11 rn field coder jobs found

RN Field Coder The RN Field Coder will be responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. The RN Field Coder will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work supported by the RN Field coder will include pre, post and wraparound visit input. Pre-Visit: Reviewing the medical records, outside results and health plan data for upcoming patient appointments and flagging important insights for the provider to review before seeing the patient. Post Visit: review the provider note, populate all supported codes (ICD-10, CPT, CPT-II, etc.), and assist submission of encounter for claim processing. Wrap Around Education- periodic review of findings, highlighting areas of opportunity in documentation and ongoing education. The Field Coder will be responsible for...

RN Field Coder Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The RN Field Coder will be responsible for documentation and coding review of medical records where...

RN Field Coder Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The RN Field Coder will be responsible for documentation and coding review of medical records where...

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. 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....

Key Responsibilities Conduct detailed audits of patient medical records to ensure clinical documentation supports quality care, medical necessity, and accurate billing practices. Identify documentation, coding, billing, and compliance discrepancies and develop corrective action recommendations. Prepare comprehensive audit reports and communicate findings to leadership and operational teams. Monitor compliance risks related to Medicare, Medicaid, and other federal healthcare programs. Provide consultative guidance regarding healthcare compliance regulations and best practices. Assist with responses to government audits, investigations, and regulatory inquiries. Review potential refund and repayment obligations related to federal healthcare programs. Support policy and procedure development based on regulatory updates and audit findings. Monitor changes in healthcare laws, regulations, and compliance requirements. Collaborate with clinical, revenue cycle, finance, legal,...

Hybrid | Des Moines, IA (Onsite Tues–Thurs, Remote Mon/Fri) $40/hour | 6-Month Contract with Potential for Conversion We are seeking a Certified Risk Adjustment Coder (CRC) to support Medicare Risk Adjustment initiatives through detailed HCC medical record reviews and direct provider engagement. This role is ideal for someone confident, collaborative, and comfortable working onsite with provider teams to drive documentation accuracy and performance improvement. This position requires onsite presence Tuesday–Thursday in Des Moines, IA with 10% local travel , and remote flexibility on Mondays and Fridays. Position Overview This role performs concurrent medical record reviews to ensure accurate capture of HCC conditions and appropriate documentation reflecting patient severity of illness. The coder will collaborate closely with physicians, clinical leadership, and provider engagement teams to improve documentation practices and support compliance with CMS guidelines. Key...

Working remotely full-time, a Certified Medical Auditor (NC) will perform validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events, while coordinating rate adjustments and providing reports on trends in medical records management. Key responsibilities Conducts validation reviews and coordinates rate adjustments with claims areas, creating reports on outcomes and trends Manages records retrieval, release, and HIPAA compliance, overseeing all aspects of document management Acts as an expert resource for medical records and coding issues, providing guidance on methodology and procedures Required qualifications Associate's degree in a job-related field or equivalent experience (2 years of job-related work experience) 3 years of experience in medical record management, including coding and validation review Registered health information administrator (RHIA), Registered health information technician (RHIT), Certified Professional Coder...

Working remotely full-time, a Certified Medical Auditor (NC) will perform validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events, while coordinating rate adjustments and providing reports on trends in medical records management. Key responsibilities Conducts validation reviews and coordinates rate adjustments with claims areas, creating reports on outcomes and trends Manages records retrieval, release, and HIPAA compliance, overseeing all aspects of document management Acts as an expert resource for medical records and coding issues, providing guidance on methodology and procedures Required qualifications Associate's degree in a job-related field or equivalent experience (2 years of job-related work experience) 3 years of experience in medical record management, including coding and validation review Registered health information administrator (RHIA), Registered health information technician (RHIT), Certified Professional...

Nurse Supervisor, SNF Jackson Memorial Perdue Medical Center is a long-term-care facility located on a beautiful 11-acre campus in South Dade. The medical center is a licensed, 163-bed skilled nursing and rehabilitation facility. We provide care for a diverse cultural population of younger and older adults. Nurse Supervisor, SNF oversees a team of staff in the absence of the Nurse Manager or department Director and acts independently to provide crisis management, interpret policy, make timely decisions that directly impact patient care, ensures effective communication and collaboration among departments. Key responsibilities are administrative in nature and include assigning coverage and on-call schedules, patient assignments to nurses on the team, overseeing the key operational functions of the center including the development of standard operating procedures, data collection/management, staff education and orientation. This role will promote professional habits through work...

Department/Unit: AMHS Revenue Integrity Work Shift: Day (United States of America) Salary Range: $70,068.00 - $108,605.00 Under the direction of the Revenue Integrity Audits Manager, this position is responsible for providing audit and research support to physicians, advanced practice professionals, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. This position reads, interprets, and distributes coding and billing guidelines to all departments to ensure regulatory compliance. Essential Duties And Responsibilities Exemplifies the AMHS Values and Code of Conduct, while striving to identify compliance risk through effective and timely review of RAC Audit requests, ensuring timely appeals, as appropriate, and reporting...

Nursing Supervisor - Medical Respite PHMC serves as both a direct service provider to individuals, families, and communities across the region and as an intermediary agent managing large-scale contracts, government and philanthropic partnerships, and multidisciplinary initiatives that require operational sophistication, strategic leadership, and deep mission alignment. The Nursing Supervisor Medical Respite will supervise nursing staff supporting clinical services in post-acute medical care to individuals released from a hospital stay following an illness, surgery, or an injury, and are too ill or frail to recover in a shelter-based setting. Participants are provided with respite-based services, including medication management, discharge planning, appointment transportation and scheduling, case coordination, and connecting clients to primary care. This individual will work closely with the Medical Director, Respite Program Administrator, and other respite staff to support...