113 healthcare services concept specialist jobs found

ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $78,500 - $104,000 The Healthcare Services Concept Specialist provides support to assigned Segment Specialists by maintaining current audit concepts as well as provide support for the development process of new audit concepts. Key Responsibilities : Responsible for the review and update of existing concepts based upon...

Job Description Job Summary: Coder II assigns diagnosis and procedure codes using the appropriate coding classification system to reflect the care and services rendered to the patients in the emergency department, ancillary, and outpatient surgery settings. Ensure the accurate selection of the principal diagnosis and procedure and all other significant diagnoses and procedures. Abstract hospital-defined data from records for data collection purposes. Ensure compliance with official guidelines, AHA Coding Clinic, AMA CPT Assistant and Guidelines, AHIMA Standards of Ethical Coding and LifePoint Health Support Center (HSC) policies and procedures. Who We Are: People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Lake Cumberland Regional Hospital is a modern, state-of-the-art 295-bed acute care facility, offering an advanced neurosurgery program with Spine Center accreditation amongst other specialty services....

Job Description Job Description Are you looking to be part of a compassionate, patient-focused care team? At NMC Health, we're proud to set an award-winning standard for healthcare in the Wichita Metro Area. We are currently seeking a Health Information Coder to join our Health Information Management team. In this role, you will convert diagnoses and treatment procedure verbiage into numerical codes using an approved disease and operation classification system. For many third-party payers particularly for the majority of patients these codes determine the amount the hospital is reimbursed for a patients stay. As a Health Information Coder, you will play a vital role in ensuring accuracy and compliance in coding processes, directly impacting hospital operations and reimbursement. This position reports to the Director of Health Information Management and is an hourly, non-exempt position. Key responsibilities include: Converting diagnoses and procedures into approved...

Job Summary Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes that can be utilized for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Job Duties Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed that explain the reason for service being provided or the admission and patient severity and comply...

Coder; Full-Time, Maui Health Job Summary: Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements and complications. Researches and analyzes data needs for reimbursement. Analyzes medical record and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff. Essential Responsibilities: Reviews and verifies documentation supports diagnoses, procedures and treatment results. Identifies diagnostic and procedural information. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines. Follows coding conventions. Serves as coding consultant to care providers. Identifies discrepancies, potential quality of care, and billing issues. Researches, analyzes, recommends...

Summary This position is in the Health Information Management (HIM) section of the Health Administration Service at the Fargo Health Care System. The Medical Records Technician (Coder) is responsible for abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided. Duties Help Total Rewards of a Allied Health Professional This position requires the incumbent to physically report for work to the Fargo ND VAMC. Major duties include, but are not limited to, the following: Assigns codes to documented patient care encounters (inpatient and outpatient); encounters are routine and less complex or for only one specialty or subspecialty. Has basic knowledge of medical terminology, anatomy & physiology, diseases, treatments, diagnostic tests, and medications to ensure proper code selection. Selects and assigns codes from the current version of one or more coding systems depending on...

divh2Medical Billing Specialist/h2pJoin WesleyLife and Help Revolutionize the Aging Experience! Discover how WesleyLife is redefining what it means to age well: The WesleyLife Way/ppWhy Work at WesleyLife? At WesleyLife, were not just a workplacewere a community that values your growth, well-being, and happiness. With over 78 years of excellence in senior living, we believe in empowering our team members to make a difference while enjoying a fulfilling, supportive, and rewarding work environment./ppA Typical Day for a Medical Billing Specialist at our Network Support Center:/pulliManage third party billing across all WesleyLife branches, ensuring accurate and timely submission of claims./liliStay updated on Medicare/Skilled billing regulations and implement necessary process changes for compliance./liliUnderstand Medicare and commercial insurance for co-insurance calculations, cash posting, and collections./liliHandle delinquent accounts and resolve credit balances./liliMaintain...

Join WesleyLife and Help Revolutionize the Aging Experience! Discover how WesleyLife is redefining what it means to age well: The WesleyLife Way Why Work at WesleyLife? At WesleyLife, we're not just a workplace-we're a community that values your growth, well-being, and happiness. With over 78 years of excellence in senior living, we believe in empowering our team members to make a difference while enjoying a fulfilling, supportive, and rewarding work environment. A Typical Day for a Medical Billing Specialist at our Network Support Center: Manage Third Party billing across all WesleyLife branches, ensuring accurate and timely submission of claims. Stay updated on Medicare/Skilled billing regulations and implement necessary process changes for compliance. Understand Medicare and Commercial Insurance for co-insurance calculations, cash posting, and collections. Handle delinquent accounts and resolve credit balances. Maintain confidentiality of client and...

Job Description Job Description Why Charlie Health? Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often, they're met with barriers to care. From limited local options and long wait times to treatment that lacks personalization, behavioral healthcare can leave people feeling unseen and unsupported. Charlie Health exists to change that. Our mission is to connect the world to life-saving behavioral health treatment. We deliver personalized, virtual care rooted in connection—between clients and clinicians, care teams, loved ones, and the communities that support them. By focusing on people with complex needs, we're expanding access to meaningful care and driving better outcomes from the comfort of home. As a rapidly growing organization, we're reaching more communities every day and building a team that's redefining what behavioral health treatment can look like. If you're ready to use your...

Summary This position is in the Coding Section at the VA Maryland Health Care System (VAMHCS). The Medical Records Technician (Coder) is responsible for abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided. This is considered the full performance level for this assignment. Coders at this level perform either inpatient or outpatient coding duties, or a combination of inpatient and outpatient coding duties. Duties Help Major Duties may Include: Identifies the principal diagnosis and principal procedure (when applicable) for every inpatient discharge; also identifies significant complications and/or co-morbidities treated or impacting treatment to correctly determine the proper Diagnosis Related Group (DRG). Upon patient admission to the Community Living Center/Nursing Home Care Unit, codes the admission diagnosis for use by unit staff. All diagnoses and procedure codes are selected...

Summary This position is located in the Health Information Management (HIM) section at the Durham VA Medical Center. MRTs (Coder-Inpatient) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. Responsibilities Select and assign codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS).Review record documentation to abstract all required medical, surgical, ancillary, demographic, social, and administrative data with guidance and instruction from supervisor or senior coder to develop knowledge of the organization and structure of an electronic patient record. Use variety of computer applications in day to day activities and duties, such as Outlook, Excel, Word, and Access; develops use of the health...

Job Summary Under the direction of the Associate Director/Revenue Manager, the Medical Billing Coder aka Professional Fee Coder - Revenue Cycle Analyst will be responsible for front-end billing functions from procedural & diagnosis coding and charge entry to contacting physicians for documentation tracking and updating. Working under direct supervision the incumbent acquires knowledge of revenue cycle coding practices and concepts. Developing proficiency to manage 500 - 1000 code combinations to include Evaluation and Management Services as well as simple to moderately complex testing and procedural code services. The Medical Billing Coder will work to acquire and master all entry-level coding functions including assigning appropriate CPT and Dx codes, associated modifiers, appropriate NCCI edits, resolving coding edits and RFIs as well as basic entry-level revenue cycle duties. Other duties may include assisting other Departments as needed/assigned. As a Medical Billing...

Medical Records Technician (Coder-Inpatient) This position is located in the Health Information Management (HIM) section at the Durham VA Medical Center. MRTs (Coder-Inpatient) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. Responsibilities include: Select and assign codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS). Review record documentation to abstract all required medical, surgical, ancillary, demographic, social, and administrative data with guidance and instruction from supervisor or senior coder to develop knowledge of the organization and structure of an electronic patient record. Use variety of computer applications in day to day activities and duties, such as...

Medical Billing Specialist Location: Madisonville, OH - In Person Employment Type: Full-Time - In Person Definition and Primary Objective: The Medical Billing Specialist ensures individuals have the financial resources to access and maintain services. This role works directly with individuals, families, and third-party payers to determine eligibility, benefits, and payment options. The Specialist helps remove financial barriers, explains insurance coverage and limits, and assists with financial assistance programs and paperwork. They proactively identify financial issues and collaborate with Intake and Finance Departments to mitigate roadblocks preventing or disrupting service delivery. Qualifications Education: Associate degree in healthcare, billing, accounting, or related field preferred; equivalent experience with high school diploma considered. Experience: Knowledge of public and private health insurance required; experience with electronic medical...

JOB DESCRIPTION To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

We are seeking a detail-driven and collaborative Risk Adjustment & Coding Manager to support our Senior CommUnity Care (PACE) programs. This role works closely with SCC Medical Directors and providers to ensure accurate capture and reporting of participant acuity through compliant diagnostic coding. The position plays a critical role in maintaining CMS compliance while directly supporting the financial integrity and performance of our PACE programs. About the Job: Works in concert with Senior CommUnity Care (SCC) Medical Directors and providers to ensure an accurate representation of participant acuity is captured through diagnostic coding and reported to CMS. Assists in the development and implementation of systems and processes to ensure the integrity of diagnostic coding and reporting, directly impacting the financial performance and compliance of the PACE programs. Acts as a liaison between PACE providers and contracted providers to ensure timely response to inquiries...

Job Description destinationone Consulting specializes in recruitment across diverse sectors, including Healthcare, Health Tech, Government, Municipalities, Non-Profits, Legal, Public Accounting, Food and more. We are proactively building a data bank for opportunities in these fields. By applying, you ensure our recruiters can quickly match you with suitable roles when they arise. Location: Various locations across New York The Medical Billing Specialist is responsible for managing the billing process for a healthcare practice, ensuring accurate and timely submission of claims and payments. This role is critical in maintaining the financial health of the organization and ensuring compliance with insurance regulations. Key Responsibilities: Prepare and submit accurate claims to insurance companies and government programs. Verify patient insurance coverage and benefits before services are rendered. Review and post payments, adjusting accounts as necessary....

Job Overview The Coder 2 analyzes clinical documentation; assigns appropriate diagnosis, procedure, and levels of service codes; abstracts the codes and other clinical data. Performs a variety of technical functions within the Outpatient coding area, codes outpatient visits, sent-in-labs, consolidated funding accounts, utilizing ICD-10-CM, CPT-4, and HCPCs Coding Classification systems. Utilizes an electronic coding software to code to the highest level of specificity, ensuring optimal and appropriate reimbursement for the services provided. Responsibility includes resolving medical necessity edits and extracting and entering data into the medical record. This information is then used to determine reimbursement levels, assess quality of care, study patterns of illness and injuries, compare healthcare data between facilities and between physicians, and meet regulatory and payer reporting requirements. Coder 2's also resolves clinical documentation and charge capture discrepancies...

Payment Integrity Nurse Coder RN III The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding...

Job Summary The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims are coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and/or a formal appeal letter. The Auditor escalates trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor performs analysis on clinical documentation, evidence?based criteria application outcome, physician documentation, physician advisor input, and completes review of the medical record related to clinical denials. The Auditor ensures appropriate action is taken within appeal time frames, communicates identified denial trends and...

Location: Work from home (Pennsylvania) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: No Job Summary: Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes that can be utilized for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Job Duties: Reviews the content of the medical record for hospital and professional inpatient or outpatient records to...

GoTo Telemed seeks an exceptional  Remote Medical Biller  to manage comprehensive Revenue Cycle Management (RCM) operations for our rapidly expanding telehealth platform serving multiple medical specialties and healthcare providers nationwide. As a key member of our distributed RCM team, you will process, manage, and optimize medical claims for an increasing portfolio of telehealth providers—with new clients and provider networks added every month as our organization scales. In this critical role, you will be the financial backbone of our provider network, managing the complete end-to-end billing lifecycle including patient eligibility verification, insurance claim submission, payment posting, accounts receivable follow-up, and comprehensive denial management. Your expertise in medical coding (CPT, ICD-10-CM, HCPCS), telehealth modifiers, payer policies, and compliance will directly impact provider revenue, patient satisfaction, and our organizational growth trajectory. This...

Summary MRTs are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. These coding practitioners analyze and abstract patients. health records and assign alphanumeric codes for each diagnosis and procedure. Responsibilities THIS IS AN ON SITE POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION Duties of the Medical Records Technician (Coder) In/Outpatient include, but not limited to: Assigns codes to documented patient care encounters (outpatient and/or inpatient professional services) covering the full range of health care services provided by the VAMC. Selects and assigns codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS). Adheres to...

Outpatient Coder Are you ready for your next career adventure?! Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Outpatient Coder to join our healthcare consulting practice. The role is fully remote within the US. We are proud of our national presence, and excited to offer great career opportunities within the organization. What you'll do Accurately assigns diagnosis and procedure codes for Outpatient specialty and any Outpatient primary care encounters billable to a third party. Researches and resolves coding edit failures as assigned. Review medical documentation and codes for compliance with federal coding regulations and DoD guidelines. Obtain clarification of conflicting, ambiguous, or non-specific documentation. Complete training on all government systems, including all annual and short notice...