5 cpc certified professional coder jobs found in Charlottesville, VA

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

Overview Using advanced knowledge required for the complex analytical functions of this job, the Analyst conducts compliance and privacy investigations using expertise of investigative procedures, research, and analysis, applies independent judgement and critical decision making to determine regulatory compliance risk to patients and the organization. The Analyst uses the advanced knowledge of the regulatory compliance profession, and research and auditing procedures. Uses professional verbal and written communication skills to document and communicate results and findings of compliance research, analysis and decision- making. Ensures health system compliance with applicable regulatory, accreditation and requirements. Responsibilities Identifies, researches and analyzes compliance and regulatory risk Researches and collects all data points relevant to the issue being investigated. Using advanced knowledge of federal, state and local regulations, analyzes the actual and/or...

Join to apply for the Lead Risk Adjustment Coder role at Augusta Health 7 months ago Be among the first 25 applicants Join to apply for the Lead Risk Adjustment Coder role at Augusta Health The Lead Risk Adjustment Coder is a system support position who completes coding and abstracting of patient encounters for the purposes of analyzing and improving the accuracy of complexity capture. The specialist works closely with physicians, the Population Health quality and data teams, the coding teams in AMG and the hospital, and the compliance department to identify and deliver high quality and accurate risk adjustment coding. The Lead Risk Adjustment Coder will demonstrate strong understanding of ICD-10-CM, CPT, HCC, and HCPCS coding guidelines and practices for outpatient and inpatient coding. Education High school diploma or equivalent is required 2 years of completed college coursework is preferred Licensure/Certification Certified Professional...

Under the direction of the Enterprise Coding Manager, the Enterprise Coding Supervisor is responsible for providing first-line supervision for Medical Coding staff. Supervisor responsibilities include but are not limited to: daily supervision and monitoring of quality and productivity performance, interviewing, hiring, and any necessary discipline of staff. This position also involves participation in process improvement projects and supporting the work needed to meet department and institutional wide goals. Provides daily supervision of coding staff and provides feedback to the Coding Manager on exceptional and/or substandard performance. Leads all efforts associated with hiring, interviewing, onboarding and discipline Provides ongoing feedback to staff on areas for improvement Ensures that all members of the coding team are following official policies and standard procedures and conducts discipline for those in violation Counsels coding staff on actions...

Reviews claims in assigned work queues in Cerner Revenue Cycle including CMG Review and Ambulatory Edit failure work items.Analyzes coding edits, reviews timeline notes, reviews clinical documentation, including provider orders, progress notes, surgical and test results thoroughly to interpret and ensure documentation supports the posted charges.Determines appropriate action needed to resolve coding edits / issues and ensure clean claim submission.Performs coding functions, including Current Procedure Terminology (CPT), International Classification of Diseases, tenth revision, Clinical Modification (ICD-10-CM), documentation review, and claim denial review.Applies appropriate modifiers.Ensures charges / coding are in alignment with the American Medical Association (AMA),Medicare, and Commercial coding guidelines on all claims reviewed.Credits / updates charges and coding as needed.Ensures queues are worked timely and efficiently.Maintains Productivity and accuracy...