562 Certified Coding Specialist jobs in the United States
Billing & Certified Coding Specialist II
Posted 18 days ago
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**Time Type:** Full time
**Work Shift:** Day (United States of America)
**FLSA Status:** Non-Exempt
**When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.**
Identifies, reviews, and interprets third party payments, adjustments and coding denials for all professional services. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and other coding needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects.
**Job Description:**
**Essential Duties & Responsibilities** including but not limited to:
**Coding Responsibilities:**
1. Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.
2. Periodic review of codes, at least annually or as introduced or required.
3. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.
4. Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.
5. Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.
6. Maintains certification requirements for coding.
**Follow Up Responsibilities:**
1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
2. Responds to incoming insurance/office calls with professionalism and helps to resolve callers' issues, retrieving critical information that impacts the resolution of current or potential future claims.
3. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
4. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
5. Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments.
6. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
7. Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
8. Reviews/updates all accounts for write-offs and refunds.
9. Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients' portion due.
10. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
11. Handles incoming department mail as assigned.
12. Attends meetings and serves on committees as requested.
13. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
14. Provides and promotes ideas geared toward process improvements within the Central Billing Office.
15. Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
16. Completes projects and research as assigned.
17. Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.
**Secondary Functions:**
1. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
2. Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
3. Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
4. Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
5. Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
6. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
7. Assists other staff as required in the completion of daily tasks or special projects to support the department's efficiency.
8. Performs similar or related duties as assigned or directed.
**Education & Professional Development:**
1. Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD's), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
2. Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
3. Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
**Organizational Requirements:**
1. Maintain strict adherence to the Lahey Health Confidentiality policy.
2. Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
3. Comply with all Lahey Health Policies.
4. Comply with behavioral expectations of the department and Lahey Health.
5. Maintain courteous and effective interactions with colleagues and patients.
6. Demonstrate an understanding of the job description, performance expectations, and competency assessment.
7. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
8. Participate in departmental and/or interdepartmental quality improvement activities.
9. Participate in and successfully completes Mandatory Education.
10. Perform all other duties as needed or directed to meet the needs of the department.
**Minimum Qualifications:**
Education: High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate
Licensure, Certification & Registration: CP (Certified Professional Coder through AAPC), CPC-A (Certified Professional Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA)
Experience: 1-2 years of experience in billing, coding, denial management environment related field.
Skills, Knowledge & Abilities:
+ Ability to work independently and take initiative
+ Good judgment and problem solving skills
+ Excellent organizational skills
+ Ability to interact and collaborate effectively and tactfully with staff, peers and management.
+ Ability to promote team work through support and communication.
+ Ability to accept constructive feedback and initiate appropriate actions to correct situations.
+ Ability to work with frequent interruptions and respond appropriately to unexpected situations.
**As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more ( about this requirement.**
**More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.**
**Equal Opportunity** **Employer/Veterans/Disabled**
Z TEMP - Certified Coding Specialist
Posted today
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Job Description
We are currently recruiting for a highly motivated Z TEMP - Certified Coding Specialist to join our team. The Certified Coding Specialist will assist the Manager Coding Quality in implementing the coding standards for the organization, including researching relevant regulations, serving as a resource for other departments and reviewing and recommending changes to systems, policies, or procedures to ensure current and appropriate coding guidelines are maintained. The incumbent will review the appropriateness of codes billed when reviewing medical records related to provider disputes and appeals. Additionally, the incumbent will respond to questions submitted to the coding support mailbox and provide code guidance based on Medicare, Medi-Cal and national standards of billing protocol.
Position Information:
- Salary: ($27.98 - $43.37)
- Work Arrangement: Full Office
- Work Schedule: Monday to Friday (8:00 a.m. to 5:00 p.m.)
Duties & Responsibilities:
- 95% - Program Support
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Supports the manager in ensuring current coding methodology and modifier rules are applied to appropriate reimbursement and ensures the organization is following Medicare and Medi-Cal protocol for payment of claims.
- Maintains and monitors code listing updates for International Classification of Diseases (ICD)-10-Clinical Modification (CM)/Procedure Coding System (PCS), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) as needed for all lines of business.
- Assists the manager with identifying questionable billing practices based on coding protocol.
- Responds with advice and instructions to any inquiries related to coding appropriateness and review of documentation provided.
- Assists the Contracting department with contractual billing requirements based on coding standards by identifying applicable procedure codes according to provider specialty.
- Presents at provider workshops and assists with provider training on regulations for appropriate coding of medical charts and documentation required to support proper claims submission.
- Assists other departments regarding evaluation of medical records, procedures or diagnosis code questions; identifies ambiguous or non-specific medical documentation regarding coding protocols related to provider disputes, appeals and coding audits on submitted claims.
- Stays current on official health care regulations, including reimbursement and documentation requirements related to professional claims billing. Ensures compliance with the standards of ethical coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official guidelines.
- 5% - Other
- Completes other projects and duties as assigned.
Minimum Qualifications:
- Bachelor’s degree in public health, health services or related field PLUS 3 years of coding experience with an emphasis on Medicare and Medi-Cal requirements in a managed care environment required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- 1 year of experience working with ICD-10 CM or PCS, CPT and HCPCS coding, medical terminology, human anatomy/physiology and regulatory requirements required.
Preferred Qualifications:
- Experience working with MS-DRG, APR-DRG and Medi-Cal coding assignments as well as Medi-Cal chart auditing.
Required Licensure / Certifications:
- Current Certified Coding Specialist (CCS), Certified Coding Specialist Physician-based (CCS-P) or Certified Professional Coder (CPC) Certification by AHIMA or American Academy of Professional Coders (AAPC) required.
Medical Coding Specialist
Posted 4 days ago
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**Job Description:**
+ Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate. Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments.
**Responsibilities:**
+ 60% Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper, Rover, MDS QC tool or other appropriate software for code validation.
+ 25% Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed, outcomes, trends, and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested. May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies.
+ 10% Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
+ 5% Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.
**Experience:**
+ 1 year of claims processing or customer service experience OR Bachelor's Degree in lieu of work experience.
**Skills:**
+ Working knowledge of word processing software. Knowledge/understanding of medical terminology and medical coding. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Preferred Skills and Abilities: Knowledge/understanding of Medicare billing process. Working knowledge of spreadsheet and database software. Preferred Software and Other Tools: Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software. Work Environment: Typical office environment.
**Education:**
+ Associate degree - Health Information Management, OR, Graduate of an Accredited School of Nursing, OR successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC). Required Work Experience: 1 year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; or 2 years: 1-year clinical experience and 1 year in either DRG, APC, HIPPS, HCPCS, or RUG coding and validation. Required Software and Other Tools: Microsoft Office. Required Licenses and Certificates: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) OR Active RN licensure in state hired, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC). Preferred Education: Associate degree- Nursing or Four-year degree in Health Information Management. Preferred Work Experience: 2 years-medical coding experience.
**About US Tech Solutions:**
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ( .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Medical Coding Specialist
Posted today
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Job Description
Minnesota Urology is looking for a dedicated Coding Specialist to join our team!
Monday- Friday
No Weekends, Holidays, or Evenings
Eligible for Hybrid Work Options after minimum of 90 days in office
PRIMARY OBJECTIVE:
To accurately link ICD-10, CPT and HCPCS codes to daily charges, ensure ICD-10, CPT and HCPCS codes are updated and reviewed regularly for accuracy, monitor physician and physician extender coding practices, and ensure that all charges are accounted for and entered in a timely manner.
ESSENTIAL SKILLS/ABILITIES TO EFFECTIVELY PERFORM RESPONSIBILITIES:
- Represent Minnesota Urology in a professional manner related to appearance, communication and the maintenance of patient and company confidentiality.
- Ability to work as a team member.
- Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.
- Ability to effectively incorporate the use of technology into day-to-day tasks (Outlook, Microsoft Office Suite, NextGen and UroChart).
- Alpha and 10-key proficient
- Ability to examine medical documents for accuracy and completeness.
- Ability to prepare records in accordance with detailed instruction.
- Ability to analyze work methods to effectively organize work, make improvements, and correct problems.
- Ability to multi-task and switch gears based on workflows and situations requiring immediate action.
- Remain up-to-date and knowledgeable of coding procedures as well as remains current with federal legislative changes that affect outcomes.
- Knowledge of basic insurance policies, procedures and reimbursement practices
- Supportive of the goals and objectives of Minnesota Urology.
- Consistent attendance and punctuality.
EDUCATION/TRAINING/LICENSURE:
- Completion in one of the following programs required within first year of starting in the position:
- CPC through AAPC
- CCS though AHIMA
- RHIT through AHIMA
- RHIA through AHIMA
- Two or more years of coding experience preferred.
- Previous independent specialty physician practice experience preferred.
- Previous EMR experience required. Experience with Athena preferred, not required.
Minnesota Urology P.A. is an Equal Opportunity Employer.
Job Posted by ApplicantPro
Medical Coding Modernization Specialist
Posted today
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Job Description
Salary: $27.00
MEDICAL CODING MODERNIZATION SPECIALIST
Pearl Harbor, HI
AAI is actively recruiting a Medical Coding Modernization Specialist. This position will support coding operations and compliance as part of the Medical Modernization Program. The coding professional will conduct internal audits; monitor coding practices and documentation deficiencies to identify, develop, deliver training and monitor effectiveness of efforts to ensure improvement to documentation, coding completion, timeliness and accuracy rates for the MTF.
RESPONSIBILITIES
- Knowledge of The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-CM), procedural coding, healthcare common procedure coding system (HCPCS)/current procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes to perform the duties described. Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and, ResourceBased Relative Value Scale (RBRVS).
- Knowledge of and the ability to interpret guidelines, rules and regulations developed by: Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Heart Association (AHA) and other applicable Federal requirements so as to provide timely and accurate information relating to coding, billing and documentation.
- Excellent oral and written communication skills, interpersonal skills along with the confidence to present complex medical coding issues and educational instruction to a diverse audience. Must be comfortable in front of high ranking, professional staff and coding peers to training and respond to questions.
- Ability to write reports, business correspondence, and procedure manuals.
- Organizational, analytical, time management, statistical, and problem-solving skills.
- Advanced knowledge of computers, keyboard skills, and various software programs including Microsoft (word processing, spreadsheet and database) as well as coding software programs.
- Medical Coding Modernization Specialists will maintain the required continuing education hours and credentials as required by their national association certification at their own expense.
- Work Environment/Physical Requirements. The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting, or bending. Carrying or lifting of medical records or documentation may be required daily. Use of one or more computer programs and monitors simultaneously is typical and frequent.
- Assists the MTF in identifying medical coding deficiencies by analyzing documentation and coding practices that may be misrepresenting or incorrectly capturing medical care activities.
- Analyzes historical encounter documentation and coding records from Government computer systems and medical records to identify clinical documentation improvement (CDI) and training opportunities.
- Compares documentation to code application to ensure accuracy. Tracks deficiencies for trending and corrective action.
- Collaborates with MTF leadership, MTF providers/staff, and other coding professionals related to the performance of tasks to address recurring documentation and coding deficiencies, Contacts providers to review findings to improve documentation practices as well as E&M leveling, capturing medical procedures and to improve diagnosis specificity issues IAW with coding guidelines.
- Develops focused training presentations from thorough analysis as outlined in the MTF modernization action plan. Seeks Government approval prior to delivering Government scheduled training to MTF providers and other staff.
- Creates and submits training activity reports to the MTF leadership. Presents reports to the Government weekly and identifies scheduling issues and obstacles to meeting improvement objectives.Creates monthly reports showing completed activities and improvement to metrics
Education/Certification:
1. Successful completion of academic requirements, at least at an associate's degree level from a health information management program is required.
2. A Registered Health Information Technician (RHIT) or equivalent certification is required.
- Must have successfully completed requirements for International Classification of Diseases, Tenth Revision ICD-10-CM/PCS proficiency certification by AHIMA standards or the AAPC ICD-10-CM proficiency test prior to their start date if an equivalency determination request for AAPC certification(s) is authorized by the Government.
Experience:
- Candidates will require a minimum of 10 years of medical coding experience in production coding environments within the past 10 years, in more than 4 medical and surgical specialties, involving assignment of ICD, E&M, CPT, and HCPCS codes. Coding, auditing and training for ancillary services such as physical, occupational therapy, speech, and nutritional medicine as well as home health, skilled nursing facilities, rehabilitation care and urgent care clinics are not qualifying.
- A minimum of four years of auditing, training, and/or compliance functions within the last eight years is required in at least 4 medical and surgical specialties as stated above OR candidates with three years of auditing, compliance, or training experience involving professional coding within the last five years in a DoD coding environment may be considered in lieu of 10 years for those without DoD experience. Auditing, compliance, or training experience is described as:
- Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation and determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.
- Training functions include identifying coding training opportunities; developing coding training plans, and development/delivery of coding training to coder and physician/provider audiences.
- Compliance functions include identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contribute to risk assessments and mitigation strategies; and data collection and statistical report generation.
UNIQUE MILITARY HEALTH CARE DYDTEMD/PROCEDURED:
- Armed Forces Health Longitudinal Technology Application (AHLTA).
- Composite Health Care System (CHCS) and/or MHS GENESIS.
- Defense Enrollment Eligibility Reporting System (DEERS).
- Essentris The client-server version of the Clinical Information System (CIS).
- Coding Compliance Editor (CCE).
- Biometric Data Quality Assurance Service (BDQAS)-
- AFMS Internal Coding Audit Methodology AFMOA Audit Tool/Coding Audit Review System (CARS), or current tool.
- MHS Coding Guidelines
- AFMS Centralized Coding Manual.
About AAI
AAI is focused on delivering outstanding services to the federal government. We have extensive experience in the fields of cyber security, development, IT infrastructure, supply chain management and other professional services such as system design and continuous improvement. AAI is a VA CVE-certified Service-Disabled Veteran-Owned Small Business (SDVOSB), SBA certified Economically Disadvantaged Woman Owned Small Business (EDWOSB), and a Woman Owned Small Business (WOSB) with offices in Hampton Roads Virginia, Montgomery, AL, Washington DC and Atlanta.
Fully qualified candidates are welcome to apply directly on our website at:
Our benefits include:
- Paid Federal Holidays
- Robust Healthcare and Dental Insurance Options
- 401a plan
- 401k plan
- Paid vacation and sick leave
- Continuing education assistance
- Short Term / Long Term Disability Life Insurance.
Veterans are encouraged to apply
AAI does not discriminate in employment opportunities, terms and conditions of employment, or practices on the basis of race, age, gender, religious or political beliefs, national origin or heritage, disability, sexual orientation, or any characteristic protected by law. Pending guidance from the Safer Federal Workforce, employees may in the future be required to provide evidence of COVID-19 vaccination or request and receive approval for a medical or religious exemption.
Medical Coding Specialist II – Inpatient
Posted 12 days ago
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This is a full-time, 1.0 FTE position that is remote. Applicants hired into this position can work from most states. This will be discussed during the interview process.
To be eligible to work remotely, you must be in an approved remote work state for UW Health. We've included a link below to view the full list of approved remote work states.
Approved Remote Work States Listing
Be part of something remarkable
Join the #1 hospital in Wisconsin!
We are seeking a Medical Coding Specialist II - Inpatient to:
- Determine and assign ICD-10-CM diagnosis codes, in addition to present on admission indicators, and ICD-10-PCS procedure codes, using official coding guidelines and knowledge of anatomy and physiology, pharmacology and pathophysiology/disease processes.
- Identify cases with clinical indicators that may require provider documentation clarification and/or specificity in order to accurately assign codes; collaborate with CDIS team as part of the clinical documentation validation and physician query workflows.
At UW Health, you will have :
- An excellent benefits package, including health and dental insurance, paid time off, retirement plans, two-week paid parental leave and adoption assistance.
- Access to great resources through the UW Health Employee Wellbeing Department that supports your emotional, financial, and physical well-being.
- Tuition benefits eligibility - UW Health invests in your professional growth by helping pay for coursework associated with career advancement.
- Options for a variety of schedules and shifts that offer flexibility and allow for work-life balance.
Qualifications
- High School Diploma or equivalent and Medical Coding Education. In lieu of a medical coding education, an active coding certification is required. Required
Work Experience
- 2 years of progressive inpatient facility coding experience Required
- 2 years or more of inpatient facility coding experience in an Academic Medical Center and/or Level 1 Trauma Center Preferred
Licenses & Certifications
- Certified Coding Specialist (CCS) Upon Hire Required or
- Certified Inpatient Coder (CIC) Upon Hire Required
- Registered Health Information Technician (RHIT) Preferred
- Registered Health Information Administrator (RHIA) Preferred
Our commitment to Social Impact and Belonging
UW Health is committed to fostering a workplace that creates belonging for everyone and is an Equal Employment Opportunity (EEO) employer. Our respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. It is the policy of UW Health to provide equal opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Job Description
UW Hospital and Clinics benefits
Medical Coding Auditor
Posted 2 days ago
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The **Medical Coding Auditor** is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. This position supports the identification of suspected Waste & Error of health insurance claims and ensures claims are accurately documented. Candidates must be able to exercise judgement/decision making on complex payment decisions that directly impact the provider and client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation daily to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible for investigating, reviewing and provide clinical and/or coding expertise in a review of claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting all compliance turnaround times mandated by the client. The Coding Quality Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on complex cases.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment
+ Determines accuracy of medical coding/billing and payment recommendation for claims
+ This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, and consideration of relevant clinical information
+ Determines appropriate level of service utilizing Evaluation and Management coding principles
+ Provides detailed clinical narratives on case outcomes
+ Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance
+ Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
+ Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards
+ Provides clinical support and expertise to the other investigative and analytical areas
+ Participate in team and department meetings
+ Engages in a collaborative work environment when applicable but is also able to work independently
+ Serves as a clinical resource to other areas within the clinical investigative team
+ Work with applicable business partners to obtain additional information relevant to the clinical review
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ High School Diploma/GED (or higher)
+ Certified Coder AHIMA (CCA, CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I)
+ 2+ years of experience as an AHIMA or AAPC Certified coder
+ 2+ years of CPT/HCPCS/Modifiers coding experience
+ 2+ years of strong medical record review experience
+ 1+ years of experience working in a team atmosphere in a metric driven environment including daily production standards and quality standards
+ 1+ years of experience in the health insurance business, using industry terminology and regulatory guidelines
+ 1+ years of experience in Waste & Error principles
**Preferred Qualifications:**
+ Healthcare claims experience/processing experience
+ Experience with Fraud Waste & Abuse or Payment Integrity
+ (Internal Posting Only) 1+ years of experience with UHC platforms - COSMOS, Facets, CPW, NICE, ISET, UNET
+ Proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity
+ Strong computer skills with the ability to troubleshoot problems
+ Intermediate level of proficiency with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)
**Soft Skills:**
+ Highly organized with effective and persuasive communication skills
+ Strong written communication skills
+ Open to change and new information; ability to adapt in changing environments and integrate best practices
+ Strong communication skills with the ability to interpret data
+ Strong analytical mindset working with medical terminology and/or coding
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
**_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
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Supervisor, Medical Coding

Posted 4 days ago
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**Job Location (Full Address):**
Remote Work - New York, Albany, New York, United States of America, 12224
**Opening:**
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
910503 United Business Office Coding
Work Shift:
UR - Day (United States of America)
Range:
UR URG 110
Compensation Range:
$60,431.00 - $84,603.00
_The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._
**Responsibilities:**
GENERAL PURPOSE
The Assistant Coding Manager serves as a key support leader within the assigned functional area(s). This role provides assistance to the Manager by driving revenue cycle results through effective oversight of activities that impact professional charging and receivables. These activities include, but are not limited to, coding abstraction, pre-bill coding edits, claims resolution functions, and providing recommendations to enhance coding acuity, quality, productivity, and provider relationships across all departments.
Additionally, the Assistant Coding Manager is responsible for ensuring proper training and supervision of assigned staff members, while implementing and upholding URMFG best practice standards. Working collaboratively with the Manager, the Assistant Coding Manager may also prepare reports and analyze data for presentation purposes.
This position requires demonstrated knowledge and expertise in all aspects of coding operations, including staff management and supervision, office workflows, accounts receivable collaboration, payer rules, compliance, and regulatory requirements. The Assistant Coding Manager must exhibit exceptional communication, interpersonal, and problem-solving skills, as well as the ability to work independently while maintaining a collaborative team-oriented approach.
**Key Functions and Expected Performances**
With general direction of the Manager, with latitude for independent judgment:
**30%** In collaboration with the Manager, the Assistant Manager plays a key role in driving revenue cycle results by effectively managing the assigned functional area and serving as the team's coding specialist. This role acts as a subject matter expert on team functions and underlying processes, demonstrating comprehensive knowledge of medical terminology and coding guidelines relevant to the assigned functional area.
The Assistant Manager ensures the accuracy and timeliness of activities and outcomes by applying expertise in coding principles and healthcare regulations. Additionally, this role is responsible for ensuring compliance with all regulatory requirements and maintaining adherence to coding standards to ensure that all coding activities are performed in a compliant and accurate manner.
**20%** Uses knowledge and experience to review and trend analytic and reporting data identifying problem areas and directing actions to resolve deficiencies. Provides feedback and recommendations to Manager to ensure functional area meets or exceeds all URMC/URMFG established performance metrics relating to revenue cycle coding management. Ensures early problem identification and effective resolution. Identifies and presents new ways to improve operations.
**25%** Provides first-line management of assigned teams. Provides supervision, leadership, coaching and counseling. Services as a role model and facilitator to staff. Ensures a positive working environment through suggestions on team building to promote heightened team morale. May participate in recruitment, performance evaluation and disciplinary processes, following University guidelines.
**10%** Ensures hands-on training is provided to assigned team. Monitors and evaluates work of subordinates to assure adherence to policies and procedures. Provides coaching and reinforces coding acuity and department relationship skills to team members to ensure exceptional service. Empowers team members by providing the appropriate level of decision making.
**15%** May serve as department liaison on matters related to business functions.
Provides a high level of problem solving and support by assisting with the resolution of outstanding issues within team, revenue cycle or stakeholders handling charging and billing related issues.
May perform other duties as assigned.
**Background Expectations:**
Required:
+ Bachelor's degree and 2 years of coding experience required, or equivalent combination of education and experience.
+ Knowledge of ICD-10-CM, CPT and HCPCS required
+ Working knowledge of medical terminology and anatomy required
+ Certification in one of the following:
+ RHIA - Registered Health Information Administrator Successful completion of American Health Information Management Association (AHIMA) accreditation examination upon hire required or
+ RHIT - Registered Health Information Technician upon hire required or
+ CCS-Certified Coding Specialist upon hire required or
+ Certified Professional Coder (CPC) from American Academy of Professional Coders upon hire required or
+ Certified Medical Coder (CMC) from the Practice upon hire required
Preferred:
Demonstrated working knowledge of the professional billing software applications. Active medical coding credential with AHIMA as RHIT, RHIA, CCS, CCS-P, AAPC certified as CPC, or PMI certified as CMC. High level, in-depth coding knowledge and experience with CPT/HCPCS and ICD-10-CM. 1-2 years billing office experience, at least 1 year of supervisory experience
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.
Notice: If you are a **Current** **Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward.
**Learn. Discover. Heal. Create.**
Located in western New York, Rochester is our namesake and our home. One of the world's leading research universities, Rochester has a long tradition of breaking boundaries-always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.
If you're looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals
At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better-Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.
Supervisor, Medical Coding

Posted 4 days ago
Job Viewed
Job Description
**Job Location (Full Address):**
601 Elmwood Ave, Rochester, New York, United States of America, 14642
**Opening:**
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
910503 United Business Office Coding
Work Shift:
UR - Day (United States of America)
Range:
UR URG 110
Compensation Range:
$60,431.00 - $84,603.00
_The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._
**Responsibilities:**
The Assistant Coding Manager serves as a key support leader within the assigned functional area(s). This role provides assistance to the Manager by driving revenue cycle results through effective oversight of activities that impact professional charging and receivables. These activities include, but are not limited to, coding abstraction, pre-bill coding edits, claims resolution functions, and providing recommendations to enhance coding acuity, quality, productivity, and provider relationships across all departments.
Additionally, the Assistant Coding Manager is responsible for ensuring proper training and supervision of assigned staff members, while implementing and upholding URMFG best practice standards. Working collaboratively with the Manager, the Assistant Coding Manager may also prepare reports and analyze data for presentation purposes.
This position requires demonstrated knowledge and expertise in all aspects of coding operations, including staff management and supervision, office workflows, accounts receivable collaboration, payer rules, compliance, and regulatory requirements. The Assistant Coding Manager must exhibit exceptional communication, interpersonal, and problem-solving skills, as well as the ability to work independently while maintaining a collaborative team-oriented approach.
**Key Functions and Expected Performances**
With general direction of the Manager, with latitude for independent judgment:
**30%** In collaboration with the Manager, the Assistant Manager plays a key role in driving revenue cycle results by effectively managing the assigned functional area and serving as the team's coding specialist. This role acts as a subject matter expert on team functions and underlying processes, demonstrating comprehensive knowledge of medical terminology and coding guidelines relevant to the assigned functional area.
The Assistant Manager ensures the accuracy and timeliness of activities and outcomes by applying expertise in coding principles and healthcare regulations. Additionally, this role is responsible for ensuring compliance with all regulatory requirements and maintaining adherence to coding standards to ensure that all coding activities are performed in a compliant and accurate manner.
**20%** Uses knowledge and experience to review and trend analytic and reporting data identifying problem areas and directing actions to resolve deficiencies. Provides feedback and recommendations to Manager to ensure functional area meets or exceeds all URMC/URMFG established performance metrics relating to revenue cycle coding management. Ensures early problem identification and effective resolution. Identifies and presents new ways to improve operations.
**25%** Provides first-line management of assigned teams. Provides supervision, leadership, coaching and counseling. Services as a role model and facilitator to staff. Ensures a positive working environment through suggestions on team building to promote heightened team morale. May participate in recruitment, performance evaluation and disciplinary processes, following University guidelines.
**10%** Ensures hands-on training is provided to assigned team. Monitors and evaluates work of subordinates to assure adherence to policies and procedures. Provides coaching and reinforces coding acuity and department relationship skills to team members to ensure exceptional service. Empowers team members by providing the appropriate level of decision making.
**15%** May serve as department liaison on matters related to business functions.
Provides a high level of problem solving and support by assisting with the resolution of outstanding issues within team, revenue cycle or stakeholders handling charging and billing related issues.
May perform other duties as assigned.
**Background Expectations:**
Required:
+ Bachelor's degree and 2 years of coding experience required, or equivalent combination of education and experience.
+ Knowledge of ICD-10-CM, CPT and HCPCS required
+ Working knowledge of medical terminology and anatomy required
+ Certification in one of the following:
+ RHIA - Registered Health Information Administrator Successful completion of American Health Information Management Association (AHIMA) accreditation examination upon hire required or
+ RHIT - Registered Health Information Technician upon hire required or
+ CCS-Certified Coding Specialist upon hire required or
+ Certified Professional Coder (CPC) from American Academy of Professional Coders upon hire required or
+ Certified Medical Coder (CMC) from the Practice upon hire required
Preferred:
+ Demonstrated working knowledge of the professional billing software applications
+ Active medical coding credential with AHIMA as RHIT, RHIA, CCS, CCS-P, AAPC certified as CPC, or PMI certified as CMC. High level, in-depth coding knowledge and experience with CPT/HCPCS and ICD-10-CM.
+ 1-2 years billing office experience, at least 1 year of supervisory experience
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.
Notice: If you are a **Current** **Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward.
**Learn. Discover. Heal. Create.**
Located in western New York, Rochester is our namesake and our home. One of the world's leading research universities, Rochester has a long tradition of breaking boundaries-always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.
If you're looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals
At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better-Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.
Medical Coding Supervisor
Posted 16 days ago
Job Viewed
Job Description
We are looking for an experienced Medical Coding Supervisor to join our team in Seattle, Washington. This role is ideal for someone with strong expertise in revenue cycle management and medical coding, who thrives in a fast-paced healthcare environment. As a key leader, you will oversee coding operations, ensuring compliance and efficiency while supporting the needs of a federally supported health center. Excellent work-life balance, with the potential of a hybrid work schedule.
Responsibilities:
- Lead and manage the medical coding team, ensuring accuracy and compliance with healthcare regulations and standards.
- Supervise revenue cycle processes, including medical claims, accounts receivable, and credentialing activities.
- Utilize Epic systems to streamline coding operations and maintain data integrity.
- Develop strategies to optimize coding efficiency and accuracy across healthcare services.
- Conduct audits and reviews to ensure adherence to coding guidelines and billing practices.
- Collaborate with healthcare providers and administrative teams to resolve coding discrepancies.
- Provide training and mentorship to coding staff, fostering growth and development.
- Monitor key performance indicators related to revenue cycle and coding operations.
- Implement best practices to maintain compliance with federal and state healthcare regulations.
- Support remote and flexible work schedules to align with team preferences and productivity.
The salary range for this position is $70k to $99k. Benefits available with this position include paid medical, dental and vision; life and disability insurances; participation in the company's 401(k) plan with a match and 15 days of paid vacation and sick leave and 9 paid holidays per calendar year.
Requirements - A minimum of 10 years of experience in medical coding and revenue cycle management.
- Proficiency in Epic systems and familiarity with federally supported health center operations.
- Strong knowledge of healthcare revenue cycle concepts, including ASC 606 and revenue recognition accounting.
- Expertise in medical terminology, coding guidelines, and claims processing.
- Demonstrated ability to manage accounts receivable and credentialing processes effectively.
- Proven leadership skills with the ability to mentor and develop a team.
- Excellent analytical and problem-solving abilities.
- Strong communication skills to collaborate across departments and resolve coding issues.
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