40 registered nurse crc coding auditor jobs found

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 limited to: Customer Service,...

Overview At HeiTech Services, our employees are our biggest assets. HeiTech Services is dedicated to attracting highly skilled and motivated professionals. We value our employees. We offer our employees challenging opportunities that facilitate professional growth and development while also providing the support you need to succeed. We are committed to your success because we understand that our employees are the driving force behind HeiTech Services’ continued growth. Our mission is to help the Federal Government keep Americans safe. Position Description This position is responsible for reviewing, prioritizing, and analyzing adverse medical events related to medical devices that are submitted on MedWatch reporting forms via hard copy or electronically to our customer, the Food and Drug Administration (FDA). Additionally, this position is responsible for processing and coding a variety of reports from device manufacturers (MFR), importers, user facilities, health care...

Medical Coder – General and Specialty Cardiology Cardiac Study Center/ Pulse Heart Institute, Tacoma, WA The Company Since its creation, Cardiac Study Center (CSC) has contracted with Pulse Heart Institute for outpatient cardiology and billing services. CSC is a proud partner of Pulse and has provided outpatient cardiology services in the Puget Sound Region for over 50 years. In 2016, CSC partnered with MultiCare Health System to create Pulse Heart Institute to work toward improving the health of cardiac patients. Pulse offers a variety of career opportunities throughout our clinic locations. If you’re interested, we may have positions open in our other sub-specialties (Heart Failure, Vascular, Electrophysiology & Device, or Imaging) Medical Coder Environment, Geography, and Shift details : This role is full-time, Monday – Friday (no weekends). The position is fully remote after a 90-day in-office training. Candidates must live within 50 miles of Tacoma, WA. Medical Coder...

Medical Coder – General and Specialty Cardiology Cardiac Study Center/ Pulse Heart Institute, Tacoma, WA The Company Since its creation, Cardiac Study Center (CSC) has contracted with Pulse Heart Institute for outpatient cardiology and billing services. CSC is a proud partner of Pulse and has provided outpatient cardiology services in the Puget Sound Region for over 50 years. In 2016, CSC partnered with MultiCare Health System to create Pulse Heart Institute to work toward improving the health of cardiac patients. Pulse offers a variety of career opportunities throughout our clinic locations. If you’re interested, we may have positions open in our other sub-specialties (Heart Failure, Vascular, Electrophysiology & Device, or Imaging) Medical Coder Environment, Geography, and Shift details : This role is full-time, Monday – Friday (no weekends). The position is fully remote after a 90-day in-office training. Candidates must live within 50 miles of Tacoma, WA. Medical Coder...

Medical Coder – General and Specialty Cardiology Cardiac Study Center/ Pulse Heart Institute, Tacoma, WA The Company Since its creation, Cardiac Study Center (CSC) has contracted with Pulse Heart Institute for outpatient cardiology and billing services. CSC is a proud partner of Pulse and has provided outpatient cardiology services in the Puget Sound Region for over 50 years. In 2016, CSC partnered with MultiCare Health System to create Pulse Heart Institute to work toward improving the health of cardiac patients. Pulse offers a variety of career opportunities throughout our clinic locations. If you’re interested, we may have positions open in our other sub-specialties (Heart Failure, Vascular, Electrophysiology & Device, or Imaging) Medical Coder Environment, Geography, and Shift details : This role is full-time, Monday – Friday (no weekends). The position is fully remote after a 90-day in-office training. Candidates must live within 50 miles of Tacoma, WA. Medical Coder...

Job Summary Designs and delivers education programs on compliant documentation, coding and billing practices, regulatory requirements, and internal policies through learning experiences such as instructor-led sessions, webinars, and e-learning modules. Serves as a key resource for physicians, clinical staff, auditors, coders, and other stakeholders, ensuring understanding and adherence to applicable standards. Analyzes data and reports to identify educational needs and may conduct limited audits to support targeted training efforts. Essential Functions: Develops and delivers targeted education based on new service or program implementation, CPT/ICD-10 changes, and regulatory changes. Reviews audit data and compliance trends to identify educational gaps and address areas of risk. Designs and maintains educational content and resources, supporting accurate CPT and diagnosis coding for professional services,...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or facility) claims vs. medical...

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...

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...

Description Are you looking for a career that will make an impact? The Leidos Military and Veterans Health Solutions Operation has an opening for a Clinical Informaticist / Clinical Coder to join the Operational Readiness Directorate at the Naval Health Research Center in San Diego, CA. This position will provide support to the Epidemiology and Data Management Support Department and involves clinical coding and data abstraction to support research on the physical and mental health of military personnel to improve overall health and readiness. The person in this position will work closely with department professionals in records management, information technology, and research teams to ensure alignment of clinical coding with research needs. Are you ready for unique and exciting work? This is a full-time position in San Diego. The candidate for this position must be located within commuting distance of San Diego to work on-site at the Naval Health Research Center as...

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...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information...

Job Description We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Think you've got what it takes? Job Duties & Responsibilities • Assess the treatment plan, clinical information, and medical necessity of all requested services • Utilizes established criteria to appropriately review billed services within established timeframe required. • Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. •...

Medical Compliance Auditor We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Job Duties & Responsibilities Assess the treatment plan, clinical information, and medical necessity of all requested services Utilizes established criteria to appropriately review billed services within established timeframe required. Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. Refers case failing medical...

Job Title USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community. Responsibilities Performs correct coding (CPT4/ICD10) for provider services; audits services billed without prior coding review to ensure accuracy; provides education, payer coding updates and documentation to leaders and providers to ensure coding is being performed based on current guidelines; performs periodic reviews and ongoing audits of claims to ensure accuracy of coding/billing and sufficiency of...

Director, Billing Compliance  Dana-Farber Cancer Institute  Boston, MA  Full Time  Overview Reporting to the VP, Chief Compliance Officer with a dotted line reporting relationship to the VP, Revenue Performance Management, the Director of Billing Compliance is a strategic leader and subject matter expert responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization. The Director provides constructive oversight and mentorship to the Billing Compliance team. This role leads the development and execution of a robust billing compliance program focused on hospital technical and professional fee billing in compliance with internal policies and state, federal and local rules. The Director serves as a key 'second line of defense' in support of accurate and compliant operational processes. The Director works as a cross functional leader, partnering with clinical, administrative, and financial teams and participating in...

TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care. This role will apply coding and clinical principles based on industry standards and...

At TREND Health Partners, a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining TREND Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Outpatient Coding Auditor’s responsibility is to review medical records, clinical documentation, and claims to ensure accurate ICD-10, CPT, and HCPCs coding and compliance with CMS and coding guidelines. The role will be to apply coding principles based on industry standards and...

Compliance Auditor-HH & HSP At Piedmont Healthcare, you’ll love a shared purpose, be motivated to be your best, and be recognized for your contributions. Piedmont Healthcare leaders are in your corner and invested in your success. Our wellness programs and comprehensive total benefits and rewards will meet your needs for today and help you plan for the future. Responsibilities: This position is responsible for conducting risk-based audits focused on documentation integrity, medical necessity, and regulatory compliance for home health and hospice services. This role also supports the Piedmont's Compliance Program by identifying areas of risk, leading investigations, and delivering targeted education to mitigate future compliance vulnerabilities. Qualifications: Education: Bachelors Degree Work Experience: 3 years of experience in healthcare auditing or coding, with a focus on home health and hospice. Required Licenses and Certifications: RN -...

A Day in the Life of the Coding Compliance & Education Coordinator You'll be diving into clinical documentation and coding records, performing detailed audits to ensure every code is accurate, complete, and compliant with regulatory standards. You'll analyze patterns, identify discrepancies, and provide actionable feedback that supports optimal reimbursement and quality reporting. You'll assist with developing and delivering training sessions for coding staff, clinical providers, and other stakeholders. You'll serve as the go-to expert for ICD-10-CM, ICD-10-PCS, CPT, and sequencing guidelines, helping teams stay current with evolving standards. You'll work closely with the Coding Manager and other leaders, ensuring coding practices align with organizational goals. Whether you're refining audit processes, answering complex coding questions, or creating educational materials, your work directly impacts compliance, revenue integrity, and patient care quality. Why Work at...

Benefits: 401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance JOB SUMMARY: Responsible for accurate inpatient and outpatient coding, timeliness of coding, and utilization of systems used to perform coding functions. Reports To: HIM Director Classification: Non Exempt Hours/Days: Mon - Fri, 8a to 5p In-Office QUALIFICATIONS: Minimum 2 years of coding experience, Coding credentials preferred. OCCUPATIONAL EXPOSURE: Office Environment RESPONSIBILITIES: 1. Assigning accurate CPT, ICD, HCPCS codes and modifiers from medical record documentation. 2. Identifying and abstracting information from medical records for audits, internal and external. 3. Work closely with the supervisor during audit procedures. 4. Retrieves Charts. 5. Abstracts accurately. 6. Reviews the unbilled on a daily basis to identify pending accounts. 7. Follows release of Information policies and procedures for H.I.M. Department...

You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006. And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here. About Us Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty...

Internal Reference Number: R1050337 Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have...