impact. Join us to be part of a forward-thinking team that prioritizes exceptional patient care, supports your growth, and believes in leading from every role. Job Summary: The Certified Professional Coder is...

Compliance Auditor, Billing and Coding Compliance The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and...

Bring More To Life Are you ready to accelerate your potential and make a real difference within life sciences, diagnostics and biotechnology? At Beckman Coulter Diagnostics, one of Danaher's 15+ operating companies, our work saves livesand we're all united by a shared commitment to innovate for tangible impact. You'll thrive in a culture of belonging where you and your unique viewpoint matter. And by harnessing Danaher's system of continuous improvement, you help turn ideas into impact innovating at the speed of life. As a global leader in clinical diagnostics, Beckman Coulter Diagnostics has challenged convention to elevate the diagnostic laboratory's role in improving patient health for more than 90 years. Our diagnostic solutions are used in routine and complex clinical testing, and are used in hospitals, reference and research laboratories, and physician offices around the world. Every hour around the world, more than one million tests are run on Beckman Coulter...

Job Description Job Description Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: You will support issue resolution in the Oscar claim environment. You will be responsible for the end-to-end claims repayment quality, process improvement and supporting root cause analysis . You will report into the VP, Payment Integrity. Work Location: This is a remote position, open to candidates who reside in: Tempe, Arizona; Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; New York City, New York; Philadelphia, Pennsylvania; Salt Lake City, Utah. While your daily work will be completed from your...

The University of Texas MD Anderson Cancer Center is seeking a Senior Clinical Coding Specialist to join its Revenue Operations and Coding team. The Senior Clinical Coding Specialist plays a critical role in ensuring accurate and compliant coding of patient encounters, supporting timely billing and reimbursement processes, and maintaining the integrity of clinical data across systems. This position works remotely and collaborates closely with coding professionals, leadership, and clinical partners. The Senior Clinical Coding Specialist at UT MD Anderson is responsible for reviewing medical records, assigning appropriate clinical codes, and supporting departmental goals for accuracy, compliance, and operational efficiency. UT MD Anderson Cancer Center is a leading institution focused on cancer care, research, education, and prevention. The ideal candidate brings strong expertise in clinical coding practices, including CPT, ICD-10, and regulatory guidelines, along with experience...

Hours of Work :8-5Days Of Week :M-FWork Shift :Job Description :The Coder 3 works closely with the business office to research, monitor, and resolve coding denials for a large and robust medical group with multiple specialties. The position reviews third party payer reimbursement denials based on the following: provider documentation, coding accuracy, medical necessity, modifier assignment, applicable federal, state and local guidelines and payer policies. Using data from these reviews, the coder 3 identifies and works to resolve documentation and/or coding issues, and takes part in creating education materials for coding staff and providers to follow-up on best practices for coding and documentation. The position is involved in auditing and coding compliance responsibilities as well as other coding duties as needed.Your Job Requirements:High School Diploma or GED required.AAPC or AHIMA coding certification required.Strong knowledge of Microsoft Office Suite required.In-depth...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

Are you ready to make a real difference in people's lives? Join the Harris Center for Mental Health and IDD as a Regulatory Compliance Auditor. The Regulatory Compliance Auditor provides coordination between the Authority and contracted services programs by technical review of the medical records, billing service codes, contracts and other documents. The Regulatory Compliance Auditor is responsible for carrying out programmatic and departmental goals and objectives as stipulated by Texas Administrative Code (TAC), Medicaid Guidelines, Texas Resiliency and Recovery Guidelines, and Quality Practices of the Agency. This position provides center-wider oversight to the Intellectual Disability Division (IDD) and Mental Health Division (MH), Forensics and CPEP, related to compliance standards, state and federal guidelines, and contract requirements. This position is responsible for planning and scheduling ongoing audits, collaborating with managers, supervisors and additional staff...

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Position is responsible for leading multiple reviews / audits of healthcare coding, billing, documentation, operations, and related risk areas to support compliance with regulatory standards, internal policies and procedures, and other guidelines. Typically reports to Director, Corporate Compliance. Job Description Location : Memorial Hermann, Memorial City Status :...

HIM/Medical Records Coding Specialist Opportunity West Oaks Hospital has provided psychiatric care to the Houston area and surrounding communities for over four decades. Our 176-bed acute care facility is fully accredited and includes a 16-bed residential treatment center for adult chemical dependency. We offer a broad range of behavioral health programs for children, adolescents, and adults. Treatment is offered at multiple levels of care including inpatient, partial hospitalization, and intensive outpatient. We are available 24 hours a day, seven days a week to assist you and answer your questions about treatment options and insurance coverage. The hospital is easily accessible off the Southwest Freeway near the Galleria. West Oaks Hospital is seeking a dynamic and talented HIM/Medical Records Coding Specialist to join our team of compassionate, dedicated professionals. The HIM/Medical Records Coding Specialist will be responsible for assigning diagnostic and procedures codes...

Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk-adjusting conditions and supporting provider documentation improvement. Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding....

Job Summary and Responsibilities The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk‑adjusting conditions and supporting provider documentation improvement. Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding. Advanced...