Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
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 with efficient management of records.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. As an affiliate of Dignity Health, they work hand-in-hand with physicians and providers throughout California to provide comprehensive health care services.
Organizes and prioritizes assigned work to ensure completion within the assigned time frame.
Reviews charts and medical records, assigning ICD and CPT code combinations to each data element.
Audits for documentation opportunities and queries clinical staff to fill in any gaps.
Riverside Health System's mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team, offering care at all stages of life, in hundreds of locations.
Review clinical documentation and assign accurate ICD-10-CM, HCPCS, and CPT codes to encounters
Ensure compliance with CMS, payer, and risk adjustment coding guidelines
Collaborate with clinicians and billing staff to clarify documentation or coding discrepancies
Main Street Health is the nation's largest provider of value-based care exclusively serving rural America. They partner with rural primary care doctors and reinforce the importance of trust and relationship-driven care in rural communities.
Assigns ICD-10 and CPT Codes and performs charge reconciliation.
Cooper University Health Care is committed to providing extraordinary health care. They are continuously discovering clinical innovations. Cooper offers career growth through professional development and is the employer of choice in South Jersey.
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.
Acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of their team, you'll have the opportunity to join their quest for better health care, no matter where you work within the Northwestern Medicine system.
Review documentation to assign appropriate CPT, HCPCS, and ICD-10 diagnosis codes
Resolve edits in WQs (charge review, claim edit, and follow up) and review denials for possible corrected claims or appeals
Work with clinic supervisors and/or providers to resolve coding issues and questions, following applicable payer rules and guidelines
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 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.
Support medical policy functions by providing medical coding and system configuration.
Perform coding analysis and utilization reporting to recommend updates to medical policies.
Participate in cross-functional meetings to align with enterprise strategic priorities.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. They are motivated by the well-being of their members and committed to sustainability and innovation.
Codes and abstracts Outpatient records for data retrieval, analysis, reimbursement and research.
Codes and enters diagnostic and procedure codes into the designated coding and abstracting system.
Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR.
CommonSpirit Health has over 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, 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.
Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems.
Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams.
Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust and motivated by member well-being, not profits. They are committed to providing best-in-class service, sustainability, and innovation.
Responsible for coding procedures and entering charges to comply with regulations and internal policies.
Coordinate with Practice Coordinator and Revenue Integrity to assure all necessary documentation is present.
Participate in audits to evaluate if all selected codes are accurate and develop methodologies to improved coding issues.
Northside Hospital is an award-winning and state-of-the-art hospital that is continually growing. They are expanding the quality and reach of their care to patients and communities which creates more opportunity for healthcare professionals in Atlanta and beyond.
Accurate coding of professional services from medical record documentation.
Reviews, codes and assigns correct ICD-10-CM diagnosis codes.
Knowledge of insurance company, third-party and government reimbursement programs.
University Health (UH) is committed to being a leader in providing healthcare. UH is an equal opportunity employer committed to a culturally inclusive workplace that values and celebrates differences.
Review and assign accurate ICD-10-CM, CPT, and HCPCS codes for medical diagnoses and procedures based on clinical documentation.
Ensure coding compliance with CMS guidelines, and state/federal regulations. Ability to write precise, professional, and well structured feedback to providers and team members.
Assist with claim reviews, denials, and coding-related audits to optimize revenue integrity.
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.
Perform audits to assess the quality of documentation, accuracy of charge code assignment and review financial billing statements.
Answer any physician and/or clinic questions and concerns regarding current ICD-10 and CPT guidelines.
Provide coding training and updates for coding staff, physicians and clinics as assigned.
Shirley Ryan AbilityLab is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions. They have an innovative, multifaceted culture that embraces collaboration, excellence, discovery, and compassion.
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Machinify is a healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They deploy a configurable, AI-powered platform and best-in-class expertise, serving over 85 health plans representing more than 270 million lives.
Ensuring the accuracy, integrity, and quality of coding practices within the HIM department.
Conducting thorough reviews of clinical documentation, coding, and billing processes to ensure compliance.
Educating and training coding staff on best practices and updates in coding guidelines.
Cooper University Health Care is committed to providing extraordinary health care. They focus on clinical innovations and access to facilities, equipment, technologies and research protocols, and offer competitive rates, compensation programs, benefits, and career growth.
Conduct audits comparing medical record documentation to reported codes.
Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.
Provide feedback, education, training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision and coding principles.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. Their platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Translate health care services and procedures into standardized codes on outpatient accounts.
Work with Epic work quests to maintain timeliness of coding, billing, and accounts receivable.
Communicate with providers, coders and clinical documentation specialists as needed for comprehensive patient record documentation.
ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges.
Codes and abstracts Inpatient records for data retrieval, analysis, reimbursement and research.
Codes diagnostic and procedure codes into a designated coding and abstracting system utilizing the 3M encoder, as appropriate.
Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR.
CommonSpirit Health is 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. With more than 700 care sites across the U.S., CommonSpirit is accessible to nearly one out of every four U.S. residents.
Responsible for maintaining the integrity, accuracy, and compliance of the hospital’s charge description master (CDM).
Ensures that all clinical services, supplies, and procedures are correctly coded and mapped for appropriate billing and revenue reporting.
Works closely with Clinical, Finance, Revenue Cycle, and IT Teams to analyze and implement new service request, coding updates, price changes, and regulatory modifications.
Ingalls Memorial Hospital is a world-class academic healthcare system. A skilled Medical Staff and talented employees dedicated to prevention, diagnosis, treatment and rehabilitation of illness and injury provide a firm foundation for our reputation for quality.