Responsible for conducting medical records and coding related reviews to validate the integrity of coded procedures.
Works closely with clinical departments and Revenue Cycle Services to ensure compliance with coding guidelines, government, payer and internal charge capture policies.
Provides education and training to clinical providers and staff within the practices on proper documentation and coding guidelines, practices and procedures.
They are committed to diversity and inclusion, welcoming all as valued members. They focus on providing the highest level of care by taking care of their incredible teams.
Performs final reconciliation on clinic/provider visits, resolving documentation issues.
Reviews, abstracts, and codes multiple services and complex cases, assigning classifications.
Researches/resolves high volume accounts/claims and educates staff on guidelines.
University of Utah Health is a patient-focused organization with a mission to enhance the health and well-being of people through patient care, research, and education. They have five hospitals and eleven clinics and are known as a Level 1 Trauma Center, nationally ranked for academic research and patient experience.
Translates patients’ medical records into standardized codes for diagnoses and treatments.
Ensures compliance with legal, regulatory, and organizational standards.
Manages records to ensures claims are processed correctly and on time.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. They are an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada.
Performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record.
Trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function.
Demonstrates expertise to resolve Optum coding edits.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of the team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system.
Determines accurate CPT, HCPCS procedure and professional supply codes and ICD-10-CM diagnosis codes.
Performs activities related to physician practice management and coding.
Provides training and education on coding and compliance issues to physicians, non-physician providers and staff.
Ohio State University Physicians is dedicated to providing exceptional patient care while fostering a collaborative work environment. The buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders.
Accurately assign ICD-10-CM, CPT, and HCPCS codes for Behavioral Health and SUD services.
Review clinical documentation to ensure coding accuracy and compliance.
Stay current with coding updates, payer policies, and regulatory changes.
Steadfast Health is dedicated to setting a new standard of care for substance use disorder (SUD) treatment. They are rapidly growing and building a dedicated team of professionals, focused on low-barrier, high-quality care accessible to all.
Accurately codes inpatient conditions and procedures using ICD guidelines.
Reviews medical record documentation and assigns ICD CM and PCS codes.
Collaborates with Clinical Documentation Improvement Specialists to address documentation concerns.
Marshfield Clinic Health System is dedicated to enriching lives through accessible and compassionate healthcare. They prioritize the needs of patients and customers and value innovation and teamwork.
Assigns appropriate billing codes to patient accounts.
Provides feedback to Coders on coding discrepancies.
Performs special projects and other duties as assigned.
Ventra is a leading business solutions provider for facility-based physicians. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions.
Perform code abstraction of medical records, diagnostic imaging, etc.
Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education.
Assist by making recommendations for process improvements to further enhance coding goals and outcomes.
Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical providers, who care for more than 200,000 patients statewide. Their mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare, with a focus on preventing the nation’s top leading causes of death.
Design engaging training, lead coders through evolving standards, perform high level audits, and shape best practices across multiple specialties.
Conduct detailed audits to identify under coding, over coding, documentation gaps, and compliance risks.
Spot trends in documentation and coding performance and collaborate on workflow improvements.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Responsible for decision-making and coding reviews.
Facilitate, obtain, validate, and reconcile appropriate provider documentation.
Ensure accurate reflection of illness severity and patient care complexity.
Millennium Physician Group (MPG), formed in 2008, is the largest independent physician group in Florida and one of the largest in the United States. They provide employees with the tools to succeed, a team atmosphere, and opportunities for growth.
Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes.
Collaborates with and leverages Segment Specialist expertise to ensure on-point results and ensure training material updates as necessary.
Conduct research, identify impact on existing concepts, and document accordingly and support activities required to package concepts.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plans. They are deployed by over 75 health plans, representing more than 170 million lives, and use an AI operating system, combined with expertise, to untangle healthcare data.
Creates and delivers education to improve documentation quality.
Collaborates with CMOs to ensure integrity of the health record.
Monitors the clinical dashboard to demonstrate improvement.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of the team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system.
Code for Multispecialty Surgery physicians primarily Single Path Coding.
Extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type.
Accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting.
Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. The firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future.
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
Maintain accurate provider profiles on CAQH, NPPES and any other applicable profiles
Complete credentialing applications to add current and new providers to commercial, Medicaid, and Medicare payers
Expressable is a virtual speech therapy practice with a mission to transform care delivery and expand access to high-quality services. They are passionate advocates of parent-focused intervention, serving thousands of clients since their inception in late 2019.
Review clinical documentation for accuracy and compliance.
Evaluate CDI program effectiveness and identify gaps.
Provide feedback to improve documentation quality.
UASI has over 40 years of experience and enduring partnerships with its valued clients. They are proud of the stability they've built and the long-term success of their dedicated team.
Collecting and verifying current demographic information
Contacting insurance companies when needed
Pediatrix Medical Group is a leading provider of specialized healthcare for women, babies, and children. Since 1979, they've grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services across the continuum of care.
Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage.
Ensure credentialing policies and documentation meet payer and regulatory requirements.
Build and continuously improve credentialing infrastructure, including SOPs and policies/procedures.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the healthcare system. They partner with health plans, providers, and community organizations to deliver culturally competent care; they are scaling rapidly across states and populations.
Lead and innovate within the Credentialing Department, driving operational excellence and compliance.
Provide strategic direction and oversight to Credentialing Specialists across all lines of business.
Develop and implement policies, procedures, and best practices for efficient and compliant operations.
Avesis has been providing essential ancillary benefit solutions since 1978, developing and administering best-in-class product choices and services. Today, their programs cover more than 8.5 million members throughout the country, striving for excellence with a focus on member satisfaction and client retention.