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Hands-on experience with the CMS EDGE server, including enrollment, medical, pharmacy, and supplemental submissions, EDGE business rules and interface control documents, RATEE and default risk adjustment charge avoidance, data submission and quality thresholds, and HHS-RADV initial validation audit and second validation audit cycles. Monitors and interprets regulatory change, including CMS Advance Notices and Rate Announcements, HHS Notice of Benefit and Payment Parameters, EDGE server business rules and interface control documents, state Medicaid companion guides, and NCQA HEDIS technical specifications; converts change into assessed, prioritized, and dated roadmap commitments.

Veradigm

Principal Product Manager, Veradigm Comprehensive Submissions (VCS)

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However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI's legal duty to furnish information. In this role, you will leverage your outpatient coding, clinical documentation, and reimbursement expertise to conduct comprehensive medical record audits and identify potential improper payments, including overpayments and underpayments.

CGI Inc

Outpatient Coding Auditor

Licensure/Certification/Listing: Required: Valid Driver's License (if driving a Cone Health vehicle, must have 5 years of driving experience and Motor Vehicle Record (MVR) must be approved by Risk Management) Required within two years of employment: Radiation Oncology Certified Coder certification and/or RHIT (Registered Health Information Technician) and/or RHIA (Registered Health Information Administrator) and/or CCS (Certified Coding Specialist). Working under close supervision, this position is also accountable for establishing acceptable financial arrangements on assigned patient accounts by way of securing sponsorship from various federal, state, and county agencies, in order to meet the patient's financial obligation and ensure reimbursement accountability.

The Moses H Cone Memorial Hospital

Financial and Admin Support Specialist

All Duke University remote workers must reside in one of the following states: North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington. Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates.

Duke University

Inpatient Coding Compliance Specialist

The Internal Applications Engineering Manager will lead that transition from both a people and technical leadership perspective —developing engineers with varying levels of full-stack experience, creating accountability around delivery and quality, removing roadblocks, and helping the team mature into an increasingly autonomous engineering organization. We expect this leader to maintain enough technical depth to coach engineers, guide technical decisions, and participate credibly in architecture discussions while spending the majority of their time leading people, developing talent, and ensuring the team delivers high-quality software.

Medical Coder Jobs in North Carolina

Principal Product Manager, Veradigm Comprehensive Submissions (VCS) Veradigm

Outpatient Coding Auditor CGI Inc

Financial and Admin Support Specialist The Moses H Cone Memorial Hospital

Inpatient Coding Compliance Specialist Duke University

Internal Applications Engineering Manager (Remote) Aeroflow Career

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