224 nurse coder jobs found

Payment Integrity Nurse Coder RN III Salary Range: $102,183.00 (Min.) - $163,492.00 (Max.) L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Job Summary 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...

Medical Coders Welcome Job Title: Nurse Chart Reviewer Location: West Hills/Canoga Park 91305 (This role is HYBRID not remote) Overview: The Retro Claims Reviewer is responsible for auditing and reviewing medical claims to ensure accuracy, regulatory compliance, and proper adjudication. This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. Key Responsibilities: • Audit denied provider and member claims for accuracy and compliance • Review and process claims in accordance with UM guidelines and regulatory standards • Analyze benefit structures and system configurations (EZCap or similar) • Collaborate with cross-functional teams to resolve claim issues and process gaps • Document findings, prepare reports, and present trends to leadership • Support automated adjudication systems and identify strategies to reduce...

PERMA FAIR is seeking a Member Experience Clinical Coder & Medical Biller in Camden, New Jersey. This role involves reviewing and validating medical claims, ensuring coding accuracy, and maintaining compliance with medical coding standards. Candidates should have a nursing degree, an active nursing license, and at least 2 years of experience in the medical field. A competitive salary ranging from $115,000 to $150,000 is offered along with comprehensive benefits including medical insurance and a 401(K) plan. #J-18808-Ljbffr

DRG Coder, Registered Nurse Remote | Full-Time | Healthcare | Clinical Documentation & Coding About the Role We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records. This role is critical in ensuring accurate DRG assignment, strong clinical documentation support, and compliance with Medicare and CMS regulations. The ideal candidate is highly analytical, clinically strong, and comfortable working independently in a production-driven audit environment. You will play a key role in improving coding accuracy, reimbursement integrity, and regulatory compliance while providing clear, defensible audit findings. Key Responsibilities DRG Validation & Chart Review Perform in-depth DRG quality audits of inpatient medical records. Validate DRG assignments against clinical documentation and coding guidelines. Identify missed opportunities, discrepancies, and documentation gaps...

Ankura Health Care Disputes, Compliance and Investigations Practice Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also...

Overview Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Benefits for Full and Part-time Employees We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay 100% of the DENTAL monthly premiums for Employee Only coverage. We provide an...

Job Description Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. BENEFITS for Full and Part-time employees who work 30 or more hours per week: We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay...

Description: Are you interested in building a career with other TOP PERFORMERS? Effingham Health System is committed to providing exceptional care and services in an environment that supports professional growth, diversity, and inclusion. Every team member's experience and work-life balance are a priority in our organization. EHS culture encourages and supports individuals in pursuing their career goals and well-being by providing work-life balance, flexible scheduling, career development, and all the benefits and perks you need for yourself and your family. New Grads are welcome to apply. Benefits Retirement plans 403 (b) and 457 Health insurance Dental Insurance Vision insurance Prescription Drug Plan Hospital Discount Flexible spending account Paid time off Extended Days off (Sick time) Employee assistance program Strive365 Wellness Program Basic Life insurance (Employer Paid) Voluntary Life insurance/Accident/Critical Illness Disability (LTD and STD) Tuition...

Ready to help us transform healthcare? Bring your true colors to blue. Job Profile: Appeals Nurse Reviewer Job Code: HCM101 Business Title: Appeals Nurse Reviewer Reports To: Patricia Corsini RN, BSN The Role The Clinical Appeals Nurse Reviewer facilitates, coordinates, and responds to provider appeals for denied services utilizing extensive clinical, regulatory, business, and coding knowledge. Collaborates with the Physician Review Units, Medical & Payment Policy Departments, Provider Service, Member Service and Claims Area to research and resolve provider claims appeals. The Team As an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and business expert for claims appeals. This role works collaboratively with Provider Service, Claims, Network Management, Physician Review, and Medical and Payment Policy teams. Key Responsibilities Review appeals utilizing sound clinical judgement, medical policy, payment policy guidelines,...

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research...

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research...

Position Summary The Member Experience Clinical Coder & Medical Biller serves as a key contributor to internal medical billing review, payment integrity, and claims adjudication. Responsible for reviewing, validating, and repricing claims on behalf of payers, providers, and claim audit partners to support accurate reimbursement and strengthen payment integrity for our self‑insured clients. Translate medical diagnoses, procedures and services into standardized coding while ensuring compliance with established guidelines and reimbursement methodologies. Collaborate closely with providers, Third-Party Administrators (TPAs), and other stakeholders to identify coding discrepancies, provide analysis, and communicate findings that drive informed decision‑making and optimal claim outcomes. Key Responsibilities Medical Coding & Documentation Review Receive, analyze, and verify patient medical records for accuracy, ensuring all required information is present for proper billing and...

Job Description Job Description Advanced Medical GI (AMGI) is a comprehensive gastroenterology practice serving the needs of patients in the Northern Virginia and DC suburbs. We specialize in the diagnosis, treatment, and management of diseases and conditions affecting the digestive system. Dr. Richard Blosser and his team of physician assistants and nurse practitioners are medical specialists who have received advanced training in gastroenterology, which involves the study of the digestive tract, including the esophagus, stomach, small intestine, colon, rectum, liver, gallbladder, and pancreas. We have provided care for over thirty years in the Northern Virginia region Overview We are seeking a dedicated biller/coder to join our healthcare team. The ideal candidate will play a crucial role in ensuring the smooth operation of our medical office by providing exceptional billing and collections support. Responsibilities Review and process billing and coding information...

Consulting Team Member This job works as a consulting team member on client or internal assignments. Handles escalated coding related projects, new services, regulatory updates and overall coding quality. Provides coding education to various groups such as coders, billers, nurses, physicians, etc. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties. This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion. Education Required High school diploma or equivalent. Preferred Bachelor's degree in information...

Remote work from Illinois, Wisconsin, Indiana, and Iowa Description The Inpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. The Inpatient Coder II has a deep understanding of disease process, anatomy/physiology, pharmacology and medical terminology. Responsibilities Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II’s typically...

RN- Registered Nurse - ER- Emergency Room, Medical/Surgical, Pediatrics, Critical Access Hospital, Supervisor Alliant has a new Travel opportunity for a ER- Emergency Room, Medical/Surgical, Pediatrics, Critical Access Hospital, Supervisor RN- Registered Nurse in Dillon, MT! You must have a valid license and current experience as a RN- Registered Nurse. Details: RN- Registered Nurse- ER- Emergency Room, Medical/Surgical, Pediatrics, Critical Access Hospital, Supervisor Dillon, MT Shift: 3x12 Estimated Gross Pay Package: $1,809.00-$1,836.00 per Week (Based on expected Hours/Week) Requirements: Current Resume Graduate of a RN- Registered Nurse education program Previous work experience as an RN- Registered Nurse. Current active and unrestricted RN- Registered Nurse license in the Assignment state, if applicable Two recent professional supervisor references. Ability to pass background/urine drug screening as well as complete other onboarding/compliance items as...

Job Description Job Description Salary: Pay commensurate with experience. At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care ." Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022, 2023, 2024 & 2025 Come be a part of our dynamic team; you'll join Ashes Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice! This is your opportunity to make a large difference in a small community! Hours: | No Supervisory Responsibilities | No Travel | Pay commensurate with experience JOB SUMMARY: The Inpatient/Outpatient Coderis responsible foraccurately coding diseases, operations, and procedures for inpatient and outpatient servicesin accordance withnationally recognized standards and guidelines. This role involvesutilizingthe 3M Encoder computer system with ICD-10 CM and CPT coding supplements, reviewing medical...

Inpatient Coder II, HB Coding, Full-time, Days (Remote - Must reside in IL, IN, IA, WI, MO, OH, MI, or FL - Sign-on bonus eligible) Full-time Job Shift: Day Job (1st) Salary Range Minimum: $28.14 Salary Range Maximum: $40.80 Compensation: USD 28.14 - USD 40.8 - hourly Company Description At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better? Job Description The Inpatient Coder II reflects the mission, vision, and values of NM, adheres to the...

Quality Assurance Coder/Auditor Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not...

Clinical Nurse Auditor Payment Integrity We are seeking an experienced Clinical Nurse Auditor to join our Payment Integrity team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a similar credential, through AAPC or AHIMA. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential. How You Will Make an Impact Investigations and Audits: Conduct in-depth medical reviews through prepayment...

Job Description Job Description Certified Home Health Coder & QA Specialist Become a part of the Hope At Home Family! We currently have a position available for a Certified Home Health Coder & QA Specialist. Position Summary: Certified Home Health Coder & QA Specialist is required to have PDGM, Oasis D1 experience, and Kinnser software knowledge. Home Health Coder is responsible for coding using ICD-10 all diagnoses and applicable procedures of skilled service visits. The position is also responsible for reviewing OASIS and abstracting visit data for billing and data collection purposes. Responsibilities: Codes records using ICD-10-CM and coding guidelines. Reviews OASIS. Observes and report unusual patterns in data collection and/or lack of adequate documentation for code assignments. Review documentation and provide ICD-10 coding recommendations based on current coding and Oasis guidelines. Performs other related duties as requested by the Home...

Job Description Job Description About Company: As one of the largest primary care practices in Southwest Georgia, Albany Area Primary Health Care (AAPHC) provides health care services to more than 54,000 patients and nearly 217,000 office visits per year. AAPHC is also one of the largest Community Health Centers in our region! To learn more about Community Health Centers, and how this benefits Southwest Georgia. At AAPHC, we strive to provide comprehensive, coordinated, and continuous care to all who access our services. Did you know that all qualifying medical offices operated by AAPHC are recognized as a Level III Patient Centered Medical Home (PCMH) by the National Center for Quality Assurance (NCQA)? NCQA offers three levels of PCMH recognition with Level III being the highest level. As a Level III PCMH, AAPHC is committed to continuously raising the quality of care within our practices, while also lowering our patients health care costs. Our health care teams are...

Medical Coding Specialist Summary/Objective: Obtain accurate reimbursement for healthcare claims. Essential Functions Reviews and resolves all assigned charges thoroughly based on coding guidelines, chart documentation and related charges in billing system. Audits task manager work files with charges reviewed by Claims Manager that were found to have coding errors/omissions. When appropriate communicates approved coding changes and/or questions to Physician's and their office staff. Also alerts providers of missing or late charges. Alerts management to coding trends discovered while working daily charges/edits. Stays informed and up to date on coding issues by attending seminars. Possesses a comprehensive understanding of carrier specific State of Florida billing guidelines. Consistently stays within the department production goal set for your area Requirements Required Education and Experience: High School Graduate or Equivalent. Must be a certified coder...