35 rn certified coder jobs found

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 Medical Group Clinical Supervisor is an individual who actively supervises patient care clinics and staff in an ambulatory care setting. The position works in a collaborative relationship with the Clinic Manager and other members of the health care team to provide leadership and to coordinate the care of patients. The individual who holds this position exemplifies the CMH mission, vision and values and acts in accordance with CMH policies and procedures. Job Requirements Knowledge of /Skill/Ability to: A thorough knowledge of ambulatory care principles and procedures; knowledge and skills in techniques of good patient care; team leadership skills; excellent customer service skills; the ability to communicate effectively orally and in writing. Must be able to read and write English, as well as speak and understand English. Excellent computer skills, 1-2 years experience working with EMR preferred. Education and/or Experience Bachelor degree or equivalent...

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...

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...

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...

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...

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...

Job Description Job Description Description: Job Role The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines. Requirements: Responsibilities will include: Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines. Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting...

Certified Risk Adjustment Coder (CRC) Hybrid | Des Moines, IA (Onsite TuesThurs, Remote Mon/Fri) $40/hour | 6-Month Contract with Potential for Conversion We are seeking a Certified Risk Adjustment Coder (CRC) to support Medicare Risk Adjustment initiatives through detailed HCC medical record reviews and direct provider engagement. This role is ideal for someone confident, collaborative, and comfortable working onsite with provider teams to drive documentation accuracy and performance improvement. This position requires onsite presence TuesdayThursday in Des Moines, IA with 10% local travel , and remote flexibility on Mondays and Fridays. Position Overview This role performs concurrent medical record reviews to ensure accurate capture of HCC conditions and appropriate documentation reflecting patient severity of illness. The coder will collaborate closely with physicians, clinical leadership, and provider engagement teams to improve documentation practices...

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements Job Overview: The Certified Risk Adjustment Coder is responsible for reviewing the ambulatory records for the appropriate risk adjustment components. The Risk Adjustment Coder will identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes. The Risk Adjustment Coder will leverage the MEAT (Monitor, Evaluate, Assess, Treat) criteria for accurate documentation by providers. When appropriate, the Risk Adjustment Coder will query providers to clarify the HCC codes placed, inquire on additional documentation to support the HCC code placed, or discuss overall opportunities within the record. The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records. The Risk Adjustment Coder...

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

Certified Risk Adjustment Coder (CRC) Hybrid | Des Moines, IA (Onsite TuesThurs, Remote Mon/Fri) $40/hour | 6-Month Contract with Potential for Conversion We are seeking a Certified Risk Adjustment Coder (CRC) to support Medicare Risk Adjustment initiatives through detailed HCC medical record reviews and direct provider engagement. This role is ideal for someone confident, collaborative, and comfortable working onsite with provider teams to drive documentation accuracy and performance improvement. This position requires onsite presence TuesdayThursday in Des Moines, IA with 10% local travel , and remote flexibility on Mondays and Fridays. Position Overview This role performs concurrent medical record reviews to ensure accurate capture of HCC conditions and appropriate documentation reflecting patient severity of illness. The coder will collaborate closely with physicians, clinical leadership, and provider engagement teams to improve documentation practices...

Job Description Job Description Medical CoderJob at a Glance Location: onsite in Columbia, SC Contract: W2 only, contract-to-hire Pay: $36 /hour Key Responsibilities 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 contracting rates. Manages records retrieval, release, HIPAA compliance, and all aspects of document management. Serves as expert resource on methodology and procedures for medical records and coding issues. Required Skills 4 years of recent clinical experience in defined specialty area, or 4 years utilization review/case management/clinical/or a combination; 2 of the 4 years must be clinical. Required Licenses a RHIT, RHIA, CIC, CPMA, or CPC An active,...

$36 per hour Columbia, SC Right to Hire Duration: 6+ Months Job Description: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Responsibilities: 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. 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 contracting rates. Manages records retrieval, release, HIPAA compliance, and all...

Certified Coder - Billing Onsite - Royal Oak, MI About Sciometrix Sciometrix is a leading digital Health company looking for RN Case Manager Spanish. We are a leader in Telehealth -healthcare Virtual care Management. Our mission to engage patients to Deliver better outcomes. Sciometrix is known among customers, peers, and patients for clinical excellence, patient experiences, and provider satisfaction. Since the inception of our patient count, technological solutions have been evolving. We empower healthcare providers with advanced technology and human expertise, revolutionizing a patient's experience. Our propriety software and related technologies ensure HIPAA compliancy with cloud access. We have established HIPAA-compliant Clinicus, an artificial intelligence (AI) bot that monitors patients 24/7 and ensures fast response in their care management program. Clinicas watches each patient's vitals and alerts our licensed team when a patient's program progress or vitals are...

Job highlights Qualifications The ideal candidate will have 3+ years of Inpatient Hospital Coding , MS-DRG and APR-DRG coding reviews Active RN (Registered Nurse) license Coding Certification from AAPC or AHIMA (CPC, CCS or CIC certification) Solid understanding of ICD-10-CM/PCS, MS-DRGs, SOI/ROM, and quality measure Minimum 1 years of CDI experience Comprehensive chart reviews Inpatient facility coding experience Responsibilities Conduct concurrent and/or retrospective reviews of inpatient medical records to ensure accurate clinical documentation Conduct MS-DRG and APR-DRG coding reviews to validate DRG assignment and reimbursement accuracy. Identify correct ICD-10-CM/PCS code assignment , sequencing, POA indicators, and discharge disposition per CMS, AHA Coding Clinic, and ICD-10 Official Guidelines. Perform clinical coding review to ensure correct coding, billing, and documentation support Apply ICD-10-CM/PCS coding knowledge to support accurate documentation and reporting Stay...

Duration: 6+ Months Job Description: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Responsibilities: Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIP nd legal records requests for all areas of Healthcare Services and the Legal Department. 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 contracting rates. Manages records retrieval, release, HIPAA compliance, and all aspects of document management. Serves as expert resource on...

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Utilization Management RN Coder will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/company's guidance. They will have a working knowledge encoder use and selecting appropriate, supportable appeal arguments from evidence-based, peer reviewed medical...

Overview: BerryDunn is seeking a Senior Consultant to join our Healthcare Group as a member of the Healthcare Compliance Practice Area. You will join a core team tasked with assisting the firm’s clients with clinical documentation improvement, revenue integrity efforts, regulatory research, and general coding and billing compliance in a multitude of healthcare settings. This role involves complex audit reviews , provider education , and data-driven analysis to identify trends, mitigate risk, and optimize revenue integrity. This position is planned to sit remotely. The ideal candidate for this position will possess both a clinical and compliance background with experience coding/auditing a diverse array of professional services and specialties, including behavioral health.   You Will: Perform comprehensive audits of facility and outpatient/professional claims for coding accuracy (i.e. CPT, HCPCS, ICD-10-CM/PCS, DRG, APC, and E/M levels) Review clinical...

A leading technology services provider is seeking an experienced Medical Coder with RN and CPC certification for a remote role. This position focuses on quality assurance reviews of medical files, supporting fair medical determinations. Applicants should possess strong medical coding skills and the ability to work independently. This role offers long-term stability and opportunities for growth, with competitive pay in Orlando, FL. #J-18808-Ljbffr

About the Role We are seeking an experienced Medical Coder with an RN and CPC certification to join a growing medical review organization that specializes in independent, evidence‑based clinical reviews. This is an excellent opportunity for an RN Coder looking to move away from bedside care and into a stable, analytical, non‑patient‑facing role . What You’ll Do Perform quality assurance (QA) reviews of medical review files to ensure accuracy, completeness, and adherence to internal and regulatory standards. Review medical records related to workers' compensation, group health, and disability claims. Gradually transition into conducting independent medical reviews, including: Writing clear, well‑supported medical review reports. Compiling and citing appropriate clinical references and medical literature. Handle designated cases that specifically require RN Coder expertise. Ensure all reviews meet quality, documentation, and compliance requirements. Required...