18 certified professional coder special investigations unit jobs found

Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: PB Revenue Integrity Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr (7:00:00 AM - 3:00:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits). Pay Range: $32.00 - $52.08 per hour Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. Summary: As a key role in the Revenue Integrity team, the Auditor & Educator is responsible for conducting reviews of EMR documentation of patient encounters to...

Job Description Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: PB Revenue Integrity Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr (7:00:00 AM - 3:00:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits). Pay Range: $32.00 - $52.08 per hour Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush’s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. Summary: As a key role in the Revenue Integrity team, the Auditor & Educator is responsible for conducting reviews of EMR documentation of patient...

Coding Specialist 1 - Edits Coder UW Medicine Enterprise Records and Health Information has an outstanding opportunity for a Coding Specialist 1 - Edits Coder. The Edits Coder position reports to the Outpatient Coding Supervisor within the Enterprise Records and Health Information Management department. Under the general supervision of the Manager of Facility Coding, and the direct supervision of the Supervisor of Outpatient Coding, the Edits Coder is responsible for implementing the mission and goals of Enterprise Records and Health Information, and incorporating a "patients are first" service culture. The Edits Coder is responsible for performing daily activities related to analyzing medical records to validate the correct coding assignment of International Classification of Disease (ICD), Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) codes in Epic work queues (WQ) and/or Hierarchical Condition Category (HCC)/Risk Adjustment...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for a Medical Bill Analyst to join its Medical Management team. This individual is responsible for processing medical billing in accordance with jurisdictional regulatory requirements, while applying appropriate fee schedule and PPO reductions. ESSENTIAL RESPONSIBILITIES Masters appropriate application of procedural (CPT) codes, diagnostic ICD-9 codes, diagnostic ICD-9-CM codes, Diagnosis Related Group (DRG) codes, Ambulatory Payment Classification (APC) codes, and modifiers. Exhibits continuous improvement under the guidance of the Medical Bill Review Supervisor, and demonstrates mastery of fundamental bill review knowledge and skills. Efficiently reviews medical bills and data reports for data accuracy and completeness. Examines bills for legibility and takes appropriate action to ensure accuracy of documentation. Accurately identifies data from claim information. Identifies and...

Certified Coder, Special Investigations Unit Investigator SummaCare – 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days Hybrid / Remote Code with Integrity. Detect with Precision. Join Us as a Certified FWA Coder! Are you a certified coding professional with a sharp eye for detail and a passion for protecting healthcare integrity with experience reviewing medical records? Step into a high-impact role where your expertise helps uncover fraud, prevent waste, and ensure compliance across the healthcare system. We’re looking for a Fraud, Waste, and Abuse (FWA) Certified Coder to join our Special Investigations Unit and play a critical role in safeguarding resources and promoting ethical billing practices. This position collaborates with investigators, clinical and compliance staff, and regulatory agencies. Summary Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record...

Edits Coder page is loaded## Edits Coderremote type: Remote (100% telework)locations: Seattle, Non-Campustime type: Full timeposted on: Posted Todayjob requisition id: REQ-0000126900**Job Description****UW Medicine Enterprise Records and Health Information** has an outstanding opportunity for a **Coding Specialist 1 - Edits Coder****WORK SCHEDULE*** 100% FTE* Mondays - Fridays* 100% Remote**POSITION HIGHLIGHTS**The Edits Coder position reports to the Outpatient Coding Supervisor within the Enterprise Records and Health Information Management department. Under the general supervision of the Manager of Facility Coding, and the direct supervision of the Supervisor of Outpatient Coding, the Edits Coder is responsible for implementing the mission and goals of Enterprise Records and Health Information, and incorporating a “patients are first” service culture. The Edits Coder is responsible for performing daily activities related to analyzing medical records to validate the...

Compliance Auditor Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community- eligible for opportunities through the New Haven Hiring Initiative or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale! Salary Range $68,000.00 - $120,500.00 Overview Coordinate and conduct medical billing audits for the Yale Medicine Administration. Evaluate medical billing, coding and documentation for 18 clinical departments under the direction of the Compliance Officer. Provide training and feedback to physicians and departmental personnel who have responsibilities with billing activities. This opportunity is currently remote (work from home, in or outside CT) for a position located in CT. CPC or similar certification needed within 12-18 months. Required Skills and Abilities 1. Demonstrated knowledge of ICD-10 and...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Associate Director, Medical Science Liaison At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to our communities through philanthropy and volunteerism. We give our best effort to our work, and we put people first. We're looking for people who are determined to make life better for people around the world. Purpose: Scientific and clinical experts (SEs/CEs) are individuals who are noted for their expertise in a therapeutic area and as a result have special needs for in-depth and cutting-edge scientific information, because they treat patients, design and implement novel research, and educate colleagues and students. The Medical Science Liaison (MSL) program is specifically designed to meet these...

Who We Are UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed acute care hospital in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los...

Job Description UW Medicine Enterprise Records and Health Information has an outstanding opportunity for an INPATIENT CODER. Experience in a Level 1 Trauma center or teaching facility is preferred. WORK SCHEDULE 100% FTE, Days Monday - Friday 100% Remote POSITION HIGHLIGHTS Implements the mission and goals of Enterprise Records and Health Information, and incorporating a “patients are first” service culture. Performs daily activities related to abstract Diagnosis Related Group (DRG) coding and billing. Analyzes the medical record to assign International Classification of Diseases (ICD), Clinical Modification (CM) diagnoses and Procedure Coding System (PCS) procedure codes to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines. DEPARTMENT DESCRIPTION Enterprise Records and Health Information (ERHI) is a Shared Service Department that supports all aspects of the patient medical record from governance, integrity,...

Effective July 1, 2025, in accordance with the applicable Memorandum of Understanding, the Personal Leave Program 2025 (PLP 2025) was implemented. PLP 2025 requires each full-time employee in Bargaining Unit 19 , and related Excluded, Exempt and Statutory Exempt employees, will have their base salary reduced by 3 percent and will receive 5 hours PLP 2025 leave credits monthly through June 2027. Salaries do not reflect the recent changes. Part-time employees are subject to the same conditions as full-time employees, on a prorated basis equivalent to their time-base. Permanent intermittent employees are subject to the same condition as full-time employees, based on the number of hours worked in the pay period. Please note: Individuals may be eligible to receive a $10,000 one-time recruitment and retention stipend should they meet the eligibility criteria, including but not limited to remaining employed with CCHCS for six months. Additionally, individuals may be eligible to...

Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Programs Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women Children's Health Insurance Program (CHIP) for the children of low‑income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions. Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D...

Salary : $101,536.34 - $139,533.58 Annually Location : Riverside Job Type: Regular Job Number: 25-74191-01 AL Department: RUHS-Medical Center Opening Date: 09/09/2025 Closing Date: Continuous ABOUT THE POSITION Riverside University Health System (RUHS) is seeking a skilled Coding Compliance Auditor (Administrative Services Manager I) to support the Compliance Department. The Compliance Auditor will review inpatient and outpatient medical records to ensure quality, accuracy, and comprehensive coding in accordance with regulations. Key Responsibilities: Conduct thorough reviews of medical records for compliance with coding regulations Provide feedback and education to coders and physicians to improve coding accuracy and documentation Perform annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested Communicate effectively with all RAC stakeholders, ensuring timely and accurate responses to inquiries...