4089 specialist jobs found

South Shore Billing Services is seeking an experienced, detail-oriented Medical Billing and Coding Specialist to join our team. We provide professional billing support to primary care, OB-GYN, and behavioral health practices, helping providers maintain accurate, compliant, and efficient revenue-cycle operations. The ideal candidate is dependable, organized, and comfortable managing multiple priorities in a fast-paced medical billing environment. This individual should possess strong communication and problem-solving skills and be able to work both independently and collaboratively. Schedule Part-time: 20 hours per week Monday through Friday 8:30 a.m. to 12:30 p.m. Responsibilities Answer telephone calls and respond professionally to billing inquiries Review and resolve assigned work queues Perform charge review and verify coding accuracy Research and correct claim edits Submit clean claims promptly Post insurance and...

Billing Compliance Curriculum Development Specialist Dana-Farber Cancer Institute  Boston, MA  Full Time, Remote (Occasional Onsite)  Overview Reporting to the Manager of Billing Compliance, the Billing Compliance Curriculum Development Specialist is responsible for designing, implementing, and maintaining a comprehensive billing compliance education and awareness program that supports adherence to federal and state regulations and aligns with industry standards. This role develops and delivers training for billing providers, including physicians and advanced practice providers, and provides post-review education and feedback in collaboration with Billing Compliance Reviewers and Senior Billing Compliance Reviewers, as needed. The Specialist creates, updates, and manages instructional materials such as presentations, tip sheets, slide decks, and other training resources, and tracks training completion and effectiveness. The position also supports the...

Your Role The Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medicaid and Medicare Advantage lines of business. This role involves auditing, monitoring, and evaluating risk adjustment processes, identifying areas of non-compliance, and recommending corrective actions. The Principal collaborates with internal teams and external partners to maintain the integrity of risk adjustment data and supports the development and implementation of compliance programs. Responsibilities Your Work In this role, you will:  Conduct regular audits and reviews of risk adjustment data submissions to ensure compliance with regulatory requirements (e.g., CMS, OIG, HHS). Monitor changes in risk adjustment guidelines, policies, and regulations, and communicate updates to relevant stakeholders. Analyze risk adjustment...

About Us Undeniable Health puts AI billing agents to work inside the revenue cycle operations of healthcare providers and the billing companies that serve them. We handle the full claim lifecycle: charge entry, credentialing, prior authorization, claim submission, claim management, and denial recovery, including the denied claims traditional billing teams can't afford to chase. We work inside our clients' existing systems, under their credentials, as an embedded member of their team. No software to sell. No dashboards to manage. We get the money back. We're backed by investors who know the RCM space, and led by co-founders Alex Poon and Jason Griffith, repeat entrepreneurs with multiple successful exits. We service all specialties, with a current focus on diagnostic labs and behavioral health. The Role This is a production billing job, and we mean that as a compliment. You'll work inside client billing systems every day doing the work that keeps revenue moving: entering...

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado. We are seeking a motivated Coding Education Specialist with an emphasis in Surgery experience to join our Coding Services department.    This job can be performed 100% remotely and out of state candidates will be considered. The Coding Education Specialist will primarily be responsible for supporting and leading ongoing education to existing coding staff,...

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Risk Adjustment Coding Specialists are an important part of the Team at Virtix Health. The HCC Coding Team Member will review medical records to abstract ICD-10 codes, specifically those that map to HCCs, RxHCCs, and ESRD models. Coders will follow Medicare guidelines, ICD-10-CM guidelines as well as client specific requirements. Equipment provided along with Encoder software with access to AHA Coding Clinic ESSENTIAL DUTIES AND RESPONSIBILITIES:  Note: The essential duties and...

We are expanding our outpatient coding and clinical documentation capabilities and are looking for an experienced outpatient coding or CDI professional to support this work on a contract basis. - Location:   Remote - Type:   1099 Contractor About Ambience Healthcare Ambience Healthcare is a clinical documentation AI company building tools that improve the accuracy and efficiency of medical documentation. Role Overview We are seeking a meticulous outpatient coding or CDI specialist to review outpatient encounters, analyze clinical documentation, and determine accurate ICD-10-CM diagnosis codes.  Your work will directly inform how we evaluate and improve the accuracy of clinical coding at scale. This is not a traditional role embedded in a health system — you will be reviewing outpatient data and making determinations about ICD-10-CM codes, identifying gaps, and providing expert-level feedback. What we value most:   We are looking for someone with...

Candidates must be able to work on-site. This position is not remote. GENERAL PURPOSE OF JOB: The Claims and Appeals Specialist II is a certified medical coder that performs audits for correct coding and claims payments and oversees the claims appeal process for provider and member appeals. This position also investigates Coordination of Benefit (COB) claims. The Claims and Appeals Specialist II reports to the Director of Claims Oversight. ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate...

Position Overview We are seeking an experienced Billing Specialist to join our busy infertility practice. The ideal candidate is preferred to have billing experience in women's health care. This role requires strong knowledge of medical billing workflows, insurance follow-up, denial management, payment posting, claims resolution, and patient account management specific to women’s health. Key Responsibilities   Submit clean claims accurately and timely through our EMR system  Review and resolve claim rejections and denials across all insurance platforms  Follow up with insurance companies on unpaid claims  Post insurance and patient payments accurately in our EMR system  Work aging reports and outstanding AR  Review patient accounts for billing accuracy and follow-up needs  Handle billing corrections, resubmissions, and appeals  Communicate with registration/front desk, clinical staff, and management to resolve   billing issues  Maintain compliance with...

We are seeking a detail-oriented and experienced Medical Billing and Coding Specialist to join our growing team. This on-site position is ideal for a motivated professional who thrives in a fast-paced, collaborative environment while maintaining the ability to work independently. You will support multi-specialty clinics by ensuring accurate claim submission, resolving billing issues, and driving process improvements that contribute to organizational success. Key Responsibilities Review, code, and submit claims accurately and timely Manage assigned billing work queues and charge capture Investigate and resolve claim denials and rejections Analyze denial trends and recommend solutions Prepare and submit appeals with supporting documentation Utilize payer portals for claim corrections and resubmissions Collaborate with staff and providers to resolve billing issues Required Skills & Qualifications Advanced knowledge of ICD-10, CPT coding, and CMS...

Cardiology and Vascular Billing Specialist Location: Port Richey, FL Position Overview We are seeking a detail-oriented   Cardiology and Vascular Authorization and Billing Specialist   to join our team in Port Richey, FL. This role is responsible for ensuring timely insurance approvals (prior authorizations) for cardiac procedures and vein treatments, while managing accurate billing, coding (ICD-10, CPT), and reimbursement processes. The ideal candidate will prevent denials by verifying benefits, providing clinical documentation to payers, and coordinating with clinical staff for peer-to-peer reviews. Key Responsibilities Prior Authorization Acquisition:   Obtain authorization for appointments, tests, and complex vascular/cardiovascular procedures by reviewing clinical documentation and understanding payor guidelines. Clinical Collaboration:   Partner with physicians to gather medical necessity documentation for insurance reviews. Billing & Coding:...

Summary The Experienced Medical Billing Specialist provides best-in-class full RCM billing services for our private pediatric practice clients. Review claims for accuracy; oversee processing of claims to payers; resolve insurance company payments that are late, underpaid or denied; work closely with providers, practice managers and staff to implement best practice protocols. Responsibilities Learn and become proficient with the premiere pediatric system in the industry - Physician’s Computer Company (PCC) Billing. Efficiently analyze insurance claims throughout the submission process, insuring claims are accurately coded in a timely fashion, and for optimum reimbursement and compliance. Ensure that all claims reach the payers, and independently resolve any issues (underpayments, denials, etc.) with the claims so they are paid fully and on time. Post payments, organize processing of patient correspondence and statements. Answer phone inquiries from...

SCOPE/GENERAL PURPOSE OF JOB:   The Coding Specialist is responsible for abstracting all E/M, CPT, HCPCS, ICD-10-CM, modifier, and units from the medical record documentation.  Other responsibilities include accurately entering data into coding/billing software and/or Excel reports.  Performing accurate coding using applicable guidelines and facility protocols and communicating with staff and/or providers as needed.  Provide written feedback of coding results as needed in the form of comments, summary of findings, and recommendations.  Ensure compliance with federal and state laws, regulations and standards related to health information and coding principles.       ESSENTIAL DUTIES AND RESPONSIBILITIES:   Assign ICD-10 CM and CPT codes with modifiers for services provided in the facility environment (Ancillary, ED, Evaluation and Management, Observations, Outpatient surgeries, and/or Professional fee coding) depending on the specific...

Account Specialist II Locations: Fort Worth, TX Time type: Full time Job requisition id: JR-114239 Location: Calmont Operations Building Department: CBO/Patient Financial Services Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: Under the leadership of Patient Financial Services (PFS) management, the Account Specialist II is responsible for accounts receivable through claim follow up, cash collection, and denial management for services rendered by Cook Children's Medical Center (CCMC). This position requires extensive knowledge of Federal, State, and payor regulations, reimbursement methodologies, and communication with third party payers to facilitate timely and accurate reimbursement. Perform root cause analysis and resolution of denial and variance records. Triage and resolve payor denials. Review and adjudicate insurance credit balances. Qualifications: High School Diploma or...