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.
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.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
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.
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.
Monitor incoming faxes for authorization requests, enter UM authorizations review requests, and verify eligibility and claims history.
Ensure all necessary documentation is submitted, contact providers for required medical records, and generate correspondence for notifications.
Initiate appeal cases, meet deadlines, assist UM Nurses, and handle inquiries from call centers and other sources.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly and fairly. While the company size is not mentioned, they seem to have a modern approach by utilizing AI tools in the hiring process to identify top-fitting candidates for their client companies.
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.
Train all new coders on department policies, procedures and correct coding principles
Analyze coder's workload and make recommendations to assigned supervisor to ensure all work is completed by the specified timeframes
Research and provide guidance to coders and other DHMF/CSH staff on coding-related questions or concerns
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. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.
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.
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.
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.
Review encounter documentation to confirm reported services.
Resolve pre-bill edits to confirm correct coding (modifier, diagnosis, CPT, and HCPCS review).
Educate providers on correct coding and documentation guidelines.
Northwestern Medicine is committed to prioritizing every patient interaction to cultivate a positive workplace. Because of its patient-first approach, the company stands as a leader in the healthcare industry with competitive benefits that take care of its employees.