UNKNOWN

FEED

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 position works closely with physicians, advanced practice providers, coding and billing personnel, revenue cycle leadership, compliance officers, operational leaders, and other healthcare stakeholders to promote compliant documentation, coding, billing, and reimbursement practices. Experience performing documentation, coding, and billing audits in a healthcare system, academic medical center, physician practice, consulting organization, or related setting preferred.

YEAR

PACT MSO, LLC

Medical Coding Auditor

Demonstrate abilities in supervision, statistical reporting, medical terminology, applicable area of accountability including but not limited to: ICD-CM/PCS, CPT and HCPCS Level II coding conventions, Anatomy and Physiology, Reimbursement Methodologies, Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC), Correct Coding Initiative (CCI), National Coverage Determination (NCD), Local Coverage Determination (LCD), and Charge Description Master (CDM) required. Coordinate inpatient, ambulatory, ED, outpatient and/or professional coding activities for the Health Information Management Coding Department or Revenue Cycle Administration to include the evaluation, analysis, trending, and validation of productivity and efficiency of workflow processes.

Nebraska Medicine

HIM Coding Lead - Revenue Integrity

Deliver individual and group education sessions, primarily through virtual platforms, for providers, coding teams, and leadership on risk adjustment, HCC documentation, ICD-10-CM guidelines, clinical documentation requirements, compliant query practices, CMS expectations, and value-based care initiatives. Build trusted working relationships with network practice coders, coding leaders, providers, regional clinical leaders, and operational partners to understand workflows, identify needs, and provide practical support.

Strive Health, LLC

Risk Adjustment Documentation & Coding Educator

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

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

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.

HOUR

Cuyahoga Community College

Instructor, Medical Coding

The purpose of this position is to oversee the data collection, management, analysis, and reporting functions needed to support regulatory, quality, and strategic healthcare services for the Community Wellness Department and WISEWOMAN Women's Health Program. Oversee the preparation and submission of all required, regulatory, and quality improvement data reports for various external and internal stakeholders such as CDC, HHS, NIH, IHS, HRSA, as well as the senior management team.

Southeast Alaska Regional Health Consortium

Community Wellness Data Program Manager

ea_via_bold

Assist management with oversight of augmented staff by tracking performance, escalating issues, etcServe as a key resource in facilitating the gathering of business and technical requirements in addition to test cases for all configuration changes. Work with various business areas at different levels within the organization to translate business requirements into technical specifications documents and also act as liaison to translate technical questions and processes into a format the business can understand.

<p>Neighborhood's employees come from a diverse background but all are committed to creating a more equitable health care system. Our array of experiences allows us to have a broad perspective and great creativity in facing whatever challenges arise. Unlike many other health insurance companies, we have nearly 30 nurses and social workers on staff. This structure speaks to our focus on active and compassionate care management for our members; we know that people who are alienated from the health care system require additional advocacy, outreach and support. </p>

<p>Neighborhood offers an exceptional compensation package to employees. We annually review base salaries/benefits and adjust as appropriate. </p>

Neighborhood Health Plan of Rhode Island

Senior Configuration Management Analyst (45017)

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 Claims Analyst- Hospital Bill Review

This role will support Medicaid program integrity activities related to fraud, waste, and abuse prevention; provider oversight; compliance monitoring; risk assessment; external audit coordination; recovery efforts; and Medicaid medical, dental, behavioral health, and pharmacy claims audits. Experience with government agencies, Medicaid program integrity units, fraud risk assessments, internal audits, external audits, claims audit reviews, quality assurance, corrective action planning, or improper payment prevention efforts.

BerryDunn

Medicaid Program Integrity Analyst

[AW]-iCims

Demonstrates flexibility to meet the needs of department or hospital in regard to changes in work volume, planned change, scheduling changes and emergency call-backs (i.e. weather or disaster). Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift.

West Virginia University Medicine

Surgery Billing Clerk

This critical role will bring a deep understanding of the interdependencies between health plan and provider reimbursement strategies and rely on sound financial analysis to advise upon appropriate contractual terms that support both financial performance and high-quality patient care. 5 years of provider reimbursement experience across a variety of providers, including academic medical centers, acute care hospitals, community hospitals, ambulatory surgery centers, and / or critical access hospitals.

Unity Health Insurance

Sr. Provider Contracting Strategist

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

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.

Baystate Health

Quality Improvement Specialist II

Validate whether the FWA (Fraud, Waste & Abuse) detection approach surfaces real, actionable fraud/waste/abuse signals and produce substantiated findings to support FWA product development. Comfortable working with partial or imperfect data sets, including sample extracts rather than fully developed production systems.

HireTalent

Senior SIU Analyst - FWA Detection

jobdiva

Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Document coding-related activities, findings, and resolutions in coding software or systems, maintaining accurate and complete records of coding-related suspends and resolutions.

Ventra Health, Inc.

Coding Suspends Specialist

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.

Training Manager Jobs in Summit, KY

Clinical Claims Reviewer/ RN Sentara Hospitals

Medical Coding Auditor PACT MSO, LLC

HIM Coding Lead - Revenue Integrity Nebraska Medicine

Risk Adjustment Documentation & Coding Educator Strive Health, LLC

Clinical Documentation Specialist Quincy Physician Administrative Services

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

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

Instructor, Medical Coding Cuyahoga Community College

Community Wellness Data Program Manager Southeast Alaska Regional Health Consortium

Senior Configuration Management Analyst (45017) Neighborhood Health Plan of Rhode Island

Senior Claims Analyst- Hospital Bill Review SmartLight Analytics

Medicaid Program Integrity Analyst BerryDunn

Surgery Billing Clerk West Virginia University Medicine

Sr. Provider Contracting Strategist Unity Health Insurance

SUPERVISOR- CODING - CODING Aspirus Inc

Senior Clinical Large Claims Specialist SmartLight Analytics

Quality Improvement Specialist II Baystate Health

Senior SIU Analyst - FWA Detection HireTalent

Coding Suspends Specialist Ventra Health, Inc.

Director of Compliance The Los Angeles Cancer Network

Similar Job Searches

See More Jobs

Stand out to leading employers.