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Position Overview: Responsible for activities which improve the accuracy of facility outpatient clinical documentation coding and charging, including education with the clinical departments and coding staff and root cause correction to support accurate charging and coding in compliance with policies. Demonstrated ability to utilize official coding/billing resources including CPT/HCPCS references, OPPS Manual, NCCI Manual, NUBC Manual, etc. to determine applicable charges/codes as documented in the health record.

HOUR

Sutter Health has a long history in California. Some of our facilities have been providing care in the communities we serve for more than 100 years. Today, we’re proud to partner with more than 12,000 doctors to care for more than 3 million people.
We’re inspired by our Northern California community and work tirelessly to deliver top-rated, affordable healthcare. Doctors, hospitals, care teams and employees in the Sutter Health network are always looking for new, meaningful ways to care for you and your loved ones. We believe that every moment matters when it comes to helping you live a longer, healthier and happier life.
Our not-for-profit network delivers top-rated, personalized care in more than 100 Northern California communities. Recently ranked among the Top 15 Health Systems in the nation by Truven Health Analytics™, our team of more than 50,000 doctors, employees and volunteers partner to spread innovation, improve access to healthcare services and put our patients’ needs first—all to achieve the highest levels of quality, access and affordability.

Sutter Health

Charge Audit Analyst

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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. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.

YEAR

Elevance Health

DRG Clinical Validation Auditor - RN (Cdi, Ms-Drg, Ap-Drg & Apr-Drg)

Strong customer service skills for client satisfaction, health of client AR and management of RCM team memberso answering client inquiries; prompt return and follow up to all interactions; prompt response to requests for information, both internally and externallyo acts as primary point of contact for team members and provides guidance on work matters. In addition to performing similar work, the Manager will oversee and ensure group productivity and performance in accordance with financial goals to ensure the health of the client's Accounts Receivable Supports RCM Management by efficiently and effectively providing oversight and review of the team, processes and workload.

Veradigm

RCM Manager

In addition to performing similar work, the Manager will oversee and ensure group productivity and performance in accordance with financial goals to ensure the health of the client's Accounts Receivable Supports RCM Management by efficiently and effectively providing oversight and review of the team, processes and workload. At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve.

Veradigm (formerly Allscripts)

Veradigm Inc

Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine.

Valeris Inc

Executive Care Coordinator, Bilingual

Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Personalized Case Management Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine.

Valeris

Executive Case Manager (Remote)

Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines for all short-stay Medicare inpatients and outpatients (DUH), all observation encounters, all combined/segmental billing encounter questions, and any encounter sent to the UM MCA from PRMO for patient status/post-bill medical necessity denials/coding questions. Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives.

Duke University

Utilization Manager PRN

Our clinical and operational teams work hand-in-hand, ensuring patients receive the best possible care while critical behind-the-scenes processes, like revenue cycle management, are handled with accuracy and integrity. This role requires strong problem-solving skills, initiative, and technical proficiency to ensure claims are submitted cleanly, payments are posted accurately, and outstanding balances are followed up on in a timely manner.

Advaita Health

Revenue Cycle Coordinator

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Extensive knowledge of Correct Coding Initiative (CCI) edits, CPT, HCPCS, ICD, Revenue Codes, modifiers, billing, regulations and guidelines (Medicare, Medicaid, third-party billing rules, coverage, payment, and compliance).Results oriented with the ability to meet deadlines in a fast-paced, dynamic, project-oriented environment; Proficient in time management with superior prioritization skills. This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

UNC Health

Supervisor Revenue Integrity - HIM Revenue Integrity

JOB DESCRIPTION: Compliance Specialist position reporting to Manager of Medical Necessity and Authorization Denials that supports quality audit of Authorization and Medical Necessity internal and vendor staff to ensure quality, appropriateness of appeals, the effectiveness of denial review, etc. Four years of administrative experience to acquire competence in applying compliance, coding, and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions.

Compliance Specialist

Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.

Centene Corporation Group

SIU Investigator

If you would like to provide feedback regarding an active job posting, or if you are an individual with a disability who would like to request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name, job id number, and contact information so that we may follow up in a timely manner) or email EmployeeRelations@luxotticaretail.com. LensCrafters is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions.

EssilorLuxottica SA

CFSA1319 Associate Optometrist - Durham, NC - LensCrafters

You will decide with the CFO and Clinical Leadership which networks we participate in, negotiate the fee schedules that drive revenue, and manage relationships with every major dental carrier we work with. Set and run the enterprise payor strategy for the DSO across commercial dental PPO plans, leased and umbrella networks, medical plans for oral surgery, and government programs.

Riccobene Associates Family Dentistry

Director of Contracting & Payor Relations

Workable

Oversees research billing compliance, including review and approval of research patient billing accounts in Epic, Medicare Coverage Analysis (MCA), Medicaid attestation, coding accuracy, and financial reconciliation of charges. Works collaboratively with medical staff and departmental representatives to determine study feasibility and guides studies through required processes until trials are approved and opened for enrollment.

Director Clinical Research

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job. Call center staff ensures and verifies key patient information (insurance verification, patient and guarantor demographics, etc.) is current and accurate to ensure patient safety, charging, coding, insurance processing, and billing accuracy.

Care Access Representative

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job. Description of Job Responsibilities: Conducts audits of hospital charges and documentation using clinical expertise and billing regulations to ensure compliance with quality of care, medical necessity, and appropriate reimbursement.

RN Revenue Integrity Nurse Auditor - Revenue Integrity

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. We are seeking a Revenue Cycle Management (RCM) Program Director to provide leadership and strategic direction for all end-to-end revenue cycle operations across designated healthcare facilities.

StratAcuity Staffing Partners Inc

Revenue Cycle Management (RCM) Program Director

In this role, you will drive continuous improvement across physician revenue cycle operations, using performance data, root-cause analysis, and technology-enabled solutions to strengthen operational results and support the growth of our managed services offerings. Leading physician revenue cycle operations across billing, collections, insurance AR follow-up, denial and appeal management, underpayment pursuit, payer escalation, cash posting and reconciliation, credit resolution, and financial clearance.

PwC’s accounting practice originated in London well over a century ago. As times changed and PwC expanded worldwide, our commitment to clients—like you—never wavered. With us, you’re always supported by a global network of more than 223,000 people in 157 countries with one goal: to help your business thrive.

PwC’s professional services include audit and assurance, tax and consulting that cover such areas as cybersecurity and privacy, human resources, deals and forensics. We help resolve complex issues and identify opportunities across these industries.

Let’s combine your ​aspirations with our world-class capabilities to achieve your goals.

Medical Billing And Coding Jobs in Raleigh, NC

Charge Audit Analyst Sutter Health

DRG Clinical Validation Auditor - RN (Cdi, Ms-Drg, Ap-Drg & Apr-Drg) Elevance Health

RCM Manager Veradigm

RCM Manager Veradigm (formerly Allscripts)

RCM Manager Veradigm Inc

Executive Care Coordinator, Bilingual Valeris Inc

Executive Care Coordinator, Bilingual Valeris

Executive Case Manager (Remote) Valeris

Utilization Manager PRN Duke University

Revenue Cycle Coordinator Advaita Health

Supervisor Revenue Integrity - HIM Revenue Integrity UNC Health

Compliance Specialist Duke University

SIU Investigator Centene Corporation Group

CFSA1319 Associate Optometrist - Durham, NC - LensCrafters EssilorLuxottica SA

Director of Contracting & Payor Relations Riccobene Associates Family Dentistry

Director Clinical Research UNC Health

Care Access Representative UNC Health

RN Revenue Integrity Nurse Auditor - Revenue Integrity UNC Health

Revenue Cycle Management (RCM) Program Director StratAcuity Staffing Partners Inc

Managed Services - Physician Revenue Cycle - Manager PwC

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