Medical Coder jobs at MaineGeneral Health - 18 jobs

Job Description NECS is currently seeking a full-time Remote Monday- Friday Billing Coder/Abstractor to join our professional billing team. The Coder / Abstractor accurately assigns diagnosis and procedure codes to patient records using ICD-10-CM and CPT systems, for the purpose of reimbursement and compliance with federal regulations according to diagnosis(es) and procedure(s). Analyze and review records for completeness; and coordinates the follow-up on deficient/delinquent new patient records. Abstract data for accuracy of coding and diagnosis, input ICD-10 codes from documentation into the EMR (Onco), and work closely with Billing Office and New Patient Teams to ensure correct diagnosis coding in the EMR NECS is a private medical practice composed of 18 oncologists and hematologists serving the region from 4 different locations in Maine and New Hampshire. Our mission is to make life better for people with cancer and blood disorders. Kindness, compassion, and respect are part of everything that we do - from our phone operators to our physicians, every person on our team is important, and everyone makes a difference. We are proud to be an adult oncology member of the Dana-Farber Cancer Care Collaborative, striving to provide the highest quality care and unmatched, holistic support for every patient, every day. Essential Duties and Responsibilities: Identifies and corrects data errors in process of chart review for accuracy and completeness of information. Responsible for input of coded information utilizing various programs within the computer system efficiently and timely. Enters correct ICD-10/CPT codes on all diagnoses and procedures into EMR. Acts as liaison between the Billing Department and medical staff, clinical staff for coding and documentation issues. Abstracts records to ensure proper submission of services prior to billing on predetermined selected patients. Knowledge, Skills and Abilities: Ability to understand basic billing and coding concepts. Ability to define problems, collect data, establishes facts, and draw valid conclusions. Able to demonstrate full knowledge of insurance payers. Must have ICD-10 and CPT/ICD-10 Coding. Ability to learn new computer applications quickly and independently and become a skilled user of the company's proprietary database. Demonstrated familiarity with a variety of practice management software, including: EMR(s). Requirements, Skills and Abilities High School Diploma or GED required. Certified Coder preferred At least two (2) years of coding experience; with CPT/ICD-10 & HCPCS coding for physician professional charges preferred Demonstrated knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines and principles required. Abides by the Standards of Ethical Coding as set for by AAPC and AHIMA Ability to understand basic billing and coding concepts. Ability to define problems, collect data, establishes facts, and draw valid conclusions. Able to demonstrate full knowledge of insurance payers. Must have ICD-10 and CPT/ICD-10 Coding. Ability to learn new computer applications quickly and independently and become a skilled user of the company's proprietary database. Demonstrated familiarity with a variety of practice management software, including: EMR(s). Benefits: New England Cancer Specialists offers competitive pay and a comprehensive benefits package to our employees. Our benefits include medical, prescription, dental, and vision insurances. Company-paid Life Insurance, Short Term, and Long-Term disability insurances as well as Long Term Care insurance. Other benefits include a company-sponsored retirement program, generous Paid Time Off in addition to 10 Company-paid holidays, a Wellness Program, and other voluntary benefits.

Central Maine Healthcare is seeking a Full Time, Record Analyst to join our Health Information Management team! is on-site in Lewiston, Maine. The Record Analyst, HIM assures that all records are assembled accurately. Performs cross-checks to assure that all appropriate documents are received from the nursing units/service areas and follows up to obtain necessary information in a timely manner. Performs quality review checks on all discharges and outpatient medical records to assure that required physician, nursing and clinical service documentation meets regulatory and accreditation standards and guidelines. Education and Experience: High school diploma required Associate degree in Health Information Technology (RHIT) preferred Equal Employment Opportunity: CMH actively promotes diversity in its workforce at all levels of the organization. We strive to create and maintain a setting where we celebrate cultural and other differences and consider them strengths of the organization. CMH is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities. About Central Maine Healthcare: Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application! Employment Status Full Time Shift Days

**Become a part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** + Additional Job Description **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2040 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Will provide quality services to all customers (e.g. clients and employees), which requires assistance from the HIM central department. Services might include release of information, audit support, document imaging or scanning, and other technical functions. Assists with the maintenance of permanent clinical records with respect to the retention, retrieval, control and disposal of those records. Knowledge on mental health regulatory and funding agencies such as licensing, Medicaid, Medicare, etc. Above average proficiency in the use of computer programs is essential; including, Microsoft Windows applications, Access database environments and spreadsheet applications. Experience working in networked computer environment is desirable. Experience and/or training in managing medical records required. **CHCS believes in the importance of work-life balance, we offer generous leave time with paid sick & vacation time plus seven paid holidays and five paid float holiday time to our full-time staff and pro-rated time for part-time staff.** Notice of Non-Discrimination Discrimination is Against the Law In accordance with all applicable state and federal laws and regulations cited below, Community Health and Counseling Services (CHCS) does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, pay transparency, and status as a protected veteran, or any other trait that is protected under local, state or federal law in admission or access to, or treatment or employment in, its programs or activities.

DIAGNOSTIC CODER 2CD02 PVH employment application required. All job offers contingent upon background check and completion of pre-employment physical. Position is part time, 24 hours per week. This role is primarily remote, but the selected candidate must be Maine-based and available to report onsite in Lincoln, Maine 1-2 days per month for departmental collaboration. Hourly rate, shift differential as worked, non-exempt, union. JOB FUNCTIONS 1. Review and process records. 2. Assign codes. 3. Checks for record completeness and distributes record deficiencies appropriately. 4. Sends records to scanning at completion. 5. Answers telephone promptly. 6. Retrieves information requested. 7. Provides customer service support to all visitors of the department as appropriate. 8. Completes statistical reports as advised by the Department Director. 9. Works with PFS on Insurance follow-up. 10. Completes other duties assigned. Quality Improvement: Actively participates in the Hospital-wide Quality Improvement Program, actively supports and implements Department-specific Quality improvement initiatives and projects, recommends process improvement as appropriate, reports any quality issues in service delivery and consistently commits to a focus on quality improvement and organizational excellence. Disaster Management: As an employee of Penobscot Valley Hospital, the position has an inherent role to care for our community members when in need. To this regard, the incumbent will be expected to participate in emergency/disaster preparedness planning and drills as requested. When called upon during a real life disaster/emergency event, the incumbent will be expected to participate in the Hospital's response to this event, within the scope of professional and personal ability to do so. Requirements High school graduate. Basic knowledge of medical terminology, anatomy and physiology. Training in the assignment of ICD and CPT codes, maintaining CCS (Certified Coding Specialist) credentials through AHIMA or AAPC. Medical secretarial training and/or experience in hospital or physician office medical coding. Basic computer and typing skills. Benefits PVH has a Section 125 Cafeteria Benefits Plan and pays a portion of the cost of our health plan, dental, basic life, and disability insurance for employees with 30+ authorized hours, and provides partial subsidy for dependent health insurance. Part-time employees are eligible to receive dental, life, and disability coverage and are eligible to participate in the health insurance plan. Other benefits include a 403(b) plan and earned time off accrual.

This position is responsible for processing all release of information requests in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations. **Essential Job Functions:** + Completes release of information requests including retrieving patient's medical chart and returning chart, scanning medical record accurately and correctly and transmitting daily, according to requests, established procedures, and established standards of quality and productivity. + Date stamps all requests and highlights pertinent data to facilitate processing. + Validates requests and authorizations for release of medical information according to established procedures. + Performs quality checks on all work to assure accuracy of the release, confidentiality, and proper invoicing. + Maintain equipment in excellent operating condition (inside and out). + Provides excellent customer service by being attentive and respectful; insures understanding of customer request and follows-through as promised; and being proactive in identifying client concerns, or problems. + May receive incoming requests including opening mail, telephone inquiries, and retrieving facsimile inquiries, depending on the needs to the client. + Maintains a neat, clean, and professional personal appearance and observes the dress code established. + Maintains a clean and orderly work area, insures that records and files are properly stored before leaving area. + Maintains working knowledge of the existing state laws and fee structure + Works within scope of position and direction; willingly accepts assignments and is available to take on additional facilities or help out during backlogs + Carries out responsibilities in accordance with client/site policies and procedures, including HIPAA, state/federal regulations related to operations, and labor regulations. + Maintains confidentiality, security and standards of ethics with all information. + Work with privileged information in a conscientious manner while releasing medical records in an efficient, effective, and accurate manner. **Qualifications:** + High School Diploma (GED) required + A minimum of 2 years prior experience in a medical records department or like setting preferred + Must have strong computer software experience - general working knowledge of Microsoft Word and Excel required + Requires ability to work remotely and at times provide support in client locations. Geographical proximity to the assigned client site required. + Excellent organizational skills a must + Must be able to type 50 wpm + Must be able to use fax, copier, scanning machine + Must be willing to learn new equipment and processes quickly. + Must be self-motivated, a team player + Must have proven customer satisfaction skills + Must be able to multi-task Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.

This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements. **ESSENTIAL RESPONSIBILITIES** + Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements. + Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding. + Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies. + Engages in RPM Coding educational meetings and annual coding Summit. + Other duties as assigned. **EDUCATION** **Required** + None **Substitutions** + None **Preferred** + Associate degree in medical billing/coding, health insurance, healthcare or related field preferred. **EXPERIENCE** **Required** + 3 years HCC coding and/or coding and billing **Preferred** + 5 years HCC coding and/or coding and billing **LICENSES or CERTIFICATIONS** **Required** (any of the following) + Certified Professional Coder (CPC) + Certified Risk Coder (CRC) + Certified Coding Specialist (CCS) + Registered Health Information Technician (RHIT) **Preferred** + None **SKILLS** + Critical Thinking + Attention to Detail + Written and Oral Presentation Skills + Written Communications + Communication Skills + HCC Coding + MS Word, Excel, Outlook, PowerPoint + Microsoft Office Suite Proficient/ - MS365 & Teams **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Remote Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $26.49 **Pay Range Maximum:** $41.03 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273522

**About Us** Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: + We serve faithfully by doing what's right with a joyful heart. + We never settle by constantly striving for better. + We are in it together by supporting one another and those we serve. + We make an impact by taking initiative and delivering exceptional experience. **Benefits** Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: + Eligibility on day 1 for all benefits + Dollar-for-dollar 401(k) match, up to 5% + Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more + Immediate access to time off benefits At Baylor Scott & White Health, your well-being is our top priority. Note: Benefits may vary based on position type and/or level **Job Summary** + The Coder 2 is skilled in three or more types of outpatient, Profee, or low acuity inpatient coding. + The Coder 2 may code low acuity inpatients, one-time ancillary/series, emergency department, observation, day surgery, and/or professional fee, including evaluation and management (E/M) coding or profee surgery. + For professional fee coding, team members in this job code are proficient for inpatient and outpatient, for multi-specialties. + The Coder 2 uses the International Classification of Disease (ICD-10-CM, ICD-10-PCS), Healthcare Common Procedure Coding System (HCPCS), including Current Procedural Terminology (CPT), and other coding references. + These references ensure accurate coding and grouping of classification assignments (e.g., MS-DRG, APR-DRG, APC, etc.). + The Coder 2 will abstract and enter required data. The pay range for this position is $26.66 (entry-level qualifications) - $40.00 (more experienced) The specific rate will depend upon the successful candidate's specific qualifications and prior experience. **Essential Functions of the Role** + Examines and interprets documentation from medical records and completes accurate coding of diagnosis, procedures and professional fees. + Reviews diagnostic and procedure codes and charges in the applicable documentation system to generate appropriate coding and billing. + Communicates with providers for missing documentation elements and offers guidance and education when needed. + Reconciles billing issues by formulating the rationale for rejecting and correcting inaccurate charges. + Works collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately. + Reviews and edits charges. **Key Success Factors** + Sound knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area. + Sound knowledge of transaction code sets, HIPAA requirements and other issues impacting the coding and abstracting function. + Sound knowledge of anatomy, physiology, and medical terminology. + Demonstrated proficiency of the use of computer applications, group software and Correct Coding Initiatives (CCI) edits. + Sound knowledge of ICD-10 diagnosis and procedural coding and Current Procedural Terminology (CPT) procedural coding. + Ability to interpret health record documentation to identify procedures and services for accurate code assignment. + Flexibility and adaptability while also balancing requirements and regulatory and accreditation guidelines that are non-negotiables. **Belonging Statement** We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve. **QUALIFICATIONS** + EDUCATION - H.S. Diploma/GED Equivalent + EXPERIENCE - 2 Years of Experience + Must have ONE of the following coding certifications: + Cert Coding Specialist (CCS) + Cert Coding Specialist-Physician (CCS-P) + Cert Inpatient Coder (CIC) + Cert Interv Rad CV Coder (CIRCC) - Cert Outpatient Coder (COC) + Cert Professional Coder (CPC) + Reg Health Info Administrator (RHIA) + Reg Health Information Technician (RHIT). As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

# At York Hospital, we#re more than a hospital.# We are a team of providers, clinicians and staff members offering expertise within a Hospital setting, our community sites, and physician practices located throughout Southern Maine and the NH seacoast. Our caregivers# commitment is to make a positive difference in the lives of one another, our patients and our community by instilling our vision of Loving Kindness for all.# # York Hospital, we are a Community. For Life. # We are looking for an experienced#Physician Coding # Charge Entry candidate.# This is a#part time, 24hrs/wk#position working in York Hospital#s Physician Practice Patient#Billing Team.# The hours for this position are#3 days/week#8:00am-4:30pm.# This position is located in York, Maine. # Primary responsibilities include: # # ######## Reviewing, posting and ensuring appropriate Medical Codes are utilized using ICD-10-CM and CPT-4 coding conventions. # ######## Periodically reviews medical records to assure specificity of diagnoses, procedures and appropriate/optimal reimbursement for professional charges. # ######## Provides follow up with physicians, staff and management related to any findings. # In order to help us continue to provide exceptional patient/customer service experiences, you must have the following: # # ######## Minimum (2) years of experience in#coding with ICD-10-CM and CPT. Inpatient/Hospital preferred # ######## Excellent customer service. # ######## Computer skills to#include Microsoft Office Suite.# Knowledge of McKesson#s Paragon software a plus. # ###### Certification AHIMA or AAPC preferred. YORK HOSPITAL IS AN EQUAL OPPORTUNITY EMPLOYER. At York Hospital, we're more than a hospital. We are a team of providers, clinicians and staff members offering expertise within a Hospital setting, our community sites, and physician practices located throughout Southern Maine and the NH seacoast. Our caregivers' commitment is to make a positive difference in the lives of one another, our patients and our community by instilling our vision of Loving Kindness for all. York Hospital, we are a Community. For Life. We are looking for an experienced Physician Coding & Charge Entry candidate. This is a part time, 24hrs/wk position working in York Hospital's Physician Practice Patient Billing Team. The hours for this position are 3 days/week 8:00am-4:30pm. This position is located in York, Maine. Primary responsibilities include: * Reviewing, posting and ensuring appropriate Medical Codes are utilized using ICD-10-CM and CPT-4 coding conventions. * Periodically reviews medical records to assure specificity of diagnoses, procedures and appropriate/optimal reimbursement for professional charges. * Provides follow up with physicians, staff and management related to any findings. In order to help us continue to provide exceptional patient/customer service experiences, you must have the following: * Minimum (2) years of experience in coding with ICD-10-CM and CPT. Inpatient/Hospital preferred * Excellent customer service. * Computer skills to include Microsoft Office Suite. Knowledge of McKesson's Paragon software a plus. * Certification AHIMA or AAPC preferred. YORK HOSPITAL IS AN EQUAL OPPORTUNITY EMPLOYER.

Sharecare is the leading digital health company that helps people -- no matter where they are in their health journey -- unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit ***************** . **Shifts:** + **Evening Shift:** **Saturday-Wednesday 3p-11:30p EST** + **Night Shift 1:** **Monday-Friday 11p-7:30a EST** + **Night Shift 2:** **Friday-Tuesday 11p-7:30a EST** **Job Summary:** This position is responsible for processing all release of information (ROI) requests in a timely and efficient manner while delivering exceptional customer service. The Associate must safeguard patient privacy at all times by ensuring that only authorized individuals have access to medical records and that all information is released in accordance with the request, applicable authorization, company policies, and HIPAA regulations. **E** **s** **sential Functions:** + Processes ROI requests from facilities timely, accurately, and in accordance with established procedures and quality standards. + Validates requests and authorizations for medical record releases based on company policy and legal guidelines. + Performs quality checks on all work to assure accuracy, confidentiality, and correct billing of all released records. + Maintains equipment in excellent working condition. + Delivers outstanding customer service by being attentive, respectful, and responsive to client needs proactively identifying and resolving concerns. + Maintains a clean, professional appearance and complies with dress code standards. + Maintains up-to-date knowledge of applicable state laws and fee structures. + Works within assigned scope and is flexible in accepting additional assignments or account coverage during backlogs. + Complies with client site policies and procedures, including HIPAA, state and federal regulations, and labor laws. + Handles confidential information with integrity and professionalism while ensuring efficient, accurate record release. **Qualifications:** + High School Diploma or GED required + Minimum of 2 years' ROI fulfillment experience with Sharecare HDS or 3 years' of external ROI experience required + Advanced knowledge of multiple EMR platforms and ROI request types + Strong documentation, communication, and customer service skills + Proficiency in Microsoft Office applications + Strong organizational and multitasking skills essential + Willingness to learn programs and processes quickly + Self-motivated, dependable, and able to work independently or as part of a team + Proven ability to maintain productivity, utilization, and quality performance standards + Strong interpersonal and problem-solving skills **Physical Requirements:** + Ability to sit or stand for extended periods + Physical capacity to lift and carry up to 25 lbs. + Manual dexterity is sufficient for long periods of typing, writing, and handling documents + Visual acuity to read documents and use a computer monitor + Clear speaking and hearing ability for effective communication + Adequate hand-eye coordination and sensory abilities for job-related tasks **Information Governance Accountabilities:** + Understand the organization's information governance program and associated responsibilities + Participate in compliance education and role-specific training **HIPAA/ Compliance:** + Maintain the confidentiality of patient and client information + Comply with HIPAA standards and all relevant corporate integrity and security obligations + Report unethical, fraudulent, or unlawful behavior or activity + Maintain current HIPAA certification annually Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.

Central Maine Healthcare is seeking a Full Time, Specialty Coder to join our Coding Team! The Specialty Coder is accountable for the coding of hospital and outpatient specialty services. Responsibilities include the assignment CPT and ICD-10 codes based on documentation, and ensuring encounters are coded accurately and timely. Essential Duties: Ensures that records are accurately coded within the time frames set by the department to maintain benchmarks in unbilled accounts. Reviews chart thoroughly to ascertain all diagnoses/procedures and billable charges. Utilizes coding/abstracting programs Codes all diagnoses/procedures in accordance to ICD-10-CM and CPT coding principles and guidelines. Posting of CPT and ICD-10 codes. Meets productivity standard established by the department. Maintains quality standard established by the department. Demonstrates knowledge of coding requirements applicable to outpatient, emergency department and hospital-based physician offices. Education and Experience: Certified AAPC /AHIMA coder with 2 or more years of previous experience as medical coder. Knowledge of ICD-10-CM coding principles Knowledge of CPT coding principals Experience with physician E/M coding preferred. Equal Employment Opportunity: CMH actively promotes diversity in its workforce at all levels of the organization. We strive to create and maintain a setting where we celebrate cultural and other differences and consider them strengths of the organization. CMH is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities. About Central Maine Healthcare: Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application! Employment Status Full Time Shift Days

Sharecare is the leading digital health company that helps people -- no matter where they are in their health journey -- unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit ***************** . **Shifts: ** + **Day Shift:** **Wednesday-Monday 7a-3:30p EST** + **Evening Shift:** **Monday-Friday 3p-11:30p EST** **Job Summary:** This position is responsible for processing all release of information (ROI) requests in a timely, efficient, and accurate manner while delivering exceptional customer service. The Associate must safeguard patient privacy at all times by ensuring that only authorized individuals access medical records, and that all information is released in accordance with the request, applicable authorization, company policies, and HIPAA regulations. This role also provides support to team members and management by serving as a subject matter expert, trainer, and escalation point. The Lead plays a key role in ensuring high-quality output and operational consistency by mentoring colleagues, assisting with work assignments, and monitoring quality and productivity metrics. **Essential Functions: ** + Processes ROI requests from facilities timely, accurately, and in accordance with established procedures and quality standards. + Validates requests and authorizations for medical record releases based on company policy and legal guidelines. + Performs quality checks to ensure accuracy, confidentiality, and correct billing of all released records. + Maintains equipment in excellent working condition. + Delivers outstanding customer service by being attentive, respectful, and responsive to client needs proactively identifying and resolving concerns. + Maintains a clean, professional appearance and complies with the company dress code. + Maintains up-to-date knowledge of applicable state laws and fee structures. + Works within assigned scope and is flexible in accepting additional assignments or account coverage during backlogs. + Complies with client site policies and procedures, including HIPAA, state/federal regulations, and labor laws. + Handles confidential information with integrity and professionalism while ensuring efficient, accurate record release. + Provides onboarding and training services for new employees. + Supports customer service by managing escalations and resolving issues. + Communicates regularly with supervisors and managers regarding quality, client concerns, or system issues. + Assists with administrative tasks such as queue management and work assignments. + Produce reports and metrics as requested. **Qualifications: ** + High School Diploma (GED) required; degree preferred + Minimum 3 years' ROI fulfillment experience with Sharecare HDS or 4 years of external ROI experience required + Advanced knowledge of multiple EMR platforms and ROI request types + Strong organizational and multitasking skills essential + Proficiency in Microsoft Office applications + Strong documentation, communication, and customer service skills + Demonstrated ability to manage time effectively and meet task deadlines + Willingness to learn programs and processes quickly + Self-motivated, dependable, and able to work independently or as part of a team + Proven ability to maintain productivity, utilization, and quality performance standards + Strong interpersonal and problem-solving skills + Serve as the Subject Matter Expert (SME) for assigned customer accounts, demonstrating strong skills in documentation, communication, and organization + Demonstrates strong leadership abilities + Ability to assist with onboarding and training of new employees + Ability to monitor production, utilization, and quality of employees + Ability to assist with adhering to customer SLAs, including turnaround time (TAT) **Physical Requirements: ** + Ability to sit or stand for extended periods + Physical ability to lift and carry up to 25 lbs. + Manual dexterity is sufficient for long periods typing, writing, and handling documents + Visual acuity to read documents and use a computer monitor + Clear speaking and hearing ability for communication + Adequate Hand-eye coordination and sensory abilities for job-related tasks **Information Governance Accountabilities: ** + Understand the organization's information governance program and the role's responsibilities + Participate in required education and compliance training **HIPPA/ Compliance: ** + Maintain the confidentiality of patient and client information + Comply with HIPAA standards and all relevant corporate integrity and security obligations + Report any unethical, fraudulent, or illegal behavior + Maintain current HIPAA certification annually Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.

This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. **ESSENTIAL RESPONSIBILITIES** + Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) + Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) + Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) + Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. (5%) + Performs other duties as assigned or required. (5%) **QUALIFICATIONS:** Minimum + High School / GED + 1 year in Hospital coding + Successful completion of coding courses in anatomy, physiology and medical terminology + Certified Coding Specialist (CCS) **OR** Certified In-patient Professional Coder (CIC) + Familiarity with medical terminology + Strong data entry skills + An understanding of computer applications + Ability to work with members of the health care team Preferred + Associate's degree in Health Information Management or Related Field **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $23.03 **Pay Range Maximum:** $35.70 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J272373

**Become a part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-12-2035 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Sharecare is the leading digital health company that helps people -- no matter where they are in their health journey -- unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit ***************** . **Job Summary:** This position is responsible for processing all release of information requests in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations. **Essential Functions:** + Completes release of information requests including retrieving patient's medical chart and returning chart, scanning medical record accurately and correctly and transmitting daily, according to requests, established procedures, and established standards of quality and productivity. + Date stamps all requests and highlights pertinent data to facilitate processing. + Validates requests and authorizations for release of medical information according to established procedures. + Performs quality checks on all work to assure accuracy of the release, confidentiality, and proper invoicing. + Maintain equipment in excellent operating condition (inside and out). + Provides excellent customer service by being attentive and respectful; insures understanding of customer request and follows-through as promised; and being proactive in identifying client concerns, or problems. + May receive incoming requests including opening mail, telephone inquiries, and retrieving facsimile inquiries, depending on the needs to the client. + Maintains a neat, clean, and professional personal appearance and observes the dress code established. + Maintains a clean and orderly work area, insures that records and files are properly stored before leaving area. + Maintains working knowledge of the existing state laws and fee structure + Works within scope of position and direction; willingly accepts assignments and is available to take on additional facilities or help out during backlogs + Carries out responsibilities in accordance with client/site policies and procedures, including HIPAA, state/federal regulations related to operations, and labor regulations. + Maintains confidentiality, security and standards of ethics with all information. + Work with privileged information in a conscientious manner while releasing medical records in an efficient, effective, and accurate manner. **Qualifications:** + High School Diploma (GED) required + A minimum of 2 years prior experience in a medical records department or like setting preferred + Must have strong computer software experience -- general working knowledge of Microsoft Word and Excel required + Excellent organizational skills are a must + Must be able to type 50 wpm + Must be able to use fax, copier, scanning machine + Must be willing to learn new equipment and processes quickly. + Must be self-motivated, a team player + Must have proven customer satisfaction skills + Must be able to multi-task Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.

This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days. **ESSENTIAL RESPONSIBILITIES** + Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. (60%) + Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) + Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) + Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work.(5%) + Acts as a mentor and subject matter expert to others. (5%) + Performs other duties as assigned or required. (5%) **QUALIFICATIONS:** Minimum + High School/GED + 5 years of Hospital and/or Physician Coding + 1 year of Coding - all specialties and service lines + Extensive knowledge in Trauma/Teaching/Observation guidelines + Successful completion of coding courses in anatomy, physiology and medical terminology + Any of the following: + Certified Coding Specialist (CCS) + Registered Health Information Technician (RHIT) + Registered Health Information Associate (RHIA) + Certified Coding Specialist Physician (CCS-P) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) Preferred + Associate's Degree **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $23.03 **Pay Range Maximum:** $35.70 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J270102

**Become a part of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Where you Come In** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will: + Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered + Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding + Utilize encoders and various coding resources + Perform CPT/HCPCS Procedure reviews + Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed + Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information + Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols + Complete appropriate system(s) entry regarding claim/encounter information + Support and participate in process and quality improvement initiatives **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. **Use your skills to make an impact** **WORK STYLE:** 100% work at home/remote **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, depending on business needs **Required Qualifications - What it takes to Succeed** + CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience + Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures + Strong knowledge of CPT/HCPCS coding + Experience reading & coding from operative reports + Chemotherapy/Therapeutic Infusion experience + Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information + Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities + Comfortable working in a production-based work environment + Ability to work independently and manage workload + Strong written and verbal communication skills; strong analytical, organizational and time management skills + Working knowledge of Microsoft Office Programs (Word, Excel) **Preferred Qualifications** + 5+ years prior coding experience + Minimum of 3 years post certification experience reading and interpreting claims + Outpatient facility auditing experience + Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology + Ambulatory Payment Classification (APC) coding experience + Radiation Oncology coding experience + Experience in prospective payment methodologies + Experience with the Claims Life Cycle including Accounts Receivable + 3M Coder software experience **Additional Information** **Work at Home Requirements** - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************