166 jobs found in Massachusetts

Medical Records Technician Reviews medical records for completeness, including required identifiers, signatures, dates, and reports associated with services rendered. Evaluates documentation for accuracy, consistency, medical necessity, and appropriate modifier usage; verifies that final diagnoses accurately reflect care provided. Reviews provider documentation to ensure appropriate Evaluation and Management (E/M) levels and correct CPT code assignment. Assigns and sequences ICD, CPT, HCPCS, CDT, and DSM codes based on documented diagnoses and procedures. Ensures diagnostic and procedural terminology aligns with current medical nomenclature and official coding guidelines.

Medical Coder Purpose of Position: To assign and group diagnoses, procedure and level codes based on medical record documentation in accordance with coding compliance, regulatory and reimbursement requirements. To ensure appropriate coding for case mix classification and expected reimbursement based on assigned diagnosis, procedure and level codes and reimbursement classifications as supported by medical record documentation. To enter diagnoses, procedure and level codes and patient demographic information into computer system. Analyzes, sequences and validates assigned codes based on medical record documentation using the automated encoder, book and coding compliance resources. Demonstrates complete understanding of coding rules, anatomy, physiology and medical terminology to appropriately code patient information. Reviews all medical record documentation to determine and assign diagnoses, procedures, level codes and modifiers. Ensures that coding compliance, regulatory and...

DEFINITION / PRIMARY FUNCTION The Senior Coder / Abstractor (remote) codes inpatient records and / or outpatient records using commonly accepted classificationsystems and abstracts the information into the coding software or EMR abstracting.POSITION QUALIFICATIONS (Minimum qualifications are required unless stated otherwise.) Experience :Two years of experience in coding with ICD-10-CM, ICD-10-PCS required.Experience in outpatient coding, or willingness to learn outpatient coding including CPT-4 and HCPCS required.Experience using coding software and EMR required.Previous coding in a teaching facility preferred.Education and Training :High School Graduate, advance education in medical terminology, anatomy and physiology, and pathophysiology are all required.Completion of a medical coding program required.License, Certification & Registration :CCS / CPC-H / RHIT / RHIA - Certified Professional Coder-Hospital Other Requirements :Ability to code all inpatient record types i.e.med...

Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Interprets a wide variety of clinical and diagnostic documentation in order to process hospital and / or pro-fee charges for episodes of outpatient care. Assigns appropriate ICD-CM (current edition) and CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as appropriate adhering to official coding guidelines. Major Responsibilities: Upon review of the medical record, performs analysis on documentation,...

Sturdy Memorial Hospital in Attleboro, MA is seeking a Medical Billing Specialist to support physicians and staff with billing questions, ensure timely completion of billing functions, and help develop billing goals. The role reports to the Revenue Cycle Manager and Lead Biller, with responsibilities including entering, reviewing and modifying daily charges and queue work. Requirements include 1–2 years of medical billing experience, excellent written and verbal communication, and proficiency #J-18808-Ljbffr

Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role involves assigning ICD-10-CM, ICD-10-PCS, and DRG codes and ensuring accurate payments. Remote position with occasional travel to Humana offices, 40 hours per week, pay range $71,100-$97,800 with bonus eligibility. Requires 4+ years in MS-DRG coding auditing and RHIA/RHIT/CCS certification. #J-18808-Ljbffr

Southern New Hampshire Health is seeking a Certified Medical Coding Specialist for the Emergency Department, working remotely in New Hampshire. The role focuses on accurate ICD-10-CM, CPT, and HCPCS coding for professional and facility services, with collaboration across ED providers, CDI, and revenue cycle teams. The ideal candidate has ED coding experience in an acute care hospital, CCS or COC certification, and proficiency with Epic and encoder software. #J-18808-Ljbffr

This is what you will do: The Associate Director Strategic Planning & Execution, US Medical Affairsis responsible forthe execution of strategic initiatives within the US Medical Affairs organization and will partner with TA Leadership teams and cross functionally to execute on projects in line with the functions overall strategic goals. This position will analyze, resolve, andcommunicate onkey strategic programsallowing forUS Medical Affairs Leadership to make informed decisions that will contribute to the overall success of the function. This position will apply good project management techniques toinsure inscope,on-time, on budget results. You willbe responsible for: Strategic Partnership: Develop annual enterprise strategy for assigned TA and/or Function and ensure effective, efficient, andequitabledelivery of key strategic programs and operational activities Oversight of business progress against performance targets through outcomes and metrics tracking/reporting...

Job Description Job Description Title: Certified Risk Coder Reports to: Manager, Risk Coding Classification: Individual Contributor Location: Boston (Remote) Job description revision number and date: 2.0, 01.06.2025 Organization Summary: Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. Job Summary: The Certified Risk Coder will be a part of an emerging...

Cognizant is seeking an ER Medical Coder – E/M, Injections & Infusions, to review clinical documentation and assign ICD-10-CM codes for outpatient settings including ED, surgery, and diagnostic encounters. The role requires strong knowledge of coding standards and regulatory guidelines, with a focus on accuracy and remote collaboration. The position offers flexible remote hours, a wage of $33–$35 per hour, and eligibility for Cognizant's incentive program. #J-18808-Ljbffr

Associate Director / Director, Medical Information Cambridge, Massachusetts, United States Cognito Therapeutics Associate Director / Director, Medical Information Reports to: Head of Medical Affairs About the Role Cognito Therapeutics is seeking a driven, scientifically rigorous Associate Director/Director of Medical Information to build and lead the Medical Information (MI) function from the ground up. This is a hands-on role suited to a motivated individual contributor who wants to establish strong operational foundations and deliver high-quality scientific content in the Alzheimer's and neurocognitive disease space. The role will design and implement core MI capabilities — inquiry management systems, standard response documents, and medical review workflows — positioning Cognito for its first commercial launch and for scaling as the pipeline grows. The role will also contribute to Cognito's Medical Affairs AI initiatives, bringing scientific and operational judgment to the...

Job Description Summary Under experienced leadership the Professional Surgical Coder I is an advanced coding position that is responsible for accurate and timely assignment of codes to diagnoses and procedures for all outpatient and inpatient diagnostic and procedural coding. Using established department policies and procedures in conjunction with the current versions of ICD-10 and CPT-4, the Professional Surgical Coder I will determine the proper diagnosis, assign co‑morbidities and complications, secondary diagnoses and any HAC (Hospital Acquired Conditions) documented. As well as both E/M codes and procedure codes. The Professional Surgical Coder I is expected at South Shore Physician Ambulatory Enterprise to query providers when documentation requires clarification and he/she proactively works with medical leadership to address concerning documentation trends. The Professional Coder I works with direct support from and under the direction of the Billing and Coding Manager to...

Physician Specialty Coder | Boston Childrens Hospital At Boston Children's Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us and discover how your unique contribution can change lives. Yours included. Position Summary: The Physician Specialty Coder works independently to manage complex coding review, validation, and charge submission processes for assigned specialty departments. Specifically Surgical Coding. This role ensures accurate and compliant ICD-10, CPT, and/or ASA coding while partnering closely with physicians, billing teams, and operational staff to resolve coding and reimbursement issues. The position also serves as a resource for...

Join Our Team at Optum Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Codes a variety of medical records using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other...

Associate Director, Medical Affairs Location: Cambridge, MA (100% Remote) Duration: 6 Months+ Possible Extension Pay Range: $100-$120/hr Manager Notes: Hybrid preferred. But remote candidates can also be considered. If Hybrid, expected to visit the office at least twice a week. No specific days, depends upon the requirement. High likelihood of further extensions beyond the given end date. Summary & Purpose of the Position Reporting to the Senior Director, Medical Affairs (Adult Cholestatic Diseases), the Associate Director, Medical Affairs, will support and oversee select medical affairs activities related to biliary atresia. This role will contribute to the U.S. medical strategy for elafibranor and the broader Medical Affairs plan for cholestatic diseases. Responsibilities include medical review of non-promotional and promotional content, information responses (in collaboration with Medical Information), scientific communications including poster presentations and...

Job Description Job Description Key Responsibilities Authorization Management Obtain and verify prior authorizations for services, treatments, and procedures. Review patient insurance eligibility and benefits to ensure coverage requirements are met. Submit authorization requests accurately and timely through payer portals, fax, or phone. Track authorization status and follow up with insurance companies as needed. Maintain accurate documentation of authorization approvals, denials, and expiration dates. Communicate authorization updates to clinical and scheduling teams. Denial Management Review denied or rejected claims to identify root causes and trends. Research payer policies and determine appropriate corrective actions. Prepare and submit appeals with supporting documentation within payer deadlines. Work collaboratively with billing, coding, and clinical departments to resolve claim issues. Monitor denial reports and maintain denial logs for...

Job Description Job Description POSITION SUMMARY: The entry level Medical Coder is responsible for documentation improvement and integrity and serves as a liaison between clinical care providers, finance, and billers. This role is also an information and educational resource, providing proactive and retrospective review of health center visits as they relate to ICD-10-CM diagnosis coding and reimbursement. The entry level Medical Coder will audit medical records to ensure completeness, accuracy and compliance with Medicaid coding and supporting documentation guidelines. KEY RESPONSIBILITES: Evaluates medical record documentation for completion to ensure accuracy and compliance to meet Medicaid and ICD-10-CM standards. Compares past and present medical history of each participant to maintain complete and accurate ICD-10 codes for appropriate reimbursement. Reviews medical records prospectively to ensure that the care of the patient is recorded in language that payers...

Job Description Job Description Key Responsibilities Authorization Management Obtain and verify prior authorizations for services, treatments, and procedures. Review patient insurance eligibility and benefits to ensure coverage requirements are met. Submit authorization requests accurately and timely through payer portals, fax, or phone. Track authorization status and follow up with insurance companies as needed. Maintain accurate documentation of authorization approvals, denials, and expiration dates. Communicate authorization updates to clinical and scheduling teams. Denial Management Review denied or rejected claims to identify root causes and trends. Research payer policies and determine appropriate corrective actions. Prepare and submit appeals with supporting documentation within payer deadlines. Work collaboratively with billing, coding, and clinical departments to resolve claim issues. Monitor denial reports and maintain denial logs for...

Coding & Compliance Auditor The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. This is a hybrid position: 2 days onsite; 3 days remote option. Compensation Pay Range: $73,000.00 - $104,400.00 Job Responsibilities Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC's, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation...

Join The Indian Health Service Make a meaningful impact in Native communities. In this role, you will support vital healthcare operations that ensure patients receive timely, high-quality care. If you're looking for a rewarding career where your work directly supports patient services and community well-being, we encourage you to apply. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021).