48 rn crc coding auditor jobs found

RN CRC Coding Auditor - REMOTE - $10K Sign On Bonus The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims are coded and billed in accordance with nationally recognized coding guidelines, standards, regulations, and regulatory requirements, as well as payor and billing guidelines. Responses may include system documentation of findings and/or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidence-based criteria application outcomes, physician documentation, and physician advisor input, and will complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and...

JOB SUMMARY The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends...

JOB SUMMARY The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will elevate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and...

CRC Auditor The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and/or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and...

Overview DRG Coding Auditor - CDI Remote - $10K Sign On Bonus at Conifer Health Solutions. Job Summary The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims are coded and billed in accordance with nationally recognized coding guidelines, standards, regulations, and regulatory requirements, as well as payor and billing guidelines. The responses may include system documentation of findings and/or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership, and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidence-based criteria, physician documentation, physician advisor input, and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates...

CRC Auditor The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and/or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and...

CRC Auditor The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and/or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and...

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 a 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...

Overview RN Clinical Coder/Auditor - Hybrid job at University of Vermont Health - Home Health & Hospice. Colchester, VT. Initial onboarding will take place at our offices in Colchester, VT. The position will then be a hybrid work arrangement with 1-2 days per week in our offices located in Colchester, VT. In-person meetings are also required at least quarterly. The Clinical RN Auditor is responsible for ensuring clinical documentation meets regulatory standards and procedures. This role involves reviewing potential quality of care issues, understanding workflows, and establishing patient care plans to support technical and clinical requirements. The auditor works to improve clinical outcomes by monitoring documentation accuracy and consistency, reducing risk, evaluating data, and collaborating with the manager of clinical outcomes to provide expertise in coding classifications. Qualifications Education and Licensure Current unencumbered Vermont RN Licensure Homecare Coding...

Overview RN Clinical Coder/Auditor - Hybrid job at University of Vermont Health - Home Health & Hospice. Colchester, VT. Initial onboarding will take place at our offices in Colchester, VT. The position will then be a hybrid work arrangement with 1-2 days per week in our offices located in Colchester, VT. In-person meetings are also required at least quarterly. The Clinical RN Auditor is responsible for ensuring clinical documentation meets regulatory standards and procedures. This role involves reviewing potential quality of care issues, understanding workflows, and establishing patient care plans to support technical and clinical requirements. The auditor works to improve clinical outcomes by monitoring documentation accuracy and consistency, reducing risk, evaluating data, and collaborating with the manager of clinical outcomes to provide expertise in coding classifications. Qualifications Education and Licensure Current unencumbered Vermont RN Licensure...

Job Description Summary Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type Regular Cost Center CC002278 SYS - Compliance Program Pay Rate Type Salary Pay Grade Health-27 Scheduled Weekly Hours 40 Work Shift Job Description The Compliance Auditor reports to the Internal Audit Coordinator and performs audits to evaluate adherence to laws, regulations and policies by reviewing records, analyzing data, and interviewing staff and stakeholders. These audits include but are not limited to services identified as high-risk via the annual risk assessment, OIG-CMS-PGBA workplan areas, ad hoc audit requests, and “for cause” coding and billing concerns. The audit scope includes a) the regulatory and industry research needed for audit planning, b) pre and post audit meetings with stakeholders, c) cohesive audit report that communicates results and includes a corrective action plan if warranted, and d) education...

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 Clinical Coding Auditor & Trainer Job duration Fulltime / Permanent Job Location Remote Candidates must be residents of New York Summary 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 findings and recommendation for areas of improvement to management Under minimal supervision responsible for all aspects of auditing...

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 a 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...

Join to apply for the Medical Billing Specialist role at Hospital to Home LLC 6 months ago Be among the first 25 applicants Join to apply for the Medical Billing Specialist role at Hospital to Home LLC Brief Description Brief Description Position Title: Medical Billing Specialist Title of Immediate Supervisor: Accounting Manager Risk of Exposure to Bloodborne Pathogens: Limited Job Summary The Medical Billing Specialist is responsible for facilitating all aspects of the billing and follow up process. Duties/Responsibilities Timely and accurate coding and submission of claims and invoices. Working of claim denials and follow up. Gathering appropriate information for billing purposes. Managing, tracking, and processing payments on behalf of customers. Maintaining detailed and organized financial records for accurate reporting. Collaborating with customers, third party institutions, and other team members to resolve billing inconsistencies and errors. Performing other...

Physician Billing Coder II | Patient Billing Coordinators | Days | Full-Time Join to apply for the Physician Billing Coder II | Patient Billing Coordinators | Days | Full-Time role at UF Health Overview Summary: Review, analyze, and assign the final diagnoses and procedures based on the practicing provider’s documentation, following all compliance policies and guidelines. Accurately code office and hospital procedures to ensure proper reimbursement. Provide physician education to ensure correct completion of Electronic Health Records and proper assignment of ICD-10, CDM, HCPCS, and CPT codes, through verbal, physical, and written communication. Responsibilities Review clinical documentation and code to the highest level of specificity for accurate charge capture. Interact with providers to provide feedback and education using physical, verbal, and written communication skills. Assign and sequence appropriate codes and modifiers using current procedure, diagnosis, and HCPCS...

RN Certified Medical Coder (RHIA / RHIT / CCS / CIC) HealthCare Support is actively seeking multiple RN Certified Medical Coders for one of our prestigious healthcare clients. Daily Responsibilities for RN Certified Medical Coder : Analyze moderately complex health care information; reviews medical records; integrate medical coding and reimbursement rules; provide pricing guidance. Ensure medical coding rules and regulations including compliance requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues. Provide regular reports on project status and progress; report project results to identify coding improvement opportunities. Production KPI : 12-15 daily Work hours : Scheduled Weekly hours : 40 HoursM-F 8-5 Length : Full time right to hire Required Qualifications for RN Certified Medical Coder : Active and Valid RN license in the state they live in Graduated from accredited nursing school Active RHIA, RHIT, CCS or CIC -...

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 a 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...

Join UPMC Corporate Compliance as an Intermediate Compliance Auditor! Are you passionate about ensuring accuracy and compliance in healthcare documentation and billing? Do you thrive in a dynamic environment where your expertise can make a significant impact? UPMC Corporate Compliance is seeking a dedicated and detail-oriented Intermediate Compliance Auditor to join our team! This position will be based out of Forbes Tower in Pittsburgh, PA . This is an onsite position with the potential to work from home. Key Responsibilities: · Comprehensive Auditing: Conduct UPMC-wide audits to ensure medical record documentation supports the services coded and billed in accordance with state and federal regulations. · Code Validation: Validate ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting. · Regulatory Compliance: Conduct audits on various compliance topics to evaluate adherence 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 a 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...

Role: Clinical Coding Auditor & Trainer Location: Remote, NY, US (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.) Permanent/Full Time Salary: USD $55,100 - $99,000 / yr Must-haves Willingness to travel to New York twice a year RN, PA, MD, APRN, DO, or MBBS license Valid/Current CPC or CIC Certification, through APPC desired or CCS through AHIMA Inpatient coding experience 1 year of experience in clinical environment - hospital Required Skills RN, PA, MD, APRN, DO, or MBBS license Associate's degree in Nursing or equivalent experience 4+ years of DRG and/or Medical Record Audit experience 1 year of clinical experience in a hospital setting Strong written communication skills Preferred or Nice-to-have Skills Inpatient coding experience Valid/Current CPC or CIC Certification, or...

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 a 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...