77 rn certified coder jobs found

Remote Rn Certified Coder Pride Health is hiring a remote RN certified coder for a well-known client! (REMOTE) Schedule: Monday-Friday (9am-5pm EST) Contract: 12 months Pay Rate: 60-64/hour Job Responsibilities Determine which codes belong to the language in the benefit plans Review what peers have designated as correct coding Facilitate any discussions needed to get to a coding document Review audit results and make adjustments as necessary Participate in project meetings Requirements 3 + years' experience with coding and reimbursement methodologies (e.g. CPT, HCPCS, ICD-10, CMS), 3+ years Certified Professional Coder (AAPC or AHIMA) Active unrestricted RN license AAPC or AHIMA certification Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an...

Pride Health is hiring a Remote RN Certified Coder for a well-known client! (REMOTE) Schedule: Monday-Friday (9am-5pm EST) Contract: 12 months Pay Rate: 60-64/hour Job Responsibilities Determine which codes belong to the language in the benefit plans Review what peers have designated as correct coding Facilitate any discussions needed to get to a coding document Review audit results and make adjustments as necessary Participate in project meetings Requirements 3 + years' experience with coding and reimbursement methodologies (e.g. CPT, HCPCS, ICD-10, CMS,), 3+ years Certified Professional Coder (AAPC or AHIMA) Active unrestricted RN license AAPC or AHIMA certification Apply with Pride Health for this opportunity! Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement...

Job SummaryWe are seeking an experienced Certified RN Medical Coder to support a full-time COC / SPD project focused on building out coding for benefit plans.This role combines clinical knowledge with technical coding expertise to ensure accuracy, consistency, and compliance across plan documentation.You'll work closely with a team of certified coders and business analysts in a collaborative, fast-paced environment where precision and partnership drive success.Why this Opportunity?Top ranked company in Fortune's 2024 World's Most Admired Companies for over a decade consecutively.This healthcare client is ranked number one in key attributes of reputation :Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness.Job Responsibilities :Determine and assign appropriate codes to benefit plan language as part of the COC / SPD project.Review coding selections made by peers...

Job SummaryWe are seeking an experienced Certified RN Medical Coder to support a full-time COC / SPD project focused on building out coding for benefit plans.This role combines clinical knowledge with technical coding expertise to ensure accuracy, consistency, and compliance across plan documentation.You'll work closely with a team of certified coders and business analysts in a collaborative, fast-paced environment where precision and partnership drive success.Why this Opportunity?Top ranked company in Fortune's 2024 World's Most Admired Companies for over a decade consecutively.This healthcare client is ranked number one in key attributes of reputation :Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness.Job Responsibilities :Determine and assign appropriate codes to benefit plan language as part of the COC / SPD project.Review coding selections made by peers...

The Olympic Medical Center Foundation in Port Angeles is seeking a Supervisor for Medical/Surgical/Pediatrics. In this role, you will manage patient care and personnel activities while ensuring the development of nursing staff. Qualified candidates should possess a BSN, with at least three years of relevant experience, and a Washington State RN License. This position offers a competitive salary, excellent benefits, and a lifestyle in the beautiful Pacific Northwest. #J-18808-Ljbffr

Recovery Resolutions Supervisor Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our...

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 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 patient...

Claims Payment Policy Lead (Contract) Location: Remote (Must reside in Pennsylvania, New Jersey, or Delaware) About the Role We are seeking a Claims Payment Policy Lead to join our Medical/Health Services team. This role sits at the intersection of clinical expertise and business operations, supporting the development and optimization of claim payment and medical policies .You will play a key role in aligning reimbursement policies with industry standards, identifying cost-saving opportunities, and ensuring policies improve affordability while maintaining quality care outcomes. This is a policy development and strategy role—not a chart audit position. What You’ll Do Lead cross-functional collaboration with clinical, coding, and business teams to design and implement claim payment policies. Develop and maintain reimbursement and medical policies aligned with: Nationally recognized standards (e.g., CMS, Medicare)State and federal regulations Internal benefits, contracting, and...

Internal Reference Number: R1051186 Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have...

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

Our corporate activities are growing rapidly, and we are currently seeking a full-time, office-based Clinical Data Coder to join our Clinical Coding & Support team in Cincinnati, OH. This position will work on a team to accomplish tasks and projects that are instrumental to the company’s success. If you want an exciting career where you use your previous coding, pharmacy, or nursing expertise and can develop and grow your career even further, then this is the opportunity for you! Responsibilities Perform accurate coding of medical terms and medications utilizing industry-wide standards as well as company standards; Coordinate the assignment of appropriate dictionaries for meeting study requirements Develop and maintain coding guidelines; Issue queries on adverse events, medications, and medical history terms to ensure high quality coding; Work collaboratively with the Medical, Data Management, Safety and Biostatistics teams to meet needs of the study; and Produce coding...

Job Title: Claims Payment Policy Lead (Clinical + Coding) Location: Remote (Must reside in PA, NJ, or DE) About the Role We are seeking a Claims Payment Policy Lead to support a dynamic Medical/Claims Policy team. This role sits at the intersection of clinical expertise and healthcare coding/billing, focusing on policy development (not audits) to drive cost efficiency and align with industry standards. Key Responsibilities Lead policy-driven initiatives to identify and implement medical cost-saving opportunities Develop and maintain claim payment and medical policies aligned with: CMS/Medicare guidelines, Industry reimbursement practices, State & federal regulations Monitor industry trends and regulatory changes Analyze utilization patterns and claims data to recommend improvements Develop business cases and policy documentation. Serve as a clinical and/or coding SME and mentor team members Ensure accurate coding alignment (CPT, HCPCS, ICD guidelines) Required...

Claims Payment Policy Lead (Contract) Location: Remote (Must reside in Pennsylvania, New Jersey, or Delaware) About the Role We are seeking a Claims Payment Policy Lead to join our Medical/Health Services team. This role sits at the intersection of clinical expertise and business operations, supporting the development and optimization of claim payment and medical policies .You will play a key role in aligning reimbursement policies with industry standards, identifying cost-saving opportunities, and ensuring policies improve affordability while maintaining quality care outcomes. This is a policy development and strategy role—not a chart audit position. What You’ll Do Lead cross-functional collaboration with clinical, coding, and business teams to design and implement claim payment policies. Develop and maintain reimbursement and medical policies aligned with: Nationally recognized standards (e.g., CMS, Medicare)State and federal regulations Internal benefits, contracting, and...

Working Nurse in Los Angeles is seeking a Clinical Policy Clinical Coder RN II to ensure accurate medical coding and compliance with regulations. The role requires collaboration with stakeholders to implement policies and oversee utilization management. The ideal candidate has at least 8 years of clinical nursing experience, particularly with Medi-Cal and Medicare, and an Associate's degree in Nursing. This position offers a full-time shift with a competitive salary. #J-18808-Ljbffr

Clinical Policy Clinical Coder RN II Salary Range: $102,183.00 (Min.) - $163,492.00 (Max.) 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. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Job Summary The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. This position serves as a key clinical and coding resource, translating medical policy requirements into diagnosis, procedure, and service code logic, including determining which codes require prior authorization. Conducts in-depth research and analysis of legislation and regulatory requirements, clinical outcomes,...

Job Title Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Location: This position is a remote position, and the hours are Monday - Friday from 8:30am - 5pm EST. Sponsorship: This position is not eligible for sponsorship now or in the future. What You'll Do: Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and...

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements...

Claims Payment Policy Lead (Contract) Location: Remote (Must reside in Pennsylvania, New Jersey, or Delaware) About the Role We are seeking a Claims Payment Policy Lead to join our Medical/Health Services team. This role sits at the intersection of clinical expertise and business operations, supporting the development and optimization of claim payment and medical policies .You will play a key role in aligning reimbursement policies with industry standards, identifying cost-saving opportunities, and ensuring policies improve affordability while maintaining quality care outcomes. This is a policy development and strategy role—not a chart audit position. What You’ll Do Lead cross-functional collaboration with clinical, coding, and business teams to design and implement claim payment policies. Develop and maintain reimbursement and medical policies aligned with: Nationally recognized standards (e.g., CMS, Medicare)State and federal regulations Internal benefits, contracting, and...

Job Title: Claims Payment Policy Lead (Clinical + Coding) Location: Remote (Must reside in PA, NJ, or DE) About the Role We are seeking a Claims Payment Policy Lead to support a dynamic Medical/Claims Policy team. This role sits at the intersection of clinical expertise and healthcare coding/billing, focusing on policy development (not audits) to drive cost efficiency and align with industry standards. Key Responsibilities Lead policy-driven initiatives to identify and implement medical cost-saving opportunities Develop and maintain claim payment and medical policies aligned with: CMS/Medicare guidelines, Industry reimbursement practices, State & federal regulations Monitor industry trends and regulatory changes Analyze utilization patterns and claims data to recommend improvements Develop business cases and policy documentation. Serve as a clinical and/or coding SME and mentor team members Ensure accurate coding alignment (CPT, HCPCS, ICD guidelines) Required...

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,...

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...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...