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The Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers. • Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.

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.

CVS Health

Special Investigation Unit (SIU) Manager

Working collaboratively with providers, clinical leaders, coding professionals, and operational teams, you will identify opportunities for documentation improvement, provide individualized education, and help implement best practices that enhance the accuracy and completeness of the medical record. As a Clinical Documentation Specialist at Quincy Medical Group, you will play a key role in advancing our Value-Based Care initiatives by partnering with providers to improve clinical documentation, diagnosis capture, and coding accuracy.

Quincy Physician Administrative Services

Clinical Documentation Specialist

PART_TIME

Verifies patient coverage and demographic information, draws conclusions, and corrects billing errors or other Claim issues. Post charges into billing system within 24-48 hours and completes other billing functions under direction of supervisor.

0635-Big Bend Medical Group

Certified Professional Coder

Our offices in South San Francisco and Indianapolis have been awarded with Top Workplaces honors by The Bay Area News Group and the Indy Star, since 2016 (the Top Workplaces honors are based solely on the results of an employee feedback survey by a leading research firm that specializes in organizational health and workplace improvement). Join the healthcare information technology team that's turning drug and medical device data into knowledge used by thousands of hospitals; the majority of U.S. health plans, retail pharmacies, and pharmacy benefit managers; and millions of healthcare decision makers throughout the world.

YEAR

Hearst Communications Inc

Medical Device Coder

Maintain a working knowledge, and stay abreast of, CPT-4, ICD-10, HCPCS coding principles, modifier usage, medical terminology, governmental regulations, protocols and third party payer requirements pertaining to billing, coding and documentation. Impact - TOA's team members use our careers — whether in our clinics or our business office to make a positive difference in the community by building relationships and helping patients live their best life.

TOA Middle

Certified Coder - Surgery

We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do.

Corewell Health

Audit Compliance Manager

In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Education: Must possess current knowledge of Healthcare/Coding as normally obtained through the completion of a bachelor's degree in healthcare administration or related field, or equivalent experience in a related field.

HOUR

StratAcuity Staffing Partners Inc

Risk Adjustment Audit Reviewer

As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. DESCRIPTION OF POSITION: Codes Inpatient, Observation and Same Day Surgery (SDS) charts using ICD10-CM and CPT coding guidelines.

Lake Charles Memorial Hospital

HIM Coding Tech II (Full Time)

The work is performed in a normal, professional office environment; The work area is adequately lighted, heated and ventilated; Typically, the employee may sit comfortably to perform the duties of the job and will perform repetitive motions with hands/fingers using a computer mouse and keyboard to type. Presents facilitative, well prepared, organized, and clear lectures and classroom activities consistent with the course syllabus (AAPC curriculum, medical terminology, anatomy & physiology, advanced medical coding, HCPCS coding, ICD-10 coding) and school policies.

Cuyahoga Community College

Instructor, Medical Coding

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. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities.

Deloitte Touche Tohmatsu Ltd

Senior Consultant, Health Insurance - Risk Regulatory & Compliance

This role evaluates coding accuracy, identifies documentation deficiencies, conducts audits, provides education to coding staff and providers, and supports revenue cycle integrity while minimizing compliance risk. The Medical Coding Auditor is responsible for keeping Sutherland coders in compliance by reviewing medical records and coding practices to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in compliance with federal, state, payer, and organizational guidelines.

As a process transformation company, Sutherland rethinks and rebuilds processes for the digital age by combining the speed and insight of design thinking with the scale and accuracy of data analytics. We have been helping customers across industries from financial services to healthcare, achieve greater agility through transformed and automated customer experiences for over 30 years. 

Headquartered in Rochester, N.Y., Sutherland employs thousands of professionals spanning 19 countries around the world. To learn more, please visit us at www.sutherlandglobal.com.

Sutherland Global Services Inc

Lead - Healthcare - Coding Quality Auditor

As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation.

Special Investigation Unit Lead Review Analyst II (Aetna SIU)

The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient''s status and provide care as described in the department''s policies and procedures manual. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission.

The state’s oldest and largest institution of higher education, the University of Utah is the flagship university of the state. The University offers more than 100 undergraduate and 90 graduate degree programs to more than 31,000 students (23,500 undergraduate and 7,500 graduate). The University is noted for its high research profile, its diversity of ideas and people, its stunningly beautiful setting and the warmth, friendliness, and collegiality of its faculty staff, and students. Imagine yourself working in a collaborative, creative, respectful environment where everyone’s contribution is needed and appreciated – University of Utah!

University of Utah

Supervisor, RCSS

Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. Active, Unrestricted RN license from the United States and in the primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) or Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) required.

Gainwell Technologies LLC

Associate Manager, Clinical Claim Review- Remote

This includes oversight of the day-to-day workflow processes, staff scheduling, productivity monitoring, staff coaching and training, exercising judgement in hiring and corrective/disciplinary action, and including supervisory of direct reports for the functional area within the coding department. The health system operates 18 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians.

Aspirus Inc

SUPERVISOR- CODING - CODING

The Revenue Cycle Manager ensures services are appropriately supported by documentation, claims and encounters are submitted accurately and timely, outstanding revenue is actively managed, reimbursement discrepancies are identified and resolved, and Revenue Cycle activities comply with payer, contractual, regulatory, and organizational requirements. Through programs such as Enhanced Care Management (ECM), Community Supports (CS), Community Health Worker (CHW) services, Behavioral Health, and other community-based healthcare programs, PHG works collaboratively with health plans, providers, community organizations, and other partners to support whole-person care.

Pacific Health Group

Revenue Cycle Manager

Workable

Supports manager by interpreting and analyzing billing data to identify and monitor performance and established benchmarks for the departmentMaintains knowledge of current and required coding regulations and assures team members are updated as regulations change. Certifications: Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Education:, Work Experience: Coding.

Carle Foundation Hospital

Coding Auditor/Educator- Laboratory

RN Clinician is responsible for reviewing provider post-payment inquiries and claim reconsiderations to ensure accurate coding in accordance with established coding guidelines, CMS guidelines, Health Plan Coding Payment Policy, and Claim Payment Policy. Ensures compliance with health plan policy and other regulatory agencies such as Bureau of Insurance (BOI), National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and Virginia Department of Medical Assistance Services (DMAS).

Sentara Hospitals

Clinical Claims Reviewer/ RN

FULL_TIME

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

Senior Clinical Large Claims Specialist

partner JazzHR

ADAPTED_NOW

Actively pursues effective and efficient operations of their respective areasin accordance withHealth New England’s Values, its Code ofConductand the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct. + Usingmedical record and clinical qualityexpertise, performs HEDIS clinical abstraction in both directelectronic medical record (EMR) and physical medical records to auditprovider compliance with HEDIStechnical specifications.

Certified Professional Coder Jobs in the United States

Special Investigation Unit (SIU) Manager CVS Health

Clinical Documentation Specialist Quincy Physician Administrative Services

Certified Professional Coder 0635-Big Bend Medical Group

Medical Device Coder Hearst Communications Inc

Certified Coder - Surgery TOA Middle

Audit Compliance Manager Corewell Health

Risk Adjustment Audit Reviewer StratAcuity Staffing Partners Inc

HIM Coding Tech II (Full Time) Lake Charles Memorial Hospital

Instructor, Medical Coding Cuyahoga Community College

Senior Consultant, Health Insurance - Risk Regulatory & Compliance Deloitte Touche Tohmatsu Ltd

Lead - Healthcare - Coding Quality Auditor Sutherland Global Services Inc

Special Investigation Unit Lead Review Analyst II (Aetna SIU) CVS Health

Supervisor, RCSS University of Utah

Associate Manager, Clinical Claim Review- Remote Gainwell Technologies LLC

SUPERVISOR- CODING - CODING Aspirus Inc

Revenue Cycle Manager Pacific Health Group

Coding Auditor/Educator- Laboratory Carle Foundation Hospital

Clinical Claims Reviewer/ RN Sentara Hospitals

Senior Clinical Large Claims Specialist SmartLight Analytics

Quality Improvement Specialist II Baystate Health

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