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The Senior Coding Quality Analyst (CPC) – Special Investigations Unit will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. • Conduct comprehensive quality reviews of completed medical coding reviews to ensure coding logic aligns with medical record documentation, CPT/HCPCS/ICD 10 guidelines, and payer, state, and federal requirements.

<p>CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all. </p>

CVS Health

Senior Coding Quality Analyst (CPC) – Special Investigations Unit (Aetna SIU)

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Strategic focus: based on regulatory and industry updates, MHS strategic initiatives, end-user feedback, and other information, identifies and achieves opportunities to improve charge capture efficiency and accuracy, eliminate missed charges, eliminate billing rework, and improve MHS net revenue. The Revenue Integrity Manager provides operational leadership for Revenue Integrity functions, overseeing staff and workflows to ensure accurate, compliant, and timely charge capture, billing readiness, reimbursement optimization, and revenue protection across the health system.

Memorial Healthcare System

Manager Revenue Integrity - FT - Days - MHS - Remote Eligible

This position ensures compliance with federal, state, and local laws and regulations governing physician practices, specialty oncology services, infusion centers, pharmacy operations, laboratory services, and clinical research (if applicable). We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

The Los Angeles Cancer Network

Director of Compliance

FULL_TIME

YEAR

This individual will analyze itemized hospital bills and claims data to identify billing errors, coding discrepancies, DRG misassignments, and other overpayment opportunities, then work directly with claims administrators on behalf of our ASO clients to secure claim adjustments, recoveries, and repricing. We are seeking an experienced Senior Claims Analyst with deep expertise in hospital claims adjudication, stop loss reporting, high-cost/catastrophic claims, and DRG (Diagnosis-Related Group) reimbursement methodology.

SmartLight Analytics

Payment Integrity Nurse Reviewer- Hospital Claims

partner JazzHR

Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products through Sentara Health Plans lines of business. Familiarity with healthcare claims, provider billing patterns, fraud, waste and abuse (FWA) concepts, and the use of data analysis to identify claims or providers requiring further review is preferred.

Sentara Hospitals

Fraud and Abuse Investigator / CPC

Federal, state and county laws and regulations governing coding; modern theories, principles and practices of effective supervision; coding principles and guidelines including, but not limited to ICD-10-CM/PCS, CPT/E&M, and HCPCS; coding documentation and billing regulations related to Medicare, Medicaid, and commercial insurance; revenue cycle workflows including, but not limited to charges/charge master, code edits, auditing, denials management, and documentation improvement; budget principles and practices; principles of information management including principles of confidentiality and other patient rights; data collection and analysis techniques; personal computers and associate software applications; department and hospital safety practice and procedures; patient rights; age specific patient care practices; infection control policies and practices; handling, storage, use and disposal of hazardous materials; department and hospital emergency response policies and procedures. Certified Professional Coder (CPC); or, multiple specialty-specific coding certifications from the American Academy of Professional Coders (AAPC); or, Certified Coding Specialist, Physician-based (CCS-P); or, Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT); or, Registered Health Information Administrator (RHIA) issued from the American Health Information Management Association (AHIMA).

Global Force USA

Coding Services Manager

Code, abstract and conduct charge quality review on all episodes of care on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC),observation (OBS) and/or inpatient OB/newborn hospital and specialty clinic encounters according to coding conventions, guidelines and hospital policy, analyzing questionable documentation to ensure to the accuracy of information and resolves identified issues. The primary purpose of the Coding Specialist II is to code and verify charge data necessary to ensure correct coding, abstracting and billing on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC),observation (OBS), specialty clinics and/or inpatient OB/newborn encounters.

Parkland Health

Coding Specialist II

May assist other coders by training and advising on coding and abstracting according to ICD-9-CM conventions and guidelines, responding to coding inquiries, reviewing and noting coded charts, providing feedback and monitoring chart corrections to ensure that noted changes have been made to facilitate coding consistency, accuracy, efficiency and appropriate billing and reimbursement. Stays abreast of the latest developments, advancements, and trends in the field of coding and abstracting of medical records by attending in service training, coding meetings, seminars/workshops, actively participating in professional organizations, and maintaining licensure.

HIM Coding Editor Specialist I

Option 3: Certification in one of the following: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), issued by the American Health Information Management Association, Certified Professional Coder (CPC), Certified Professional Coder-Physician-based (CPC-P), AND one of the following: Certified Document Improvement Practitioner (CDIP), Certified Clinical Documentation Specialist (CCDS), Certified Clinical Documentation Specialist-Outpatient (CCDS-O). Facilitates modifications to clinical documentation through extensive interactions with physicians, nursing staff, other members of the health care team and Health Information Management (HIM) coding staff to ensure that appropriate reimbursement and clinical severity is captured for the level of service rendered to all patients with a DRG based payer.

Clinical Documentation Coordinator

The Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.

CVS Health Corp

SIU Medical & Behavioral Health Coding Analyst

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Partner with Revenue Cycle, Denials Management, and Patient Financial Services to analyze coding-related denial trends and implement corrective education and Epic build enhancements to prevent recurrence. Leverage Epic tools and reporting (e.g., claim edit workqueues, coding edits, denial reason codes, and analytics) to proactively detect risk, monitor performance, and support denial prevention strategies.

Aspirus Inc

MANAGER - CODING AUDITING & EDUCATION

As a Patient Advocate, you guide patients through the twists and turns of the healthcare system, making complex insurance and care processes clear, accessible, and less stressful every step of the way. Amaze Health delivers concierge-style virtual care that feels like having a trusted “doctor friend” on call 24/7, for everything from sudden illnesses to chronic conditions and mental health.

Amaze Health

Patient Advocate

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The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Deloitte Touche Tohmatsu Ltd

Manager, Medicaid Integrity Operations, Financial Crime and Fraud

Leads high-level charge capture initiatives, payer strategy escalations, and systemwide denial prevention efforts and initiatives that ensure accurate billing, regulatory coding compliance, and optimized net revenue performance. Works closely with registration teams, coding, account follow-up, authorization and compliance to identify revenue risks, improve workflows, and strengthen reimbursement outcomes.

The Tampa General Hospital Foundation Inc

Revenue Integrity Analyst - Usftgp Umsa RCO Back End

Across the Care Synergy network, the organizations provide significant community impact, including more than 7,000 hospice patients served annually, more than 2,000 palliative care patients, more than 355,000 hospice days of care each year, and more than $1.6 million in charitable care provided annually. Care Synergy affiliated programs include The Denver Hospice, Pathways Hospice, Pikes Peak Hospice and Palliative Care, Colorado Visiting Nurse Association, CAPABLE, and Superior Medical Equipment, along with PACE programs including Colorado PACE and Pathways PACE.

Care Synergy

Senior Medical Coding Specialist

4. CPSE (Pre‑School Special Education) Billing Handle billing through NYSED/NYCPSE mechanisms , often tied to Preschool Programs in Approved Settings (PPS or CPSE programs). 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.

HOUR

South Shore Speech Language

Medical Biller

With a 97% long-term, client retention rate spanning over 20 years, MedHQ serves Ambulatory Surgery Centers (ASCs), Surgical Hospitals, Physician Practices, and Hospital and Healthcare Outpatient Facilities nationwide. The MedHQ RITE Values: Respect, Innovation, Trust, and Energy, permeate all service line offerings with a unique personalized approach balancing exceptional transactional and emotional intelligence, and above all excellent customer service.

MedHQ, LLC

Medical Coding Specialist - Wound Care

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

Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.

Mass General Brigham

Supervisor, Medicaid Claims Reviewer

The role prepares denial prevention materials that synthesize denial metrics, initiative status, and workgroup findings; leads cross‑functional discussions to connect interdependent topics; and supports DPTF Workgroups by documenting minutes, key takeaways, action items, owners, and due dates, and coordinating follow‑ups. The Senior Denials Prevention Analyst is an operational subject‑matter expert in denial prevention who combines advanced revenue cycle analytics with targeted account sampling to identify trends, pinpoint root causes, and drive sustainable reductions in initial denials for maximum reimbursement.

Certified Professional Coder Jobs in the United States

Senior Coding Quality Analyst (CPC) – Special Investigations Unit (Aetna SIU) CVS Health

Manager Revenue Integrity - FT - Days - MHS - Remote Eligible Memorial Healthcare System

Director of Compliance The Los Angeles Cancer Network

Payment Integrity Nurse Reviewer- Hospital Claims SmartLight Analytics

Fraud and Abuse Investigator / CPC Sentara Hospitals

Coding Services Manager Global Force USA

Coding Specialist II Parkland Health

HIM Coding Editor Specialist I Parkland Health

Clinical Documentation Coordinator Global Force USA

SIU Medical & Behavioral Health Coding Analyst CVS Health Corp

MANAGER - CODING AUDITING & EDUCATION Aspirus Inc

Patient Advocate Amaze Health

Manager, Medicaid Integrity Operations, Financial Crime and Fraud Deloitte Touche Tohmatsu Ltd

Revenue Integrity Analyst - Usftgp Umsa RCO Back End The Tampa General Hospital Foundation Inc

Senior Medical Coding Specialist Care Synergy

Medical Biller South Shore Speech Language

Medical Coding Specialist - Wound Care MedHQ, LLC

Physician Coding Educator Essen Healthcare

Supervisor, Medicaid Claims Reviewer Mass General Brigham

Sr. Denials Prevention Analyst (Remote) Stanford Health Care

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