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POSITION QUALIFICATIONS: High School Diploma required plus CCS coding certification from AAPC or AHIMA, or accredited college, or a minimum of 5 years of applicable ICD diagnostic, CPT procedural, and HCPCS coding in a hospital or diverse specialty physicians office. This position will assist the HIM Manager with daily activities of the department, including release of information (ROI), scanning and validating paper documents, compiling statistics, gathering data for trauma and cancer registries, filing, transcribing, and maintenance of data dictionaries.

Boundary Community Hospital And Clinics complies

CODER/HEALTH INFORMATION MANAGEMENT TECHNICIAN/Full-time

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Works closely with department managers, physicians and advanced practice professionals, nursing, ancillary service departments, pharmacy, supply chain, health information management, coding, billing, patient financial services, compliance, finance, information technology, and external vendors. Evaluate charge-capture workflows for hospital departments, specialty clinics, and Rural Health Clinics; identify missed, duplicate, delayed, or unsupported charges and recommend corrective action.

Gritman Medical Center

Charge Description Master Specialist | Patient Accounting | Full Time | HYBRID (On-Site/Remote)

FULL_TIME

OTHER

Technical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.

TriWest Healthcare Alliance

Supervisor, Utilization Management

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Works closely with department managers, physicians and advanced practice professionals, nursing, ancillary service departments, pharmacy, supply chain, health information management, coding, billing, patient financial services, compliance, finance, information technology, and external vendors. Support CAH- and RHC-specific reimbursement workflows, including review of clinic designation, provider enrollment impacts, encounter routing, professional and facility billing, and qualifying visit processes.

Revenue Integrity Analyst | Patient Accounting | Full Time | HYBRID (On-Site/Remote)

UM Process - Coordinate, create, and document UM cases in the electronic record by validating preauthorization requirements, utilizing a basic understanding of ICD, CPT and HCPCS codes, and including plan types, member benefits, eligibility, limitations, exclusions, and claims history. Utilize knowledge, understanding and critical thinking to research difficult cases related to UM processes and requirements from members, providers, employer groups, agents, member representatives and internal customers.

YEAR

PacificSource

UM Coordinator I (Tuesday-Saturday)

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Handles executive-level internal and external communications which includes; handling incoming phone calls, returning phone calls, responding to voice-mails, managing incoming e-mails by forwarding and responding to e-mails as appropriate, and creating and mailing letters and memos on behalf of Executive and department. Acts as project manager on assigned projects, provides administrative assistance as needed on other special projects and maintains departmental file sharing and intranet site(s), as requested.

Reinsurance Group of America Inc

Executive Assistant (open to remote)

To determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford.

Based in Atlanta, Georgia, Crawford &amp; Company is the world's largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with an expansive global network serving clients in more than 70 countries. 

The Crawford System of Claims Solutions(SM) offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines, including property and casualty claims management, workers compensation claims and medical management, and legal settlement administration 

The Company's shares are traded on the NYSE under the symbols CRDA and CRDB.

Crawford & Co

Claims Specialist-WC

Identifies trends in provider coding/documentation and vendor risk adjustment reporting and makes those trends known to leadership as well as coding team manager and training lead to develop intervention strategies - all in service of creating a person-focused health care experience. As a member of the Risk Adjustment team, our The Risk Adjustment Auditor performs Retrospective/Prospective chart review utilizing various types of records to ensure accurate risk adjustment reporting.

HOUR

Cambia Health

QA Risk Adj Auditor II

Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system. 

Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:

•       help people achieve better health and well-being 
•       make health care more available, affordable and accessible 
•       are easily understood by everyone

We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.  

Cambia Health Solutions Inc

QA Risk ADj Auditor II

This role owns the health, stability, and compliance posture of a suite of clinical and regulatory R&D platforms - including Axway Secure Transport (ST), eClinical Elluminate, Eclipse (medical coding), and EAST - across the full engagement lifecycle: implementation, configuration, validation, and steady-state managed services. The team operates at the intersection of IT infrastructure, clinical operations, and quality/regulatory compliance, partnering closely with global business and technology stakeholders to support end-to-end clinical trial data lifecycles from data capture and coding through statistical analysis and submission-ready outputs.

Deloitte Touche Tohmatsu Ltd

Clinical Data AMS Sr. Consultant

Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings.

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 Corp

Senior Investigator, Special Investigations Unit (Aetna SIU)

The Patient Financial Services Supervisor provides leadership, training, coaching, and performance management for assigned staff while monitoring key performance indicators related to accounts receivable, denials, prior authorizations, financial assistance, cash collections, and medical records operations. Monitors key performance indicators, including cash collections, accounts receivable days, clean claim rates, denial rates, appeal success rates, authorization performance, financial assistance activity, and medical records turnaround times.

Valor Health

PATIENT FINANCIAL SERVICES SUPERVISOR

GGH is dedicated to building an inclusive, diverse, equitable, and accessible workplace that fosters a sense of belonging - so if you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, we encourage you to still consider applying. Whether through our own senior-focused primary care clinics or our suite of integrated clinical solutions for health plans and provider groups, we are making value-based care more accessible and more effective.

Greater Good Health

Nurse Practitioner - Primary Care (ID license required)

The FRL interfaces with healthcare professionals, including their ancillary staff, nurse case managers (NCMs), HUB coordinators, Market Access team, and various Channel Partners on complex access and reimbursement cases by providing education on Crinetics sponsored patient programs and process guidance in response to prior authorizations, resubmissions, and denials. Essential Job Functions and Responsibilities: These may include but are not limited to: Conduct office calls with HCPs and/or office staff for support with appropriate patient access to Crinetics' products, including assistance in resolving reimbursement, patient programs, and coverage questions.

Crinetics Pharmaceuticals Inc

Field Reimbursement Liaison - Northwest

The Patient Financial Services Supervisor provides leadership, training, coaching, and performance management for assigned staff while monitoring key performance indicators related to accounts receivable, denials, prior authorizations, financial assistance, cash collections, and medical records operations. The Patient Financial Services Supervisor oversees the daily operations of billing, collections, payment posting, accounts receivable follow-up, denial management, appeals, financial assistance, prior authorizations, and medical records functions.

Patient Financial Services Supervisor

Applies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.

Utilization Clinical Reviewer

Our Claims Examiners are intellectually disciplined in applying, analyzing, and evaluating information gathered to determine the validity and compensability of claims received and work strictly within the program's statutes and guidelines. Idaho's Crime Victims Compensation Claims Examiners review bills as they are received to ensure expenses are crime-related and work with health care providers if additional detail is needed.

State of Idaho

CRIME VICTIMS CLAIMS EXAMINER

In this role, you will be responsible for analyzing, programming, debugging, building, deploying, testing, and documentation of applications in development and production environments, as well as database design and system testing and documentation. Expected deliverables include requirement analysis, system analysis, system design, data models, program design, source code development, unit test case development, unit and system testing, and documentation.

Data Platform Engineer III (Hedis Support)

Data Platform Engineer III (HEDIS Support)

What You Will Do at Cambia: Collaborate closely with Provider Services, Network Management, corporate business support, operations staff and others to ensure negotiated provider and institutional payments are implemented correctly and promptly. As a member of the Provider Reimbursement team, our Pricing and Reimbursement Analysts analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across all regions and Regence subsidiaries.

Coding Manager Jobs in Idaho

CODER/HEALTH INFORMATION MANAGEMENT TECHNICIAN/Full-time Boundary Community Hospital And Clinics complies

Charge Description Master Specialist | Patient Accounting | Full Time | HYBRID (On-Site/Remote) Gritman Medical Center

Supervisor, Utilization Management TriWest Healthcare Alliance

Revenue Integrity Analyst | Patient Accounting | Full Time | HYBRID (On-Site/Remote) Gritman Medical Center

UM Coordinator I (Tuesday-Saturday) PacificSource

Executive Assistant (open to remote) Reinsurance Group of America Inc

Claims Specialist-WC Crawford & Co

QA Risk Adj Auditor II Cambia Health

QA Risk ADj Auditor II Cambia Health Solutions Inc

Clinical Data AMS Sr. Consultant Deloitte Touche Tohmatsu Ltd

Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

PATIENT FINANCIAL SERVICES SUPERVISOR Valor Health

Nurse Practitioner - Primary Care (ID license required) Greater Good Health

Field Reimbursement Liaison - Northwest Crinetics Pharmaceuticals Inc

Patient Financial Services Supervisor Valor Health

Utilization Clinical Reviewer TriWest Healthcare Alliance

CRIME VICTIMS CLAIMS EXAMINER State of Idaho

Data Platform Engineer III (Hedis Support) Cambia Health

Data Platform Engineer III (HEDIS Support) Cambia Health Solutions Inc

Pricing Reimbursement Analyst I Or II Cambia Health

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