UNKNOWN

FEED

OTHER

Required Performance Knowledge, Skills, and Abilities: Good knowledge of NYS Medicaid Behavioral health billing requirements and procedures; good knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and ICD-10 coding; good knowledge of managed care authorization and claims processes; good knowledge of electronic health record (EHR) and billing systems; good knowledge of revenue cycle management best practices; ability to manage, analyze and reconcile billing and payment detail accurately; ability to understand and carry out moderately complex oral and written directions; ability to develop and maintain effective working relationships; ability to work independently and collaboratively; ability to interpret insurance documents, including insurance cards, policies, payment remittances, denials, explanation of benefits, etc. ability to organize and maintain accurate records and files; ability to analyze and organize data and prepare record reports and spreadsheets; ability to operate a computer and utilize common software programs including word processing, spreadsheets and databases; ability to maintain the confidentiality and integrity of all medical records; ability to communicate effectively orally and in writing; ability to pay close attention to detail; ability to exhibit clerical aptitude, accuracy, tact, courtesy, and good judgment.

Otsego County

Behavioral Health Billing and Claims Management

Betterteam

Apply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules; resource-based relative value methodologies; diagnosis-related groups; ambulatory payment classifications; per-diem, case-rate, percent-of-charge, and other medical reimbursement arrangements.

YEAR

Capital Rx, Inc.

Lead, Medical Network Claims Pricer

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Capital Rx LLC

Lead, Medical Network Pricer

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Lead coding and documentation integrity strategies, including pre- and post-bill review, provider queries, addendums, signatures/co-signatures, identification of inappropriate documentation practices or cloning, and proactive provider education to address documentation gaps and support accurate coding. This leader will serve as a subject matter expert in professional billing and coding and will partner closely with clinical, operations, finance, compliance, credentialing, product, to identify revenue cycle risks and opportunities and translate them into actionable operational strategies.

Oscar Health

Senior Manager, Revenue Cycle Management, Provider Operations

GreenHouseAPI

Develop and deliver educational programs and training sessions on medical coding, billing, and documentation review- Create engaging and interactive learning materials, including presentations, handouts, and online resources- Conduct assessments and evaluations to measure the effectiveness of training programs- Provide guidance and support to healthcare professionals on coding guidelines, regulations, and best practices- Stay up-to-date with industry changes and advancements in medical coding and billing practices- Collaborate with other educators and subject matter experts to continuously improve training materials and curriculum. Experience: Minimum of 3 years of experience in medical coding or billing- Strong knowledge of anatomy, health information management, medical terminology, HCPCS coding, and medical office operations- Previous experience in teaching or training healthcare professionals is highly preferred- Excellent communication skills with the ability to effectively convey complex information to diverse audiences- Proficient in using technology for delivering virtual training sessions.

Essen Healthcare

Physician Coding Educator

FULL_TIME

Handle billing through NYSED/NYCPSE mechanisms , often tied to Preschool Programs in Approved Settings (PPS or CPSE programs). South Shore Speech is looking for a competent, responsible and dedicated individual to join our busy/fast paced, award winning team.

SOUTH SHORE SPEECH LANGUAGE

Medical Biller

Our practice features state-of-the-art care for speech, language, swallowing, and voice disorders, and offers a variety of highly specialized techniques and procedures that utilize the latest in technology. Handle billing through NYSED/NYCPSE mechanisms , often tied to Preschool Programs in Approved Settings (PPS or CPSE programs).

South Shore Speech Language

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Collaborate directly with our Data Science and Engineering teams to validate AI-flagged claims in the prepayment queue, providing expert coding feedback to continuously train and refine our machine learning models. Leverage internal AI tools and predictive models to proactively identify anomalous billing patterns, emerging trends, and new opportunities for targeted prepayment audits.

Clover Health Investments Corp

Medical Claims Auditor

This role leads onboarding for new physicians, provides targeted education following audit results, and ensures providers and coders fully understand identified issues and required corrective actions. Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), Certified Healthcare Compliance (CHC), or AHIMA certifications (RHIT/RHIA).

Our Billing Co LLC

Quality Educator

HiringThing

Qualifying health facilities and programs include hospitals, nursing homes, adult homes, ambulatory care facilities, managed care organizations, psychiatric centers, diagnostic and treatment clinics, home health agencies, assisted living facilities, hospice, renal dialysis units, alcoholism and substance abuse treatment facilities, developmental centers, and community-based programs for the mentally ill and developmentally disabled. Minimum Qualifications PREFERRED QUALIFICATIONS: The ideal candidate will have a strong clinical background with knowledge of ICD-10-CM, CPT, and HCPCS Level II codes, and/or possess a Certified Professional Coder (CPC) credential, have experience with interpreting and analyzing data sets, and be comfortable utilizing Microsoft Office Suite products.

New York State Thruway Authority

Health Care Surveyor 3 (Nursing)

Qualifications:- Strong working knowledge of CMS‑HCC risk adjustment model (required for accurate coding and compliance)- Solid understanding of ICD‑10‑CM coding guidelines- Ability to accurately identify and code chronic conditions requiring annual recapture- Experience reviewing face‑to‑face encounters and validating provider documentation- Skilled in retrospective and/or prospective chart reviews- Experience with provider education or documentation improvement initiatives Knowledge, Skills, & Abilities:- Deep understanding of chronic disease processes (e.g., CHF, CKD, COPD, diabetes with complications)- Familiarity with hierarchical logic and exclusion rules in HCC coding- Strong analytical, organizational, and problem‑solving skills, especially in Excel- Ability to research and resolve coding discrepancies independently- Effective written and verbal communication with clinical and non‑clinical staff- Team-based orientation with ability to manage and report out KPIs- Cultural sensitivity and ability to work with diverse team members, both US-based and offshore, and with medical providers- Consistent ability to meet productivity and quality benchmarks Education:- High School Diploma or equivalent (required)- International Medical Graduate (preferred)- Certified Risk Adjustment Coder (CRC)- Certified Professional Coder (CPC) or CCS / RHIT / RHIA (AAPC or AHIMA). They will become experts in HCC-based risk adjustment (prior experience preferred, but not necessary), they will conduct medical chart reviews to identify suspect conditions, and they will design and manage workflows to ensure that providers are made aware of suspect conditions, so that they can evaluate the patient thoroughly and correctly document the patient's risk factors.

HOUR

ACO Risk Coding Specialist (Hybrid)

Oscar Health Inc

The investigator analyzes claims, encounter, enrollment, medical record, and provider data; conducts interviews, field investigations, and on-site audits, when necessary; prepares detailed investigative reports; and collaborates with compliance, legal, operational stakeholders, regulatory agencies, and law enforcement. Responsibilities: The SIU Fraud Investigator is responsible for identifying, investigating, and resolving allegations and indicators of fraud, waste, and abuse (FWA) involving providers, vendors, members, and other parties participating in Elderplan's product lines.

Metropolitan Jewish Health System

Fraud Investigator

Responsibilities: Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts. Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Oscar Health Insurance

Risk Adjustment Auditor

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SUNY Upstate Medical University

Staff Assistant 2 - Radiology

REQUIRED EDUCATION AND EXPERIENCE: Associate's degree in Business, Healthcare, or a related field; and at least five (5) years of healthcare experience, including at least two years in an active role involving coding, auditing, finance, revenue cycle management, and/or physician billing (preferably within an Academic Medical Center setting); or equivalent combination of education and experience. ESSENTIAL RESPONSIBILITIES / DUTIES: Revenue Cycle Initiative Leadership: Leads complex revenue cycle initiatives and large-scale optimization projects across high-revenue-generating or at-risk clinical departments to improve overall revenue integrity, operational efficiency, and regulatory compliance.

Boston Medical Center

Senior Coding/Revenue Integrity Analyst

Senior Coding and Revenue Integrity Analyst

Works with revenue producing departments to ensure the ongoing coordinated consistency of the chargemaster and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes. 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 any identified risks to Legal Services and Corporate Compliance Departments.

Albany Medical Center

Charge Master Analyst

Heartflow is the first AI-driven non-invasive integrated heart care solution across the CCTA pathway that helps clinicians identify stenoses in the coronary arteries (RoadMapAnalysis), assess coronary blood flow (FFRCT Analysis), and characterize and quantify coronary atherosclerosis (Plaque Analysis). The flagship product-an AI-driven, non-invasive cardiac test supported by the ACC/AHA Chest Pain Guidelines called the Heartflow FFRCT Analysis-provides a color-coded, 3D model of a patient's coronary arteries indicating the impact blockages have on blood flow to the heart.

Heartflow Inc

Field Reimbursement Manager - Northeast

Preferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

Certified Professional Coder Jobs in New York

Behavioral Health Billing and Claims Management Otsego County

Lead, Medical Network Claims Pricer Capital Rx, Inc.

Lead, Medical Network Pricer Capital Rx LLC

Senior Manager, Revenue Cycle Management, Provider Operations Oscar Health

Physician Coding Educator Essen Healthcare

Medical Biller SOUTH SHORE SPEECH LANGUAGE

Medical Biller South Shore Speech Language

Medical Claims Auditor Clover Health Investments Corp

Quality Educator Our Billing Co LLC

Health Care Surveyor 3 (Nursing) New York State Thruway Authority

ACO Risk Coding Specialist (Hybrid) Essen Healthcare

Senior Manager, Revenue Cycle Management, Provider Operations Oscar Health Inc

Fraud Investigator Metropolitan Jewish Health System

Risk Adjustment Auditor Oscar Health Insurance

Staff Assistant 2 - Radiology SUNY Upstate Medical University

Senior Coding/Revenue Integrity Analyst Boston Medical Center

Senior Coding and Revenue Integrity Analyst Boston Medical Center

Charge Master Analyst Albany Medical Center

Field Reimbursement Manager - Northeast Heartflow Inc

DRG Clinical Validation Lead Elevance Health

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