72 risk adjust coder risk management jobs found

Company Overview Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast‑growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Job Summary Alignment Health is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities related to risk adjustment data submitted to CMS. In this role, you will conduct provider and coder‑level audits, review medical record documentation and coding accuracy, identify compliance risks and...

Job Description Job Description Description: About Primary Health Solutions Our Mission We meet people where they are and partner with them on their journey towards wellness. Our Vision The destination for servant leaders to provide comprehensive and exceptional care. Our Values R – Respect I – Innovation S – Stewardship E – Excellence Billing and Coding Specialist Summary Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. A Day in the Life · Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. · Review incomplete encounters and code based on available documentation in EHR systems. · Know and understand several different...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a remote position. The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of...

Description If you're looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we're looking for you. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees. As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn't a work life and a home life, there is one life. This...

Job Type Full-time Description About Primary Health SolutionsOur Mission We meet people where they are and partner with them on their journey towards wellness. Our Vision The destination for servant leaders to provide comprehensive and exceptional care. Our Values R - Respect I - Innovation S - Stewardship E - Excellence Billing and Coding Specialist Summary Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. A Day in the Life • Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. • Review incomplete encounters and code based on available documentation in EHR systems. • Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT,...

Risk Adjustment Compliance Auditor Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Alignment Health is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities related to risk adjustment data submitted to CMS. In this role, you will conduct provider and coder-level audits, review medical record documentation and coding accuracy, identify compliance...

MRA Coding Auditor Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a remote position. General Duties/Responsibilities Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality & performance improvement standards are maintained,...

Western Growers Health — a part of Western Growers Family of Companies — provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry. Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today! Compensation: $46,669.19 - $65,668.50 with a rich benefits package that includes profit‑sharing. This is a remote position and can reside...

We meet people where they are and partner with them on their journey towards wellness. Our Vision The destination for servant leaders to provide comprehensive and exceptional care. Our Values R – Respect S – Stewardship Billing and Coding Specialist Summary Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. A Day in the Life Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. Review incomplete encounters and code based on available documentation in EHR systems. Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS. Use computers / billing software to create and bill encounters that generate...

SUMMARY The HIM Coder is responsible for coding activities of patient records. Compliance with rules and regulations of all applicable federal, state and local laws as well as PMHC policies is a condition of employment. ESSENTIAL FUNCTIONS Incumbent must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation: Determines proper ICD-10-CM diagnoses and CPT procedure codes on all hospital patients, using the TruCode Encoder, and coding books when necessary.Retrieves records for appropriate medical personnel.Responds to correspondence as necessary.Prepares information for Birth Certificates and transmits to State of Nebraska.Presents a professional, pleasant and positive image.Greets guest promptly and courteously.Maintains confidentiality at all time.Responsible for personal development in attendance of educational programs, etc. SUPERVISORY RESPONSIBILITIES Directly responsible to the...

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 position...

Billing And Coding Specialist Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. · Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. · Review incomplete encounters and code based on available documentation in EHR systems. · Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS. · Use computers / billing software to create and bill encounters that generate clean claims. · Attend internal meetings relevant to EHR workflows and share best coding practices. · Assist Operations when coding guidance is requested for existing or new services. · Understand payer reimbursement and...

Description If you're looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we're looking for you. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees. As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn't a work life and a home life, there is one life....

Company Description More Than Just Care, It's Community Imagine doing meaningful work in a place where people vacation. That's life at Munson Healthcare - northern Michigan's largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties. If you want a career in healthcare and a lifestyle most people only dream about - with freshwater lakes, scenic trails, charming downtowns, a vibrant arts scene, and endless outdoor adventures - you might just be Munson Material. To us, that means teammates who live by our values of excellence, teamness, positivity, creativity, and a commitment to creating exceptional experiences for our patients and each other. Join a team that delivers outstanding care in one of the most beautiful regions in the country. Invested in You Grow: Tuition reimbursement, in-person and online development, and access to our career hub to help you advance. Thrive: Full benefits,...

Bon Secours Nursing Supervisor Scheduled Weekly Hours: 0.01 Work Shift: Nights (United States of America) Primary Function/General Purpose of Position Supervises the clinical and administrative functions of the Hospital through proven management skills during designated tour of duty. Provides leadership and direction to nursing staff, collaborates with physicians and other departments throughout the Hospital, and the community in problem solving and resolution. Combines clinical skills, and organizational and administrative abilities to provide quality patient care through innovation. Employment Qualifications Must be a graduate from an accredited school of nursing with a BSN preferred. Must be licensed and currently registered as a professional nurse in the State of Virginia. Should have 3-5 years recent clinical experience including work experience in a supervisory role. Must be CPR certified and be able to perform both adult and child CPR in any setting throughout the...

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura’s Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura’s health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the largest...

Description Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. Our main campus is located on 20+ acres just north of mid-town Miami, and is home to our support departments like Finance, Accounting, Human Resources, Marketing and more. Join us now to do purposeful work with our diverse and respectful team. Job Title: HCC Risk Adjuster and Coder Job Summary Reviews medical records and accurately codes and sequences diagnosis in order to obtain maximum reimbursement. Essential Job Functions Audits PACE medical record to ensure accuracy, upon enrollment and disenrollment, and assigns appropriate HCC codes per established department guidelines Performs follow up coding of medical records as a result of internal and external reviews which identify coding discrepancies Meet with PACE providers via MS Teams to assist with documentation improvement tied to reimbursement Assists with other...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Utilizing an electronic medical record and computerized encoder, assigns and sequences diagnosis and procedure codes and present on admission indicators for inpatient encounters based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, encoder software guidance and Health Information Management (HIM) policies and procedures. Responsibilities: Reviews and validates accuracy of Admission-Discharge-Transfer (ADT) data fields; abstracts discharge disposition, physicians, procedure dates, and present on admission (POA) indicators.Maintains strict adherence to patient confidentiality according to MHS Standards and regulatory requirements.Reviews...

Coding Specialist Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data. Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing). May assign and sequence basic CPT...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines. Responsibilities: Maintains thorough knowledge of ICD-10CM/PCS, and CPT coding principles and guidelines; possesses substantial knowledge of MSDRG, APRDRG,...

Position Overview Compliance Auditor – monitors and improves the quality of clinical and financial documentation related to the provision of patient services. Under general supervision, the Compliance Auditor compares clinical and financial records to ensure documentation supports patient charges, codifies findings, and assists in reporting, monitoring, and education. Responsibilities Performs audits of clinical documentation of physician, technical or specialty (e.g., Home Health, Hospice, Inpatient Rehab) billing and payment records and applicable industry standard billing codes by analyzing medical records, coding records and health system bills, validating clinical documentation in conjunction with the bill; assessing the level and accuracy of coding; determining that governmental and third‑party payer regulations are being complied with; and evaluating appropriateness of billing and coding procedures. Evaluates accuracy of coding and billing performance by individuals,...

Supervisor of Medical/Surgical/Pediatrics Imagine working on Washington State's beautiful North Olympic Peninsula where recreational opportunities abound. Whether you enjoy hiking, camping, fishing, kayaking or cycling, the Olympic Peninsula is home to numerous adventures for outdoor enthusiasts. It's a great place to live, work, play and raise a family. Bordered by the scenic Olympic National Park, the Strait of Juan de Fuca and the Pacific Coast - with Seattle and Victoria, BC just a ferry ride away - you won't find a better location. You'll receive a competitive salary, excellent benefits plus an amazing PNW lifestyle a perfect combination! FTE: 100% Work Shift: Days Pay Range: $100,817.60 - $164,486.40 Job Description The Supervisor of Medical/Surgical/Pediatrics is responsible for the management of patient care, personnel activities, and staff development in conjunction with the Clinical Educator and other Supervisors/Managers under the direction of the Director of...

Primary Function / General Purpose Of Position Supervises the clinical and administrative functions of the Hospital through proven management skills during designated tour of duty. Provides leadership and direction to nursing staff, collaborates with physicians and other departments throughout the Hospital, and the community in problem solving and resolution. Combines clinical skills, and organizational and administrative abilities to provide quality patient care through innovation. Employment Qualifications Must be a graduate from an accredited school of nursing with a BSN preferred. Must be licensed and currently registered as a professional nurse in the State of Virginia. Should have 3-5 years recent clinical experience including work experience in a supervisory role. Must be CPR certified and be able to perform both adult and child CPR in any setting throughout the hospital. ACLS and PALS certifications (Can obtain during orientation). Essential Job Functions Performs...