63 rn certified coder jobs found

Remote Rn Certified Coder Pride Health is hiring a remote RN certified coder for a well-known client! (REMOTE) Schedule: Monday-Friday (9am-5pm EST) Contract: 12 months Pay Rate: 60-64/hour Job Responsibilities Determine which codes belong to the language in the benefit plans Review what peers have designated as correct coding Facilitate any discussions needed to get to a coding document Review audit results and make adjustments as necessary Participate in project meetings Requirements 3 + years' experience with coding and reimbursement methodologies (e.g. CPT, HCPCS, ICD-10, CMS), 3+ years Certified Professional Coder (AAPC or AHIMA) Active unrestricted RN license AAPC or AHIMA certification Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an...

Pride Health is hiring a Remote RN Certified Coder for a well-known client! (REMOTE) Schedule: Monday-Friday (9am-5pm EST) Contract: 12 months Pay Rate: 60-64/hour Job Responsibilities Determine which codes belong to the language in the benefit plans Review what peers have designated as correct coding Facilitate any discussions needed to get to a coding document Review audit results and make adjustments as necessary Participate in project meetings Requirements 3 + years' experience with coding and reimbursement methodologies (e.g. CPT, HCPCS, ICD-10, CMS,), 3+ years Certified Professional Coder (AAPC or AHIMA) Active unrestricted RN license AAPC or AHIMA certification Apply with Pride Health for this opportunity! Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement...

Job SummaryWe are seeking an experienced Certified RN Medical Coder to support a full-time COC / SPD project focused on building out coding for benefit plans.This role combines clinical knowledge with technical coding expertise to ensure accuracy, consistency, and compliance across plan documentation.You'll work closely with a team of certified coders and business analysts in a collaborative, fast-paced environment where precision and partnership drive success.Why this Opportunity?Top ranked company in Fortune's 2024 World's Most Admired Companies for over a decade consecutively.This healthcare client is ranked number one in key attributes of reputation :Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness.Job Responsibilities :Determine and assign appropriate codes to benefit plan language as part of the COC / SPD project.Review coding selections made by peers...

Job SummaryWe are seeking an experienced Certified RN Medical Coder to support a full-time COC / SPD project focused on building out coding for benefit plans.This role combines clinical knowledge with technical coding expertise to ensure accuracy, consistency, and compliance across plan documentation.You'll work closely with a team of certified coders and business analysts in a collaborative, fast-paced environment where precision and partnership drive success.Why this Opportunity?Top ranked company in Fortune's 2024 World's Most Admired Companies for over a decade consecutively.This healthcare client is ranked number one in key attributes of reputation :Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness.Job Responsibilities :Determine and assign appropriate codes to benefit plan language as part of the COC / SPD project.Review coding selections made by peers...

Outpatient Coder The Outpatient Coder works under general supervision to complete charge documents for outpatient services. The Certified Professional Coder, LPN, or RN is responsible for reviewing a patient's medical records after a visit and translating the information into codes that payors use to process claims from patients. The coder will work under general supervision to complete charge sessions for outpatient services within the primary care setting. The coder must have a strong work ethic as there is a productivity requirement with the completion of a minimum of 240 charge sessions daily. The outpatient coder will be responsible for complying with medical coding guidelines and policies regarding appropriate CPT/ICD-10/HCPCS codes. Education & Experience: Certified Professional Coder (CPC) certification, or, graduate from a school of nursing (LPN or RN), required If candidate is a graduate from a school of nursing without coding certification, then AAPC (CPC and...

QA Nurse / Coder (RN) As a QA Nurse / Coder, you will ensure the accuracy, completeness, and regulatory compliance of Home Health documentationparticularly OASIS assessments, the Home Health Plan of Care (485), and face-to-face encounter noteswhile properly sequencing diagnoses according to federal/state standards and agency policy. Core responsibilities include: Review OASIS forms and Plans of Care for appropriateness, completeness, and compliance. Assign and sequence ICD?10 codes in line with current home health coding guidelines. Ensure consistency and compliance of face-to-face encounter documentation with OASIS and care plans. Conduct additional clinical record audits and OASIS reviews as assigned. Stay current on Medicare reimbursement policies, home health regulations, and compliance requirements. Maintain relevant certifications (HCS?D, HCS?O or COS?C). Participate in quality assurance and performance-improvement efforts. Coordinate with physicians, facilities,...

Job Title 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. Position Purpose: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) 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. Location: This is a remote position, Monday - Friday from 8:30am...

KPN Pro Fee Coding Specialist This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of CPT,...

Job Description Job Description Description: POSITION SUMMARY: Reporting to the VP of Compliance, the Compliance Auditor is responsible for ongoing analysis and review of coding accuracy, medical necessity documentation, and regulatory compliance in patient records. ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES: Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity, supporting documentation and other operational functions. Conducts ad hoc reviews and audits based on high risk, problem prone, or otherwise specified areas. Maintains tools, reports, data, metrics, benchmarking, tracking, and trending patient and compliance data. Participates in various committees to address risks and opportunities for improvement, to report on compliance data, and collaborate in process improvement initiatives. Provide reports to management on compliance metrics and audit findings as requested. Requirements: EDUCATION AND QUALIFICATIONS: RN or...

A global staff augmentation firm is seeking a candidate with expertise in medical record management to conduct validation reviews and coordinate rate adjustments. This role requires an associate degree in Nursing or Health Information Management and active RN licensure. With at least 3 years of experience, the candidate will manage coding issues and HIPAA compliance while preparing detailed reports. Offered in Columbia, South Carolina, this position provides a typical office environment for effective operations. #J-18808-Ljbffr

Duration: 6+ Months Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Responsibilities 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. Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates. Manages records retrieval, release, HIPAA compliance, and all aspects of document management. Serves as expert resource on methodology and procedures for...

Clinical Data Coder Our corporate activities are growing rapidly, and we are currently seeking a full-time, office-based Clinical Data Coder to join our Clinical Coding & Support team in Cincinnati, OH. This position will work on a team to accomplish tasks and projects that are instrumental to the company's success. If you want an exciting career where you use your previous coding, pharmacy, or nursing expertise and can develop and grow your career even further, then this is the opportunity for you! Responsibilities Perform accurate coding of medical terms and medications utilizing industry-wide standards as well as company standards; Coordinate the assignment of appropriate dictionaries for meeting study requirements Develop and maintain coding guidelines; Issue queries on adverse events, medications, and medical history terms to ensure high quality coding; Work collaboratively with the Medical, Data Management, Safety and Biostatistics teams to meet needs of...

Nursing Supervisor (RN) – Medical Surgical Urology/Genitourinary – Full Time Days Bring your passion to Texas Health so we are Better + Together Work location: Texas Health Dallas, 8200 Walnut Hill Lane, Dallas Texas, 75231 Work hours: Full Time – Days (7A-7P) Medical Surgical department highlights: • 24-Bed Urology Inpatient Medical-Surgical Unit • Self-scheduling with rotating weekend requirements • Working with a Multi-Disciplinary Team • Work with patients and provide life-saving care • The opportunity to work with a diverse patient population Qualifications: What you need: • Associate Degree in Nursing required; BSN preferred. • Current RN licensure or compact licensure recognized by the Texas Board of Nursing upon hire required • BCLS – prior to providing independent patient care and maintained quarterly required • ACLS - Advanced Cardiac Life Support 90 Days Req And • CPI – Crisis Prevention Intervention Training – within 90 days of hire • 2-year experience as a...

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 from patient...

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 Our client is seeking an experienced RN Inpatient Coder in Fort Worth, TX to join their Payment Integrity and Clinical Appeals team. In this role, you will perform DRG validation, inpatient audits, and clinical appeals for pre and postpay claims in accordance with CMS guidelines and payer policies. The ideal candidate is a Registered Nurse with strong acute inpatient clinical experience and a background in hospital bill audits, DRG review, and appeals/denials, looking for a nonbedside RN role.This is a remote position; however, candidates must be available to work Monday through Friday, 8:00 AM - 5:00 PM Central Time (CST). Requirements: Active RN license required (unencumbered) Active Coding Certification e.g. CIC, CPC, CCS, etc. 1+ year experience in one or more of the following: RN Inpatient Coding or DRG Validation Hospital Bill Audit or Inpatient Claim Audit Clinical Appeals or Denials Management Payment Integrity or Healthcare...

Job Description Job Description Description: Job Role The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines. Requirements: Responsibilities will include: Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines. Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting...

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...

A healthcare technology firm is seeking a Nurse Coder DRG Auditor to validate coding accuracy and medical necessity of inpatient claims. The role involves applying industry standards and guidelines to perform DRG validations while collaborating within a team. Successful candidates will have an active RN license, relevant coding certifications, and experience in clinical practice. A competitive salary of $85,000 to $90,000 is offered, along with a comprehensive benefits package. #J-18808-Ljbffr

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 -...

1 day ago Be among the first 25 applicants This range is provided by TalentPlug LLC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $55,100.00/yr - $99,000.00/yr Direct message the job poster from TalentPlug LLC The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Position Purpose: Responsible for developing and conducting training and quality auditing programs for the Diagnosis Related Group (DRG) and Medical Record Audit Programs for Fidelis Care. The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Responsibilities: Conducts auditing of work performed by staff and present...

Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, 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. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. This position serves as a key clinical and coding...