3131 medical reviewer coder jobs found

J29, Inc. seeks experienced RVC Reviewers to perform automated and complex reviews of Medicare FFS claims, ensuring proper payments and adherence to CMS rules. The role emphasizes accuracy, compliance, and collaboration across teams. Qualified candidates have 5+ years in medical coding, experience with DRG validation, and remote work capability. This position supports ongoing audits and process improvements within a health and human services context. #J-18808-Ljbffr

About J29 J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since companyinceptionin 2017 as an employee-centered healthcare management consulting company. Our team of 260 employees focuses on providing processing,review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinicalexpertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels. J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to dogreat thingsfor the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to...

J29 J29, Inc. has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels. J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit...

Job Summary The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical validity of reported diagnoses and procedures. This role evaluates coding accuracy, DRG assignment, reimbursement impact, and regulatory compliance in accordance with official coding guidelines, CMS regulations, payer policies, and organizational standards. The reviewer retrieves, analyzes, and documents medical record information to support appropriate reimbursement, documentation integrity, and audit outcomes for hospital inpatient services. Responsibilities Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and CPT-4 coding conventions. Review inpatient medical records to validate the accuracy and appropriateness of reported primary and secondary diagnoses and procedures using ICD-10-CM/PCS guidelines. Evaluate diagnosis and procedure sequencing to ensure...

Certified Risk Adjustment Medical Coder (CRC) Our client is seeking an experienced Certified Risk Adjustment Medical Coder (CRC) to support CMS and HHS Risk Adjustment Data Validation (RADV) audits. This position is responsible for reviewing inpatient and outpatient medical records to validate Hierarchical Condition Categories (HCCs) while ensuring compliance with CMS documentation standards, ICD-10 coding guidelines, and regulatory requirements. The ideal candidate will have extensive experience performing CMS and HHS RADV audits, vendor-side coding reviews, and risk adjustment auditing while maintaining exceptional coding accuracy and productivity standards. Key Responsibilities Review inpatient and outpatient medical records to validate HCC diagnoses. Determine whether submitted diagnosis codes meet CMS and HHS documentation requirements. Ensure documentation satisfies M.E.A.T. (Monitor, Evaluate, Assess, Treat) criteria. Perform coding reviews using ICD-10 Official...

Medical Record Reviewer The purpose of this position is to review the medical record to assure specificity of diagnoses, procedures and appropriate/optimal reimbursement for hospital and/or professional charges; Retrieves information from medical records, ensuring adherence with established methods and procedures. Key Responsibilities/Accountabilities: Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-9-CM and CPT-4 coding conventions. Sequence the diagnoses and procedures using coding guidelines. Ensure DRG/APC assignment is accurate. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Serves as backup to other administrative functions as assigned. Meets job standards for achieving contract deliverables. Assists with other job- and education-related duties as assigned. Other duties as assigned Read, understand, and adhere to all...

Medical Coder Educator Serves as the coding reviewer and documentation educator for USFTGP Revenue Cycle Operations. Collaborate extensively with compliance; utilizing approved coding industry tools and approved internal documentation. This position is responsible for providing coding literacy and awareness using adult methodologies to revenue cycle, coding professionals, department managers, medical staff and others, ensuring proficiency is accurate and within compliant coding practices for billing. Analyze and report review findings indicating documentation gaps reimbursement and data internation, inpatient, outpatient and professional service coded. Report to compliance focused areas of improvements, recommendations and actions taken to improve medical staff knowledge and coding accuracy. Conduct individual and group coding and documentation support instructions as assigned and acts as an internal coding expert resource. Qualifications Required: High School Diploma or GED...

Ohio Living seeks a Clinical Reviewer - Medical Coder & QA to review and approve patient information from licensed professionals during start of care, recertification, resumption of care, or evaluation visits. You will ensure quality care, maintain documentation standards, and assist with staff training across home health and hospice programs. Responsibilities include performing ICD-10 coding, validating OASIS data, and ensuring accurate Plan of Care selections. #J-18808-Ljbffr

Clinical Data Management Lead Manage single and multi-service projects, ensuring quality deliverables on time, within budget and to the customer's satisfaction; Provide expert skills as part of a Clinical Data Management (CDM) team to provide quality data that meet customer needs; Provide leadership to the team in the area of coding, project planning and execution, financial management, communication and milestone tracking; Viewed as an expert in coding of clinical data. Essential Functions Serve as an account lead, or internal or external point of contact on standalone coding studies or accounts Maintain post-coding dictionary up-versioning synonym and coding reconciliation to align coding to latest dictionary versions. Perform Dictionary up-versioning activities. Perform external verbatim coding of data from non-EDC sources in line with required coding dictionary versions. Manage the customer relationship for the project team including active participation in...

Description About Us: At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD-9-CM/ICD-10-CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality...

We’re unique.  You should be, too. We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management. Provides Delegated UM by covering the specified territories as assigned: Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on...

To support medical record audit activities, the full-time Certified Medical Coding Reviewer will review claims for pre-payment and post-payment functions, research and analyze claims, and collaborate with internal departments, all while working remotely. Key responsibilities: Make payment decisions on a variety of claims based on medical coding guidelines and policies Research and analyze moderately complicated claims, ensuring adherence to departmental standards Identify and report suspected Fraud, Waste, or Abuse, and implement process improvements Required qualifications: Associate's degree required; equivalent work experience may be accepted in lieu of education Three years of medical billing coding experience required Certified Medical Coder (CPC, RHIT, or RHIA) required at time of hire Medicaid/Medicare experience preferred Clinical background with understanding of claims payment preferred

Certified Risk Adjustment Medical Coder (CRC) Our client is seeking an experienced Certified Risk Adjustment Medical Coder (CRC) to support CMS and HHS Risk Adjustment Data Validation (RADV) audits. This position is responsible for reviewing inpatient and outpatient medical records to validate Hierarchical Condition Categories (HCCs) while ensuring compliance with CMS documentation standards, ICD-10 coding guidelines, and regulatory requirements. The ideal candidate will have extensive experience performing CMS and HHS RADV audits, vendor-side coding reviews, and risk adjustment auditing while maintaining exceptional coding accuracy and productivity standards. Key Responsibilities Review inpatient and outpatient medical records to validate HCC diagnoses. Determine whether submitted diagnosis codes meet CMS and HHS documentation requirements. Ensure documentation satisfies M.E.A.T. (Monitor, Evaluate, Assess, Treat) criteria. Perform coding reviews using ICD-10...

Certified Risk Adjustment Medical Coder (CRC) Key Details Location: 100% Remote (Must reside in an approved state) Duration: Contract (Potential for extension) Schedule: Monday-Friday, 7:00 AM-4:00 PM or 8:00 AM-5:00 PM (Local Time) Hours: 40 hours per week, with 5-10 hours of overtime as needed (Candidates must be willing to work overtime) Work Arrangement: Fully Remote Compensation: $27.00 per hour Employment Type: W2 (Not open to C2C, 1099, or visa sponsorship) Role Overview Our client is seeking an experienced Certified Risk Adjustment Medical Coder (CRC) to support CMS and HHS Risk Adjustment Data Validation (RADV) audits. This position is responsible for reviewing inpatient and outpatient medical records to validate Hierarchical Condition Categories (HCCs) while ensuring compliance with CMS documentation standards, ICD-10 coding guidelines, and regulatory requirements. The ideal candidate will have extensive experience performing CMS...

About Us: At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact—whether we’re supporting data-driven decisions, modernizing systems or safeguarding critical programs. Job Overview We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD-9-CM/ICD-10-CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality...

Responsibilities Responsible for understanding the billing requirements for all payers Enters and approves data into the Management Information system according to appropriate guidelines Analyzes provider documentation for appropriate Evaluation & Management coding levels Provides expertise to billing staff in addressing appeals for denials Completes audits of provider encounters to ensure compliance Serves as coding reviewer to support charge posting Accept charges, review, analyze, and code diagnostic and procedural information Conducts periodic Quality Assurance Processes for Revenue Cycle Coders Develop training materials for ongoing use by provider staff and Patient Accounts staff Perform other duties as assigned Requirements High School Diploma or GED CPC-A, RHIA, RHIT, CCA and/or CCS certification required CPC and/or CRC preferred Ability to interact positively and build rapport with patients, coworkers and/or external contacts Ability to work...

About Us: At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD‑9‑CM/ICD‑10‑CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance efforts....

About Us: At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD‑9‑CM/ICD‑10‑CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance efforts....

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values.These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.Reporting to the Supervisor of Outpatient Coding, The OP Senior Coder is a vital multifaceted role within the Outpatient Coding Department.This position provides support to the Outpatient Coding Department as a OP coding subject matter expert, educator, QA reviewer, and also focuses daily efforts on A/R management and oversight.Additionally, this person works with partner departments to problem solve issues and streamline processes.The OP Senior Coder is also required to mentor other team members and also prepare them for the role of OP Senior Coder.The OP Senior Coder possesses a strong level of OP clinical coding expertise, and has the ability to handle multiple priorities.This position...

Medical Coder Educator - USFTGP RCOServes as the coding reviewer and documentation educator for USFTGP Revenue Cycle Operations. Collaborate extensively with compliance; utilizing approved coding industry tools and approved internal documentation. This position is responsible for providing coding literacy and awareness using adult methodologies to revenue cycle, coding professionals, department managers, medical staff and others, ensuring proficiency is accurate and within compliant coding practices for billing. Analyze and report review findings indicating documentation gaps reimbursement and data internation, inpatient, outpatient and professional service coded. Report to compliance focused areas of improvements, recommendations and actions taken to improve medical staff knowledge and coding accuracy. Conduct individual and group coding and documentation support instructions as assigned and acts as an internal coding expert resource.QualificationsRequired:High School Diploma or...

Join to apply for the Remote Ambulance Coder role at Pafford Medical Services1 day ago Be among the first 25 applicantsJoin to apply for the Remote Ambulance Coder role at Pafford Medical ServicesGet AI-powered advice on this job and more exclusive features.Job Title :Remote Ambulance CoderWork Location :Pafford Medical Services, Inc.- Oklahoma CityDivision / Department :PMBSReports To :Director of Pafford Medical Services BillingFull-TimeNonexemptJob DescriptionResponsible for charge validation and assigning appropriate ICD-10 and HCPCS codes to ambulance claims.Responsible for reviewing ambulance trip reports to determine medical necessity and to assign the appropriate level of care.Includes fulfilling assigned duties and responsibilities for the accurate submission of all ambulance transports in order to process third party claims and patient bills.Essential Duties And ResponsibilitiesResearches all information to complete accurate billing processes including assignment of...

Wipro Limited is seeking a dedicated Medicare appeals specialist to review medical records and analyze denials under CMS guidelines. The role focuses on NCD/LCD denials, duplicate denials, and MUE denials, with duties including documentation and effective communication within the team. The position expects familiarity with FACETS and COSMOS, a coding certificate, and strong analytical skills to ensure accurate determinations of coverage. #J-18808-Ljbffr

Medical Coder - Edit and Charge Review FocusHourly Compensation: $21.00 - $25.00 per hour (based on experience) + Bonus Plan Eligibilitiy FLSA Classification: Nonexempt, Full-Time, Benefit Eligible Location: Remote. East Coast and SC Upstate area candidates strongly preferred. The Opportunity: The Certified Medical Coder is responsible for reviewing clinician-entered charge suggestions, resolving coding edits, validating charge accuracy, and managing coding queues within obstetric and GYN services. This role supports accurate charge capture by reviewing suggested CPT, HCPCS, and ICD-10 coding and making coding corrections when documentation review identifies discrepancies or opportunities for improvement. This role is primarily focused on coding validation and edit resolution rather than routine chart abstraction or full medical record coding. OBHG is a great place to work, offering remote work opportunities, a monthly bonus program, health and 401(k) benefits, generous paid time...

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided. This role is available for remote, onsite and hybrid work arrangements. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Appropriately document work and final conclusions in designated computer program Additional duties as assigned KNOWLEDGE & SKILLS: Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology Knowledge of applicable fee schedule and or applicable U&C Guidelines Proficient in Microsoft Office applications...