The Claims Edit Specialist will review and resolve hospital-based claim edits for both inpatient and outpatient services.
Provide specific education on these claim edits to hospital coders through a variety of mediums.
Responsible for facilitating training, education, and support to hospital coders which may be based on detailed analysis of general or coder-specific trends.
Directs the coding audit and education operations.
Facilitates training, education, and support to hospital coders.
Provides support to all areas of Management, internal Coding and Billing.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities and advocating for those who are poor and vulnerable.
Performs CPT and ICD10 coding by abstracting from medical records, focusing on complex encounters.
Collaborates with Providers and Clinical areas to ensure accurate medical record reflection of patient services.
Trains physicians and staff on documentation, billing, and coding, while resolving Optum coding edits.
Northwestern Medicine is dedicated to providing a positive and patient-first workplace. They are a leader in the healthcare industry, offering opportunities for employees to contribute to better healthcare across the system.
Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types
Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans
Perform necessary research to provide to the client to support findings.
UASI is recognized as a Top Workplace. With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we’ve built and the long-term success of our dedicated team.
Accurately abstracts information from service documentation and assigns CPT, ICD-10, and HCPCS codes for billing compliance.
Reviews and resolves coding denials and completes charge sessions in assigned work queues in a timely manner.
Ensures documentation meets current EM Guidelines and specific payer rules before releasing codes for billing.
UofL Health is a fully integrated regional academic health system with hospitals, medical centers, and numerous physician practice locations. It has over 14,000 team members, including physicians and nurses, focused on delivering patient-centered care.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards.
Ensure claims are processed correctly and on time.
Dignity Health Medical Foundation was established in 1993, and it is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation works together with physicians and providers throughout California to provide comprehensive health care services.
Creates and delivers education to the Coding Team, Clinical Documentation Nurses, Physicians, and other licensed providers to improve documentation quality.
Collaborates with CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
Monthly monitoring of the clinical dashboard demonstrating improvement in statistical targets.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system.
Codes and abstracts Outpatient records for data retrieval, analysis, reimbursement and research.
Enters diagnostic and procedure codes into a designated coding and abstracting system utilizing the 3M encoder.
Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR.
CommonSpirit Health has more than 700 care sites across the U.S. Their combined resources are committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen both inside our hospitals and out in the community.
Supports coding and documentation quality assurance.
Performs internal audits to assess compliance and quality.
Researches coding, billing, and charging compliance issues.
Presbyterian Healthcare Services is dedicated to improving the health of patients, members, and communities. They are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group, employing nearly 14,000 individuals.
Assigns ICD-10-CM/PCS codes and assigns DRGs for inpatient medical records accounts; assigns ICD-10-CM/PCS codes and CPT codes for outpatient medical record accounts
Abstracts key data elements required for billing
Interacts with providers for clarification of documentation/education
UChicago Medicine has been at the forefront of medicine since 1899 and provides superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, they need employees with passion, talent and commitment… with patients and with each other.
Lead advanced coding education for individual providers and large provider groups, utilizing remote methods such as E/M and Medicare Preventive services.
Design, implement, and lead specialty-specific documentation and coding training programs to address unique needs and challenges.
Monitor market trends and emerging issues related to documentation and coding, ensuring timely and relevant updates to training programs.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. Their platform is led by top industry talent and consists of scalable operations and end-to-end, cloud-based technology.
Codes and abstracts hospital medical records for diagnostic and procedural coding.
Utilizes federal, state procedures/guidelines to assure accuracy of coding.
Collaborates with medical staff and clinical documentation improvement (CDI) staff to clarify documentation.
Virtua Health is dedicated to offering quality care through its extensive range of services and facilities. They have over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners committed to providing quality healthcare.
Conducting inpatient coding reviews and SMART audits.
Providing feedback and education.
Detail-oriented and committed to quality, self-motivated, flexible and adaptable to change.
UASI works with top hospitals and HIM experts. They provide employees with the tools needed for professional growth and development and recognize that their employees are their greatest asset.
Codes assigned accounts in accordance with the rules, regulations, and coding conventions set forth by NCHS (CDC) and AMA.
Abstract patient data.
Communicates with Care Providers by creating queries to clarify and improve documentation.
Children's Mercy is a pediatric hospital that is committed to making a difference in the lives of all children and shining a light of hope to the patients and families served. They have been recognized by U.S. News & World Report as a top pediatric hospital for eleven consecutive years.
Performs claims processing, insurance and charge verification, payment posting, account resolution, customer service and follow up.
Educates staff and physicians on CPT/HCPCS/ICD-10 codes and appropriate documentation requirements to reduce errors and remain compliant.
Works directly with staff when needed for insurance authorization assistance, IPA guidance and insurance optimization.
Community is committed to providing the highest standard of care. They value their diverse team members and offer various opportunities for growth and development.
Responsible for managing and overseeing activities for multiple value streams within the revenue cycle.
Provide ongoing input in the strategic planning of business requirements and corporate objectives for the Revenue Cycle.
Ensure compliance with all federal, state, and local statutes and regulations, as well as all third-party payer policies.
Virginia Mason Franciscan Health brings together two award-winning health systems in Washington state - CHI Franciscan and Virginia Mason. As one integrated health system, our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.