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.
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.
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.
Handle inbound and outbound phone calls to assist customers with inquiries.
Document all interactions in ticketing systems and track requests.
Research customer claims and provide accurate data within required timeframes.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, giving them an enduring financial edge. The company is growing and investing in its people to shape the future of healthcare technology.
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.
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.
Interpret clinical documentation to accurately assign diagnosis and procedure codes for outpatient encounters.
Maintain current knowledge of ICD-10 and CPT coding systems and ensure documentation supports assigned codes.
Manage daily work queues and perform data and charge entry within patient accounting systems.
This partner company operates within an academic medical environment, providing healthcare services and supporting accurate outpatient coding. Their culture is supportive and collaborative, with a focus on high-quality healthcare operations and continuous learning.
Monitor clearinghouse portals and resolve rejected medical claims daily.
Investigate rejection causes including coding errors and eligibility issues.
Correct claim information and resubmit to insurance payers for reimbursement.
Our partner is a healthcare revenue cycle management company focused on optimizing medical claims processing for providers. They offer a collaborative, inclusive work culture with opportunities for professional growth in a remote environment.
Serve as coding lead for the Inpatient Coding Supervisor, supporting daily coding activities like productivity monitoring, scheduling, and edit review.
Ensure coding compliance with regulatory guidelines and assist with charge review and failed claims/follow-up resolution.
Act as primary trainer and mentor for new coders, providing education, training, and research support.
Mercy is a Catholic health system dedicated to improving community health through innovation, technology, and compassion. It is a large, collaborative organization with a heritage spanning over 195 years, offering a supportive culture and growth opportunities.
Process and maintain accurate Medicare enrollment and disenrollment requests, ensuring compliance with CMS regulations.
Reconcile membership reports and resolve enrollment system rejections, building case files for CMS approval.
Mentor junior team members and collaborate on special projects, including process documentation and quality reviews.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, aiming to modernize operations and improve competitiveness. UST HealthProof, a fast-growing company, focuses on reducing administrative costs and improving healthcare experiences, led by seasoned leaders fostering a supportive, growth-oriented environment.
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.
Create the blueprint for configuration of medical and dental plans from plan documents and standards.
Build, validate and test plan benefits and code mapping logic for accurate claims processing.
Troubleshoot system issues and coordinate with teams to improve efficiency and resolution.
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Backed by leading healthcare and technology investors, the company is headquartered in Buffalo, NY and values resilience, uncommon thinking, and positivity.
Conduct independent coding audits of inpatient, outpatient, and professional fee services across multiple specialties.
Analyze sampled medical records to identify and substantiate coding, documentation, and compliance errors.
Provide targeted education and train-the-trainer sessions to strengthen coding practices.
This company provides medical coding auditing and validation services for Veterans Affairs medical centers, supporting healthcare data quality and compliance. It operates in a mission-driven environment focused on improving coding accuracy for veteran-serving facilities.
Manage referral and clinical documentation workflows to ensure patient records are complete and available for coordinated care.
Obtain and review clinical documentation from network providers, resolve missing records, and maintain accurate recordkeeping.
Collaborate with clinicians, Military Treatment Facilities, and internal teams to support efficient referral and documentation processes.
International SOS Government Medical Services supports healthcare programs that improve patient care and operational readiness across the U.S. and internationally. Founded in 1984, the company operates in more than 90 countries and delivers healthcare, medical assistance, emergency response, and workforce support services worldwide.
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.
Manage accident-related accounts from intake to resolution, coordinating no-fault and liability benefits.
Submit claims to carriers, maintain accurate records in AcciClaim, and monitor insurance portals.
Work independently, set priorities, and communicate professionally with patients and adjusters.
Revecore helps hospitals recover revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, the company combines specialized expertise with proprietary technology and fosters a supportive, innovative workplace.
Code a high volume of outpatient encounters, including clinic visits, ancillary services, diagnostic testing, and outpatient surgery.
Assign E/M levels, apply NCCI edits and modifiers, and review clinical documentation in VA systems like CPRS and VistA.
Maintain 95% coding accuracy, protect patient information, and complete federal background investigation requirements.
Our partner is a healthcare organization that provides medical coding services for Veterans Affairs facilities. The company emphasizes mission-driven work, accuracy, and confidentiality while supporting veteran healthcare services across the United States.
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.
Act as the main point of contact for VA HIMS staff and lead a remote coding team across eight facilities.
Assign work, monitor turnaround times, and conduct ongoing quality reviews of at least 5% of coded data.
Train coders on VA policies and VistA/CPRS workflows and prepare monthly and quarterly reports.
Aptive Resources provides healthcare staffing and program support to federal agencies, including coding services for Veterans Affairs medical centers. As part of a Service-Disabled, Veteran-Owned Small Business joint venture, the company emphasizes an agile, mission-focused, results-driven approach.