8 cpc certified professional coder jobs found in Fishersville, 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...

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...

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...

Hospital Outpatient Coder II The Hospital Outpatient Coder II is responsible for coding recurring provider based billing (PBB), outpatient diagnostic, specialty outpatient diagnostic, medical observation, and emergency department encounters for the purpose of reimbursement, statistical analysis, and other clinical purposes in compliance with federal, state, and regulatory agencies' guidelines using the most current International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Current Procedural Terminology (CPT) classification systems. Performs clinical documentation review, coding, charge entry, and charge review that includes appending modifiers to resolve claim edits. The Hospital Outpatient Coder II will be skilled in coding all services of Hospital Outpatient Coder I and be responsible for coding the following services: cardiology, PET scans, infusion therapy, maternity/newborn, radiation oncology, recurring PBB locations to include...

Outpatient Specialty Medical Coder The Outpatient Specialty Medical Coder is responsible for coding outpatient records, Facility, and/or Professional, for the purpose of reimbursement in compliance with federal, state, and regulatory agencies' guidelines using the most current taxonomic and classification systems. Performs coding, charge entry, and charge review including but not limited to, reviewing clinical documentation, appending modifiers and/or correcting edits. The Outpatient Specialty Medical Coder I will be responsible for coding the following services: Non Centra Medical Group (CMG) Vascular, Endoscopy, Orthopedic Surgery, Gynocologic Surgery, Surgical Observation, General Surgery, Plastic Surgery, Neurosurgery, Urology, Bariatric Surgery, and Pain Management. Responsibilities Reviews clinical documentation and assigns appropriate outpatient facility and/or professional codes, reviews/posts charges for the purpose of reimbursement, research, and compliance in...

Job Overview The Hospital Inpatient Coding Specialist reviews inpatient medical records and assigns International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) diagnosis and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) procedure codes that derives an All Patient Refined Diagnosis Related Group (APR-DRG) or Medical Severity Diagnosis Related Group (MS-DRG) for optimal reimbursement. The Hospital Inpatient Coding Specialist will work in collaboration with the Clinical Documentation Integrity Specialist at times to ensure accuracy consistent with Centra’s coding policies. The Hospital Inpatient Coding Specialist will abstract pertinent information according to established guidelines for the organization and will formulate provider queries to clarify information. Responsibilities Assign diagnosis and procedure codes. Verify accuracy of DRG. Accurately abstract required information. Initiate provider...

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...