Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.
Review and verify healthcare claims for accuracy, coding, eligibility, and coverage.
Approve or deny claims according to policy terms and regulations, and resolve discrepancies.
Process claims efficiently, meet performance targets, and maintain accurate records.
Blue Cross and Blue Shield of Kansas is a health insurance company providing coverage to Kansans. With over 80 years in the community, it fosters an inclusive, family-first culture and supports professional growth.
Must hold AHIMA or AAPC certification (CPC, CIC, COC) with at least two years of recent inpatient coding in acute care.
Requires proficiency in ICD-10-CM and ICD-10-PCS coding, MS DRG classification, and remote connectivity tools.
Must meet productivity targets and maintain coding quality of 95% or greater.
UASI is a coding and HIM services provider with over 40 years of experience, offering remote work opportunities for healthcare professionals. They have been recognized as a Top Workplace by the Cincinnati Enquirer for five consecutive years and value long-term employee stability and growth.
Lead cross-functional teams for claims adjudication, benefit configuration, and production support.
Drive modernization and strategic roadmap for pharmacy claims and configuration capabilities.
Oversee client benefit plan implementation, regulatory compliance, and operational metrics.
Prime Therapeutics is a pharmacy benefit manager (PBM) focused on reimagining pharmacy solutions to simplify healthcare. The company fosters a purpose-driven, inclusive culture and is an equal opportunity employer.
Manage the full lifecycle of PIP and Medical Payments claims, from coverage verification and investigation to settlement or denial.
Apply medical cost-containment strategies, coordinate experts, and identify subrogation opportunities while meeting compliance standards.
Work remotely within the US, maintaining accurate claim files and communicating professionally with claimants and stakeholders.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The partner company is seeking a remote Associate PIP Claims Rep to handle Personal Injury Protection claims across multiple states in a structured, compliance-focused environment.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Supervise and advise claims examiners in all phases of the adjudication process and ensure compliance with regulations and departmental standards.
Manage workflow, caseload challenges, and team performance to meet production goals and quality standards.
Act as subject matter expert for complex claims, provide coaching and training, and participate in hiring and performance evaluations.
Protective helps protect customers against life's uncertainties by providing insurance and peace of mind. The company is focused on employee wellbeing and offers a broad benefits package including health, financial, and paid time away.
Respond to patient inquiries through chat, email, and internal messaging with clarity, warmth, and professionalism.
Break down complex topics (billing, CPT codes, coverage, device returns) into simple, patient-friendly explanations.
Document all interactions clearly and accurately, ensuring consistent follow-up until issues are fully resolved.
Salvo Health takes a new approach to help millions of Americans facing chronic health conditions, centered on chronic gut health and metabolic conditions. Backed by leading health care investors, Salvo's team includes board-certified physicians, dietitians, nurses, and therapists who provide evidence-based, continuous care.
Provide professional and timely service to internal and external customers regarding benefit administration.
Resolve benefit service issues with internal staff and outside vendors.
Perform monthly reconciliation of Carrier invoices to report to customers.
OneSource Virtual (OSV) works exclusively with Workday customers to automate payroll, taxes, earned wage access, accounts payable, and benefits. With over 1,500 customers and 92% retention, OSV offers a values-based culture and professional development.
Review complex inpatient medical records and assign ICD-10-CM, ICD-10-PCS, and DRG codes accurately.
Ensure compliant documentation and billing by applying federal and VHA coding guidelines.
Maintain 95% coding accuracy and meet facility-specific turnaround requirements while working remotely.
This role is with a partner company that supports inpatient coding operations for Veterans Affairs medical centers. The environment is structured and mission-driven, with a focus on accuracy, compliance, and federal healthcare standards.
Review inpatient and outpatient records and assign accurate ICD-10, CPT, and HCPCS codes.
Maintain a minimum coding accuracy of 95% while meeting turnaround and quality standards.
Work fully remotely within the US supporting multiple medical facilities.
This position is listed on behalf of a partner company within a large healthcare network. They focus on health information management and clinical coding accuracy, offering a fully remote environment.
Review and analyze complete patient medical records to identify all diagnostic and procedural information.\n- Assign accurate diagnostic and procedural codes using encoder software to ensure proper MS-DRG assignment and sequencing.\n- Maintain compliance with coding guidelines and verify medical record completeness for accurate reimbursement.
Henry Ford Health is a leading academic health system providing a comprehensive continuum of care, including primary to complex care, virtual care, and health insurance. With 12 hospitals and hundreds of ambulatory locations across Michigan, it is headquartered in Detroit and committed to innovation and community impact.
Apply certified coding expertise to healthcare coding activities while maintaining high accuracy and quality.
Review and interpret clinical and administrative documentation to support appropriate coding outcomes.
Follow established coding standards, policies, and regulatory requirements while protecting data confidentiality.
A partner company in the healthcare coding industry seeks a certified coding professional. The full-time remote role supports accurate and compliant coding operations in a structured environment.
Provide timely and accurate support to participants and clients regarding eligibility, benefits, claims, and plan inquiries via phone and email.
Document all customer interactions and navigate multiple systems while maintaining HIPAA confidentiality.
Educate members on self-service options and contribute to a positive, team-oriented environment.
Point C is a national third-party administrator that delivers customized self-funded benefit programs and innovative cost containment solutions. It is a mission-driven company with a collaborative culture focused on innovation, inclusion, and partnership.
Conduct clinical documentation reviews to ensure compliance with coding guidelines and regulations.
Provide education and training to providers and coding staff on documentation standards.
Analyze data and report findings to leadership to improve coding accuracy.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It has been recognized as a Top 150 Place to Work in Healthcare and fosters a culture of belonging.
Conduct audits of medical records for compliance with federal coding regulations and guidelines.
Provide education and training to providers on CPT, ICD-10, and HCPCS codes.
Act as an internal expert to ensure coding compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company collaborating with medical groups, health plans, and health systems. It aims to optimize physician practices and improve patient experiences through cloud-based technology and scalable operations.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
Code inpatient services with 95% or above accuracy following ICD-10 guidelines.
Abstract medical records and assign accurate diagnosis and procedure codes using Epic and 3M 360.
Collaborate with coding leadership and CDI reviewers to resolve coding issues and support compliance.
Oregon Health & Science University (OHSU) is Oregon's only public academic health center, providing patient care, leading research, and training healthcare professionals. As Portland's largest employer, OHSU offers opportunities to learn and advance across hospitals and clinics in Oregon and Southwest Washington.
Convert raw medical claims (837 EDI, UB-04, CMS-1500) into canonical models applying healthcare coding standards.
Perform data quality audits and write SQL/Spark SQL queries to validate pipeline output and detect overpayment patterns.
Act as SME on claims coding, adjudication rules, and payer policy, mentoring analysts and collaborating with cross-functional teams.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients across the US. Deployed by over 85 health plans and representing more than 270 million lives, the company combines an AI-powered platform with industry expertise to maximize financial outcomes and reduce healthcare costs.
Address client employee insurance concerns, answer benefit-related questions, and assist with claims resolution.
Maintain detailed records in Salesforce and generate client analysis reports as needed.
Monitor resolution timelines to ensure benefit issues and claims are closed within the designated timeframe.
Foundation Risk Partners is an insurance brokerage and consulting firm, one of the fastest growing in the US, hiring for its Corporate Synergies team. The company offers a comprehensive benefits package and values exceptional customer service and collaboration.