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
$26.5-41 hourly 30d ago
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Coding Specialist
Deerfield Management Companies 4.4
Medical coder job in Durham, NC
Exciting Career Opportunity with Avance Care!
Join our rapidly expanding network of 37 practice locations in the Triangle Area (Raleigh-Durham-Chapel Hill), the Charlotte Region, and Wilmington, NC.
Avance Care is dedicated to elevating the standard of healthcare. As one of North Carolina's largest networks of independent primary care practices, we offer comprehensive services to support the physical, mental, and emotional health of our patients.
As a Coding Specialist, you'll support and maintain coding compliance and patient assessments by applying Certified Professional Coding (CPC) principles to claim documentation process, reducing institutional, legal and financial risk.
This is a full-time role involving 8 hours weekday shifts with no weekends schedule.
We operate in a busy, fast-paced environment, and we seek a candidate who thrives under such conditions.
We offer a comprehensive benefits package available on the first of the month following 30 days of employment.
Selected Responsibilities:
Actively abstract and code daily patient encounters through chart documentation, billing for all services, and appropriate assignment of E&M coding related to chart documentation, time, and medical decision making
Thorough understanding of clinic coding (E/M) documentation requirements and HCC concepts impacting population Health Risk Adjustment reimbursement initiatives
Ability to review documentation and abstract all codes with specific emphasis on identifying the most accurate severity of illness according to CMS HCC guidelines
Maintains knowledge regarding policies and procedures with Medicare/Medicaid Carriers and third-party payers, including HCC and RAF guidelines
Effectively work with and support providers through structured communication as it related to chart documentation and coding practices
Understand and apply Correct Coding Initiative (CCI) edits and modifiers, as sometimes specifically required by 3
rd
party payers or Medicare
Assign missing procedure CPT, or HCPCS from the Current Procedure Manual and Common Procedure Coding System Manual when necessary
Candidates should preferably have one of the following certifications: Certified Professional Coder (CPC) required, Certified Professional Coder (CPC-A) preferred, or Certified Risk Adjustment Coder (CRC) highly preferred along with at least one year of E&M Coding experience.
Other Priorities:
Strong verbal and written communication
Knowledge of insurance practices
Knowledge of CPT, HCPCs, and ICD-10 coding
Time management and workload prioritization skills
If you are excited to join a growing organization focused on changing the way healthcare is delivered to patients in North Carolina, please submit your resume.
All offers of employment are contingent upon the successful completion of a background check and drug screen.
Avance Care provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to religion, race, creed, color, sex, sexual orientation, gender identification, alienage or citizenship status, national origin, age, marital status, pregnancy, disability, veteran or military status, predisposing genetic characteristics or any other characteristic protected by applicable federal, state or local law.
$97k-120k yearly est. Auto-Apply 60d+ ago
MEDICAL CODER SPECIALIST
Duke University 4.6
Medical coder job in Durham, NC
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. About Duke Health's Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
Occ Summary
The MedicalCoder Specialist will have frequent and daily interactions with internal and external clients, including but not limited to physicians and Non-physician Surgical Providers. Responsibilities include primary diagnosis and procedural coding for the designated major surgical specialty areas and other major procedural areas, including capture of applicable Physician Quality Reporting System (PQRS) and reconciliation of all surgical cases performed at each hospital where applicable. The MedicalCoder Specialist focuses their work on the detailed physician surgical chart abstraction, as well as being an immediate liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes for the providers in these areas. Surgical abstraction coding is defined as the identification of codes based solely on the source documentation for CPT and ICD-10-CM, respectively.
Work Performed
Primarily code from final surgical/procedural operative reports signed by the provider. Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions. Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures. Correlate information from "approved" supporting clinical documentation, not limited to Pathology, Radiology, and/or other Physician Consultations, after review by the Attending Physician, wherever appropriate. Provide education/training to physicians and other providers on coding and clinical documentation. Consult with and educate/train physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Provide real-time feedback to surgical/procedural providers as it pertains to proper coding and clinical documentation of services performed. Engage in provider/ department contact and education as the primary liaison for clarification of documentation and coding for defined surgical operative cases, including documentation deficiencies. Mentor and assists in the training of other coders within the department.
Participate in the development of coding policies and procedures as identified. Coordinate/mentor the work of designated coding employees to ensure quality and quantity of work performed through regular audits. Assist with research and development of presentation materials for continuing education programs for physician in their areas of specialization. Interact with and provide high-level analysis of trends to Management, Revenue Managers, and others about coding-related issues. Researches and identifies trends in unbilled accounts. Contact appropriate personnel for clinical documentation inefficiencies. Coordinate quality reporting measures with/ providers and revenue managers/management (PQRS). Collaborate with appeal and edit coders to expedite the resolution of accounts. Use authorized electronic media/ systems for Physician and Non-physician Clinician documentation, Coding Abstraction for each Surgical Procedure, Review of CCI Edits, LCD, and NCD coverage. Perform other related duties incidental to the work described herein.
Knowledge, Skills, and Abilities
Extensive knowledge of coding surgical procedures, applicable modifiers in a multi-specialty setting. Understands and applies appropriate Center Medicare Services guidelines to coding Advanced ICD-10-CM & CPT-4 coding conventions, Anatomy and Physiology, Medical Terminology. Extensive DRG/APC reimbursement knowledge, Coding software familiarity, Effective written and verbal communication skills, Data entry/CRT
Level Characteristics
Code and abstract from Surgical Operative Notes while providing the primary communication with/ specialty surgical providers in the health system.
Minimum Qualifications
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation, or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Education
Bachelor's degree in medical record administration or associate degree in medical record technology, or a year coding diploma or courses in Medical Terminology, Anatomy & Physiology with extensive training in coding.
Experience
Requires four years of coding experience, with at least two of those years in surgical abstraction (physician or medical group in multi-specialty surgical practices, i.e., Cardiothoracic Surgery, Neurosurgery, General Surgery, Orthopedics, etc.).
Degrees, Licensures, Certifications
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS), or Certified Professional Coder (CPC)
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Nearest Major Market: Durham
Nearest Secondary Market: Raleigh
$55k-71k yearly est. 10d ago
Entry -Level Medical Coder
Revel Staffing
Medical coder job in Raleigh, NC
A confidential healthcare organization in Raleigh is seeking a motivated Entry -Level MedicalCoder / Billing Assistant to join their administrative team. This position offers a great pathway into the healthcare field for individuals interested in medical billing and coding.
Key Responsibilities
Code medical procedures accurately for billing and insurance claims.
Prepare financial reports and submit claims to insurance companies or patients.
Enter and maintain patient data in administrative and billing systems.
Track outstanding claims and follow up on unpaid accounts.
Communicate with patients to discuss balances and develop payment plans.
Maintain confidentiality and comply with HIPAA and all healthcare regulations.
Qualifications
High school diploma or equivalent required; healthcare coursework a plus.
MediClear or equivalent compliance credential required.
Strong communication, organization, and time -management skills.
Ability to remain professional and calm while working with patients and insurance representatives.
Basic computer proficiency and familiarity with billing software or EMR systems preferred.
Why Join Us
Excellent opportunity for those starting a career in healthcare administration.
Supportive, team -oriented work environment.
Comprehensive benefits and advancement potential within a growing healthcare organization.
$44k-64k yearly est. 52d ago
Senior Medical Coder
Biodata Partners
Medical coder job in Raleigh, NC
Perform dictionary coding in accordance with study specific coding conventions using MedDRA and WHO Drug within various coding systems. Manage end-to-end delivery of clinical data management coding responsibilities concurrently for single/multiple projects ensuring quality and timeliness. Provide leadership and mentorship to Medical Coding Specialists as needed. Create, review, and maintain guidance and training documentation for coding guidelines an accordance with ICH guidance, official coding guidelines and dictionary definitions
Responsibilities:
Perform coding in accordance with study specific coding conventions as outlined in the Data Management Plan (DMP)
Perform coding using MedDRA and WHO Drug of (eCRF) verbatim terms using various coding systems
Provide independent review of coded data by ensuring consistent code assignment within a project by reviewing coding and re-assignment
Responsible for medical coding review, synonym dictionaries review, therapeutically aligned coding conventions
Create, review, and maintain guidance and training documentation for coding guidelines an accordance with ICH guidance, official coding guidelines and dictionary definitions
Provide support to other departments concerning dictionary use and code assignment
Ensure compliance with industry quality standards, regulations, guidelines and procedures
Management of query assignment within eCRF systems for questionable verbatim terms
Preparation of specific study coding reports for accuracy and consistency as well as client requirements
Interaction with clients regarding specific coding requests and coding timelines
Participate in system upgrades, including User Acceptance Testing (UAT) to maintain a validated coding environment
Perform coding related study close activities ensuring all coding is accurate and proper documentation is complete
Liaise with Clinical Data Managers and Programmers for purposes of project requirements
Communicate issues that require decisions, including proposal for a solution
CTCAE coding and review
Experience:
5+ years in Pharmaceutical/Biotechnology industry or CRO environment
Thorough knowledge and experience with WHODrug AND MedDRA dictionaries
Knowledge of ICH/GCP guidelines, 21 CFR Part 11 and clinical trial methodology
Excellent verbal and written communication skills
Detail oriented, ability to multitask with strong prioritization, planning and organization skills
Excellent team player
Proficiency in Microsoft Office Applications
Working knowledge of MedDRA and WHODrug best practice documents
Good understanding of Clinical Data Management processes and the applicable regulatory requirements
Good overview of all systems lined to the coding process, and understanding of their interactions and dependencies
Education:
Bachelor of Science degree in biology or health-related field preferred
Language Skills Required:
Speaking: English (Required)
Writing/Reading: English (Required)
$44k-64k yearly est. 60d+ ago
Senior Inpatient HIM Coder
Oracle 4.6
Medical coder job in Raleigh, NC
**About the Role:** We are seeking a highly skilled and experienced Senior Inpatient HIM Coder to join our dynamic healthcare information management team. This role is crucial in bridging the gap between clinical data and technology, as we aim to develop cutting-edge AI solutions for medical coding and billing processes. The successful candidate will play a pivotal role in providing valuable insights and expertise to enhance our product development efforts.
**Requirements and Qualifications:**
+ A minimum of 3 years of hands-on experience as an acute HIM inpatient medicalcoder in a hospital environment.
+ Proficiency in identifying and extracting ICD-10-CM, ICD-10-PCS, HCPCS/CPT codes, and associated modifiers from patient records.
+ In-depth understanding of supporting evidence requirements for accurate coding.
+ Practical experience using grouper software for MS-DRG and APR-DRG assignment.
+ Strong communication skills to interact effectively with the billing department regarding coding-related issues.
+ Stay abreast of the latest ICD-10-CM, ICD-10-PCS, HCPCS/CPT coding guidelines and updates.
+ Familiarity with 3M 360 or Optum HIM encoder software is preferred.
+ AHIMA Certified RHIA or RHIT certification is mandatory.
+ Associate's or Bachelor's degree in Health Information Management (HIM) is required.
**Responsibilities**
**Job Responsibilities:**
+ Collaborate closely with product management and engineering teams to contribute to the creation and improvement of AI models for medical coding.
+ Utilize your extensive knowledge in acute HIM inpatient medical coding to train and validate AI systems in extracting ICD-10-CM, ICD-10-PCS, and HCPCS/CPT codes, along with relevant modifiers from diverse clinical documentation.
+ Assist in the development of AI algorithms to generate precise MS-DRGs for accurate reimbursement.
+ Perform data collection, entry, verification, and analysis tasks to monitor and evaluate the performance of AI models against defined business goals.
+ Serve as a subject matter expert, ensuring the quality and integrity of medical coding data used in product development.
Disclaimer:
**Certain US customer or client-facing roles may be required to comply with applicable requirements, such as immunization and occupational health mandates.**
**Range and benefit information provided in this posting are specific to the stated locations only**
US: Hiring Range in USD from: $75,000 to $178,100 per annum. May be eligible for bonus and equity.
Oracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle's differing products, industries and lines of business.
Candidates are typically placed into the range based on the preceding factors as well as internal peer equity.
Oracle US offers a comprehensive benefits package which includes the following:
1. Medical, dental, and vision insurance, including expert medical opinion
2. Short term disability and long term disability
3. Life insurance and AD&D
4. Supplemental life insurance (Employee/Spouse/Child)
5. Health care and dependent care Flexible Spending Accounts
6. Pre-tax commuter and parking benefits
7. 401(k) Savings and Investment Plan with company match
8. Paid time off: Flexible Vacation is provided to all eligible employees assigned to a salaried (non-overtime eligible) position. Accrued Vacation is provided to all other employees eligible for vacation benefits. For employees working at least 35 hours per week, the vacation accrual rate is 13 days annually for the first three years of employment and 18 days annually for subsequent years of employment. Vacation accrual is prorated for employees working between 20 and 34 hours per week. Employees working fewer than 20 hours per week are not eligible for vacation.
9. 11 paid holidays
10. Paid sick leave: 72 hours of paid sick leave upon date of hire. Refreshes each calendar year. Unused balance will carry over each year up to a maximum cap of 112 hours.
11. Paid parental leave
12. Adoption assistance
13. Employee Stock Purchase Plan
14. Financial planning and group legal
15. Voluntary benefits including auto, homeowner and pet insurance
The role will generally accept applications for at least three calendar days from the posting date or as long as the job remains posted.
Career Level - IC4
**About Us**
As a world leader in cloud solutions, Oracle uses tomorrow's technology to tackle today's challenges. We've partnered with industry-leaders in almost every sector-and continue to thrive after 40+ years of change by operating with integrity.
We know that true innovation starts when everyone is empowered to contribute. That's why we're committed to growing an inclusive workforce that promotes opportunities for all.
Oracle careers open the door to global opportunities where work-life balance flourishes. We offer competitive benefits based on parity and consistency and support our people with flexible medical, life insurance, and retirement options. We also encourage employees to give back to their communities through our volunteer programs.
We're committed to including people with disabilities at all stages of the employment process. If you require accessibility assistance or accommodation for a disability at any point, let us know by emailing accommodation-request_************* or by calling *************** in the United States.
Oracle is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability and protected veterans' status, or any other characteristic protected by law. Oracle will consider for employment qualified applicants with arrest and conviction records pursuant to applicable law.
$75k-178.1k yearly 40d ago
Coder II (Clinic & E/M Coding)
Baylor Scott & White Health 4.5
Medical coder job in Raleigh, NC
**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.
$26.7 hourly 43d ago
Qualified Professional (QP)
Freedom House Recovery Center 4.2
Medical coder job in Chapel Hill, NC
Provide assessments, Person Centered Planning, authorization for services and immediate interventions.
· Ensure the provision of services needed by individuals in the most appropriate environment of consumer's choice.
· Provide screening, interviews and assessments in a professional and engaging manner, including the required information, organizing it for key personnel to suggest level of care for each client assigned, and clearly presenting the information to the treatment team. Completes the required written documentation at the time of the service.
· For each client assigned, provide an orientation that outlines a goal statement, explain and schedule services and clarify the following: confidentiality, client rights, consents for services, and financial requirements.
· Provide Person Centered Planning/treatment planning by preparing the initial diagnosis; describing strengths, preferences and needs; and identifying treatment goals and strategies for each client assigned. Complete and document the treatment/service plan by the time the client enters the service.
· For each client assigned, update the service plan for Person Centered Plan at established target dates
· Establish a therapeutic counseling relationship with each client assigned; facilitate individual, group and family counseling.
· Provide case support by identifying additional services needed for client care, coordinating and collaborating with relevant services, preparing and discussing discharge plan with each client assigned.
· Identify elements of client crisis, respond to client needs to ensure their safety, integrate crisis experience into the treatment process for each client assigned.
· Provide client education by conducting alcohol and other drug education classes, conducting HIV/AIDS classes as assigned.
· For each client assigned, identifies appropriate referral resources, coordinates services with referral resources, and assists client with utilizing referral resources.
· Document progress notes for clients assigned within one working day of service, comply with information guidelines and signature requirements, maintain chart organization, and file in a timely manner.
· Comply with the goals and objectives of supervision contract.
· Pursue staff development opportunities to meet privileging and credentialing requirements, expand skills, and to obtain licensure or certification within 3 years of date of hire or to maintain certification or licensure.
· Regularly attend division team meetings. For clients assigned, provide appropriate and relevant information regarding client care to the treatment team.
· Willingly participate in the collection of urines as requested.
· Use the results of urine test appropriately and as a therapeutic tool to determine the client's progress in treatment.
· Demonstrate a willingness to provide clinic coverage as needed.
· Maintain a schedule approved by supervisor.
· Is reliable in work attendance and follows Freedom House procedures when requesting planned or unplanned leave
$48k-65k yearly est. 30d ago
Medical Record Clerk
Us Tech Solutions 4.4
Medical coder job in Durham, NC
USTECH is a global firm providing a wide-range of talent on-demand and total workforce solutions. Through the USTECH Talent Network of 100% company-owned and managed offices, we provide highly-skilled professionals whose education, skills and experience are vetted and matched to your unique hiring needs, work environment and company requirements.
Our 24x7 global service delivery drives time and cost out of any recruiting and staffing process (15-30% cost reduction in most cases) across all of our services and solutions, providing you with the talent you need on-demand when, where and how you need it.
Job Description
Job Title
:
Medical Record Clerk
JOB ID- :
(14809)
Location
:
Durham, NC 27713
Duration
:
(at first 1+ month contract)
Qualifications:
Candidate will need to have experience indexing medical records and scanning.
This is a special short term project.
Must be able to stand long periods of time and able to lift up to 50 lbs.
Thanks ,
Asma.
Additional Information
All your information will be kept confidential according to EEO guidelines.
$29k-36k yearly est. 1d ago
Certified Medical Billing-Coding Specialist
Axil Health
Medical coder job in Raleigh, NC
Job DescriptionDescription:
Job Title: Medical Billing/Coding Specialist
Type: Full Time (eligible for Benefits Package), Hourly/Non-Exempt
Job Overview: We are seeking a certified, detail-oriented and experienced Medical Billing and Coding Specialist to join our healthcare team. The successful candidate will be responsible for accurately translating medical procedures and diagnoses into standardized codes for billing and insurance purposes. This role requires a strong understanding of medical terminology, coding systems, and compliance with relevant regulations.
Requirements:
Responsibilities:
Review and accurately assign medical codes to diagnoses, procedures, and services using ICD-10, CPT, and HCPCS systems.
Submit clean claims to insurance companies electronically or via paper when necessary.
Collaborate with healthcare providers to obtain necessary documentation for coding.
Verify patient information and ensure accuracy in coding processes.
Resolve billing discrepancies and collaborate with clinical staff for documentation clarification.
Follow up on unpaid or denied claims; resubmit or appeal as appropriate.
Maintain patient confidentiality and comply with all relevant healthcare privacy laws
Communicate effectively with patients, providers, and insurance representatives.
Stay current with coding updates, payer guidelines, and industry regulations.
Assist with special projects and additional tasks on an as needed basis
Qualifications:
Required Certification in medical billing and coding (e.g., CPC, CCS, CCA, or equivalent).
High school diploma or equivalent required; associate degree in healthcare administration or related field preferred.
2+ years of experience in medical billing and coding in a healthcare setting.
Proficient in using electronic health records (EHR) and billing software.
In-depth knowledge of medical terminology, coding systems, and insurance claim processes.
Familiarity with Medicare, Medicaid, and commercial payer requirements preferred.
Strong attention to detail and analytical skills.
Excellent communication and organizational skills.
Ability to work independently and collaboratively in a team environment.
Working Conditions:
Office-based environment with regular business hours (Monday through Friday, 8am to 5pm).
May require occasional overtime during peak periods.
If you meet the qualifications and are passionate about accurate medical coding, we invite you to apply for this rewarding position in our healthcare team.
$35k-45k yearly est. 16d ago
PGA Certified STUDIO Performance Specialist
PGA Tour Superstore 4.3
Medical coder job in Raleigh, NC
Overview (pay range: 15-23 HR) At PGA TOUR Superstore, we are always looking for enthusiastic, self-motivated, flexible individuals who will share a passion for helping transform our business. As one of the fastest growing specialty retailers, we are dedicated to hiring selfless team players from different backgrounds to influence the growth of our organization. Part of the Arthur M. Blank Family of Businesses, PGA TOUR Superstore continuously strives to create a family culture for our Associates - driven by our vision to inspire people through golf and tennis.
Position Summary
Reporting to the Sales and Service Manager, the STUDIO Performance Specialist delivers world-class service through expert instruction and precision fitting. This hybrid role blends the responsibilities of a Golf Instructor and a Fitting Specialist, ensuring every customer receives a tailored experience that improves their game and drives lasting relationships.
The STUDIO Performance Specialist is responsible for achieving KPIs across both fittings and lessons, proactively growing their client base, and maintaining a fully booked schedule. The role also supports the visual and operational excellence of the STUDIO, leveraging advanced technology and product knowledge to deliver measurable performance results.
Key Responsibilities:
Customer Experience & Engagement
* Engage every customer with world-class service by demonstrating PGA TOUR Superstore's Service Behaviors.
* Build lasting relationships that encourage repeat business and client referrals.
* Educate and inspire customers by connecting instruction and equipment performance to game improvement.
Instruction & Coaching
* Conduct one-on-one lessons, clinics, and group events tailored to player needs, goals, and skill levels.
* Utilize technology such as TrackMan, SAM PuttLab, and USchedule to deliver data-driven instruction.
* Develop personalized lesson plans and track student progress, providing constructive feedback and measurable improvement.
* Proactively organize clinics and performance events to build customer engagement and community participation.
Fitting & Equipment Performance
* Execute professional club fittings using PGA TOUR Superstore's certified fitting techniques and technology.
* Maintain a brand-agnostic approach to ensure customers are fit for the best equipment based on their unique swing data and goals.
* Educate customers on product features, benefits, and performance differences across brands.
* Accurately enter and manage custom orders, ensuring all specifications are documented precisely.
Operational & Visual Excellence
* Maintain all STUDIO areas (simulators, components drawers, putting green) to the highest visual and operational standards.
* Ensure equipment, software, and technology remain functional and calibrated.
* Support front-end operations, including returns, lesson redemptions, loyalty programs, and promotions.
* Stay current on marketing campaigns and merchandising events, executing promotional setups and maintaining accurate displays.
Performance & Business Growth
* Achieve key performance indicators (KPIs) such as:
* Lessons and fittings completed
* Sales per hour and booking percentage
* Clinic participation and conversion to sales
* Proactively grow the STUDIO business through client outreach, networking, and relationship management.
* Provide consistent feedback to the Sales and Service Manager to improve operations, merchandising, and customer experience.
Qualifications and Skills Required
* Certification: Only PGA Members and Apprentices in good standing with the PGA of America are eligible for this role. The candidate must maintain good standing with the PGA for the duration of employment. The candidate may be asked to provide proof of PGA membership in the form of a current membership card or proof of membership dues payment.
* Communication: Strong interpersonal, listening, and verbal/written communication skills with the ability to engage and educate customers.
* Technical Proficiency: Working knowledge of Microsoft Office Suite and fitting/instruction technology (TrackMan, SAM PuttLab, USchedule).
* Organization: Ability to manage multiple priorities, maintain schedules, and meet deadlines.
* Education: High school diploma or equivalent required; PGA certification or equivalent instruction credentials preferred.
* Experience:
* 2+ years of golf instruction and club fitting experience preferred.
* Experience with swing analysis tools and custom club building highly valued.
* Physical Demands: Must be able to stand for extended periods, move throughout the store, lift up to 30 lbs overhead, and work in simulator environments.
* Availability: Must maintain flexible availability, including nights, weekends, and holidays.
* Accountability: Demonstrates strong self-accountability, professionalism, and a proactive drive for results.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
PGA TOUR Superstores is an Equal Opportunity Employer, committed to a diverse and inclusive work environment.
We comply with all laws that prohibit discrimination based on race, color, religion, sex/gender, age (40 and over), national origin, ancestry, citizenship status, physical or mental disability, veteran status, marital status, genetic information, and any other legally protected status. Employment discrimination isn't just unlawful, it violates our policies and is not who we are. Every associate at every level in the organization is prohibited from engaging in any form of discrimination.
An associate who believes s/he is being discriminated against should report it immediately to the Human Resources department. The law and our policies prohibit retaliation against anyone for making such a report.
$39k-53k yearly est. Auto-Apply 23d ago
Certified Peer Specialist (PSS)
Higher Heights Home Care Inc.
Medical coder job in Wilson, NC
Job DescriptionBenefits/Perks
Competitive Compensation
Great Work Environment
Career Advancement Opportunities
We are seeking a Certified Peer Specialist (PSS) to join our team! As a Mental Health Aide, you will assist nurses and doctors with the day-to-day care of our patients, including assisting in eating, bathing, and even getting dressed. You may occasionally accompany patients for tests or treatments, assist with restocking equipment or supplies, and strive to create a safe, clean environment for our patients and other staff. The ideal candidate is compassionate, works well within a team environment, and has strong communication and interpersonal skills.
Responsibilities
Assist doctors, nurses, and others aides in day-to-day care, including helping patients with basic functions
Maintain a clean, safe, healing environment for all staff and patients
Restock equipment and supplies, as needed
Maintain excellent records of patient interactions, and report anything concerning immediately
Qualifications
Strong communication and interpersonal skills
Strong problem-solving abilities
The ability to work well within a team environment
Positive, compassionate attitude helpful
$47k-71k yearly est. 5d ago
Qualified Professional (QP)
Ralph Scott Lifeservices 3.8
Medical coder job in Burlington, NC
PRIMARY DUTY, PURPOSE, AND OBJECTIVES:
The Qualified Professional (QP) is responsible for the clinical oversight and supervision of assigned services. This includes planning, monitoring, and preparation of billing documentation for billable services for assigned individuals. The QP meets criteria for Qualified Professional and performs clinical duties related to programming and records. Provides day-to-day oversight of staff and works to ensure seamless delivery of services.
JOB DUTIES, FUNCTIONS, AND RESPONSIBILITIES:
Essential Functions:
Familiar with all applicable federal, state, and local standards related to specified services and Ralph Scott Lifeservices, Inc. Policies and Procedures.
Maintains current and comprehensive knowledge of individuals, their issues, conditions, goals, and services.
Implements, monitors, and documents outcomes set forth in the person-centered plan.
On a weekly basis, monitors programs and data for accuracy, completeness, and progress. Provides written documentation and progress notes.
Provides direct monitoring of planned outcomes for individuals as well as performance of staff by on-site presence in assigned Apartment location(s) and direct contact with individuals on a schedule determined and/or approved by supervisor.
Works closely with Care Coordinators to ensure that needed services are being provided.
Provides monthly written clinical and administrative supervision of paraprofessionals.
Provides ongoing in-service training on the person-centered plan and current services
Reviews all documentation for assigned individuals.
Responsible for program plans, billing differentiation, and authorizations for assigned individuals.
Serves as an advocate for individuals receiving services.
Assures that work is done smoothly, efficiently and as scheduled according to the authorizations.
Schedule staff to adhere to established schedule and meet requirements for supporting residents.
Coordinate transportation for scheduled activities and appointments
Notify and coordinate with RSL maintenance as required for maintenance needs.
Operate within the established program budget.
Routine Required Functions:
Provides direct monitoring of planned outcomes for individuals as well as performance of staff by regular on-site presence in work locations.
Rotates “On-Call” responsibilities.
Participates in in-service training for professional development.
Will complete a minimum of 4 hours per year of professional training approved in advance by his/her supervisor over and above required training or updates of required training.
Serves as relief staff in emergencies.
Participates in Person Centered Planning activities for individuals.
Participates in Peer Council activities on a regular rotation. Maintains an active awareness of cultural competency of individuals and other employees and works to accommodate that diversity in work, training, and leisure activities.
Is familiar with RSL Policy and Procedure Manual and with the RSL Bloodborne Pathogens/TB/Infectious Disease Plans, Policies for Individuals Receiving Services, OSHA, and HIPPA.
Routinely follows safe work practices in all functions of the job.
Performs other duties as requested by his/her supervisor.
MEASURES FOR SUCCESS:
At Ralph Scott Lifeservices, care and compassion are at the core of our mission. We are committed to excellence, quality services and collaboration, recognizing that every team member plays a vital role in our success.
Employee's work performance positively supports the mission and culture of the organization.
Work is done competently, efficiently, and within budget.
Compliance is maintained with regulatory and accreditation standards.
Needs of individuals served are addressed and met; and, as often as possible, services are provided beyond minimum standards required.
Relevant concerns are presented to supervisory staff for review and resolution.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Working knowledge of developmental disabilities.
Ability to communicate both orally and in writing.
Proficient in Windows operating systems with competency in Microsoft Office Suite (Word, Excel) and/or Google Workspace (Docs, Sheets); efficient in managing email and Google Calendar; skilled in basic data entry and organizing digital files.
Ability to understand and apply operating policies and licensing and certification standards.
Ability to plan and supervise the work of others.
Working knowledge of simple budgeting.
Ability to work flexible work hours including evenings and weekends.
MINIMUM QUALIFICATIONS, EDUCATION AND EXPERIENCE:
A four-year degree in human services field, and must meet the criteria for a Qualified Professional as outlined in 10A NCAC 27G.014, and have an additional two years clinical and supervisory experience.
Must have own transportation for travel on RSL business.
$37k-49k yearly est. 60d+ ago
Medical Records and Referrals Coordinator
Piedmont Health Services 4.3
Medical coder job in Burlington, NC
Job Description
What is PACE?
At Piedmont Health Senior Care, we are dedicated to enhancing the lives of seniors in our community through our Program of All-inclusive Care for the Elderly (PACE). We help seniors maintain their independence and continue living at home for as long as possible. We achieve this by offering comprehensive, personalized healthcare and related services, all tailored to the unique needs and aspirations of each senior we serve.
Our approach is unlike any other healthcare plan! PACE emphasizes a participant-centered strategy, focusing on providing the right care and services that best support each participant's unique needs and goals. We integrate and coordinate all aspects of care, leveraging a team of dedicated doctors, nurses, therapists, dieticians, and other specialized professionals who work together as a care team to manage and address the complete health needs of each.
Job Title - Medical Records and Referral Coordinator
Department - PACE
Reports to - Site Director
Benefits -
Medical, Dental, Vision, Life Insurance (Short & Long Term Disability)
403(b) Plan
Paid Holidays
CME (Continuing Medical Education)
About Position: The Medical Records and Referral Coordinator is responsible for maintaining an accurate and complete medical record per PHSC policy and procedure and for coordination of authorized participant appointments per PHSC policy and procedure.
Work Location: 1214 Vaughn Road Burlington, NC 27217 & 163 Chatham Business Dr, Pittsboro, NC 27312
Schedule: Monday through Friday, 8:00am - 5:00pm
This position will work 3 days per week at PACE Burlington on Monday/Wednesday/Friday and at PACE Pittsboro on Tuesday/Thursday.
Duties/ Responsibilities -
Complete referral documents in the electronic medical record.
Schedule appointments for referrals, contact families and participants with referral times to include mailing an appointment reminder card as well as a courtesy reminder call prior to the scheduled appointment; coordinate referral times with the participant's family first - if family is unavailable, arrange via PHSC Transportation Manager.
Match consultation documents with referral orders and close referrals out via the appointment database.
Work closely with Medical Records Coordinator to ensure consultation documents are processed efficiently and relevant goals are being met.
Schedule and coordinate outside appointments for participants based on days of attendance/time/availability of transportation services to include the coordination with clinical staff when an aide/family escort is needed.
Work with the Medical Providers to reschedule appointments as needed per our PHSC appointment guideline as well as based on transportation services availability.
Document appointments within Centricity and appointment database.
Notify Nurse Care Manager of any scheduled procedures and give forms to be filled out; need to go over with participant prior to the scheduled appointment.
Make weekly schedule for authorized appointments and distribute.
Complete appointment paperwork (chart note/rationale for visit/etc.)
Consistently follows authorization and referral policies and procedures to include maximum number of appointments that can be approved and arranged per day.
Audit medical records for being up-to-date and complete.
Ensure referrals are completed according to determined goals, and referrals reports for open, held, and closed appointments are reviewed on at least a weekly basis with supervisor, providers, and Site Director.
Provides administrative support to the PACE Center as needed.
Ensures that Piedmont Health SeniorCare maintains an accurate and complete medical record as well as ensures the safety of participant confidential information, security of the facility and all data according to Federal and State Regulations.
Contacts outside offices for medical records, notes, images, follow-up and cancellations.
Ensures medical notes from specialty appointments, hospitalizations, etc are received and uploaded to the chart on a timely basis (no later than a week after appointment.
Close out the medical record of deceased and/or disenrolled participants.
Establishes and maintains medical records for each participant, including: requesting, scanning, uploading records, notes, images, follow-up and cancellations from external sources to include, labeling information once scanned into computer system as well as closes out referrals.
Achieves quality goals for medical records of a complete and accurate current medical record for every participant.
Abides by all established SeniorCare policies, rules and regulations, including patient, staff and SeniorCare information.
Perform all other duties as assigned.
Qualifications -
Education: Associates Degree in relevant field required or 2-3 years of relevant experience, education, or certification.
Required:
Must be able to work effectively in a team environment.
Strong oral and written communication skills.
Must meet a standardized set of competencies established by Piedmont Health SeniorCare and approved by CMS before working independently.
Preferred: One year of work experience with the frail or elderly preferred.
Immunizations: Be medically cleared for communicable diseases and have all immunizations up-to-date prior to beginning employment.
Pay Range : $17.66/Hourly - $23.74/Hourly
(
commensurate with years of experience)
EEO Statement
Piedmont Health Services, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex, sex stereotyping, pregnancy (including pregnancy, childbirth, and medical conditions related to pregnancy, childbirth, or breastfeeding), race, color, religion, ancestry or national origin, age, disability status, medical condition, marital status, sexual orientation, gender, gender identity, gender expression, transgender status, protected military or veteran status, citizenship status, genetic information, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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$17.7-23.7 hourly 26d ago
Coder - Inpatient
Highmark Health 4.5
Medical coder job in Raleigh, NC
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
$23-35.7 hourly 37d ago
MEDICAL RECORDS CODER II
Duke University 4.6
Medical coder job in Durham, NC
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. About Duke Health's Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
Occ Summary
The Medical Records Coder II is a certified Coder. Coordinate/review the work of subordinate employees and assist with the training and continuing education programs. Code medical records utilizing ICD-10-CM and CPT-4 coding conventions. Review the medical record to assure specificity of diagnoses, procedures and appropriate/optimal reimbursement for hospital and/or professional charges. Abstract information from medical records following established methods and procedures.
Work Performed
Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions. Coordinate/review the work of designated employees. Ensure quality and quantity of work performed through regular audits. Assist with research, development and presentation of continuing education programs on areas of specialization. Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and CPT-4 coding conventions. Sequence the diagnoses and procedures using coding guidelines. Ensure DRG/APC assignment is accurate. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information. Communicate with nursing and ancillary services personnel for needed documentation for accurate coding. Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD- 10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures. Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc. Assist with special projects as required. Perform other related duties incidental to the work described herein.
Knowledge,Skills and Abilities
Advanced ICD-10-CM & CPT-4 coding conventions Anatomy and Physiology Medical Terminology Extensive DRG/APC reimbursement knowledge Coding software familiarity Effective written and verbal communication skills Data entry/CRT
Level Characteristics
N/A
Minimum Qualifications
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes.To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Education
High school diploma required.
Experience
RHIA certification- no experience required RHIT certification- no experience required CCS certification- one year of coding experience required CPC or HCS-D certification- two years of coding experience required
Degrees, Licensures, Certifications
Must hold one of the following active/current certifications: Registered Health Information Administrator (RHIA) Hospital Coding Registered Health Information Technician (RHIT) Hospital Coding Certified Coding Specialist (CCS) Hospital Coding Certified Professional Coder (CPC) Homecare Coding Specialist-Diagnosis (HCS-D) Homecare Coding
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Nearest Major Market: Durham
Nearest Secondary Market: Raleigh
$65k-83k yearly est. 28d ago
Medical Record Clerk
Us Tech Solutions 4.4
Medical coder job in Durham, NC
USTECH is a global firm providing a wide-range of talent on-demand and total workforce solutions. Through the USTECH Talent Network of 100% company-owned and managed offices, we provide highly-skilled professionals whose education, skills and experience are vetted and matched to your unique hiring needs, work environment and company requirements.
Our 24x7 global service delivery drives time and cost out of any recruiting and staffing process (15-30% cost reduction in most cases) across all of our services and solutions, providing you with the talent you need on-demand when, where and how you need it.
Job Description
Job Title : Medical Record Clerk
JOB ID- : (14809)
Location : Durham, NC 27713
Duration : (at first 1+ month contract)
Qualifications:
Candidate will need to have experience indexing medical records and scanning.
This is a special short term project.
Must be able to stand long periods of time and able to lift up to 50 lbs.
Thanks ,Asma.
Additional Information
All your information will be kept confidential according to EEO guidelines.
$29k-36k yearly est. 60d+ ago
Certified Medical Billing-Coding Specialist
Axil Health
Medical coder job in Raleigh, NC
Full-time Description
Job Title: Medical Billing/Coding Specialist
Type: Full Time (eligible for Benefits Package), Hourly/Non-Exempt
Job Overview: We are seeking a certified, detail-oriented and experienced Medical Billing and Coding Specialist to join our healthcare team. The successful candidate will be responsible for accurately translating medical procedures and diagnoses into standardized codes for billing and insurance purposes. This role requires a strong understanding of medical terminology, coding systems, and compliance with relevant regulations.
Requirements
Responsibilities:
Review and accurately assign medical codes to diagnoses, procedures, and services using ICD-10, CPT, and HCPCS systems.
Submit clean claims to insurance companies electronically or via paper when necessary.
Collaborate with healthcare providers to obtain necessary documentation for coding.
Verify patient information and ensure accuracy in coding processes.
Resolve billing discrepancies and collaborate with clinical staff for documentation clarification.
Follow up on unpaid or denied claims; resubmit or appeal as appropriate.
Maintain patient confidentiality and comply with all relevant healthcare privacy laws
Communicate effectively with patients, providers, and insurance representatives.
Stay current with coding updates, payer guidelines, and industry regulations.
Assist with special projects and additional tasks on an as needed basis
Qualifications:
Required Certification in medical billing and coding (e.g., CPC, CCS, CCA, or equivalent).
High school diploma or equivalent required; associate degree in healthcare administration or related field preferred.
2+ years of experience in medical billing and coding in a healthcare setting.
Proficient in using electronic health records (EHR) and billing software.
In-depth knowledge of medical terminology, coding systems, and insurance claim processes.
Familiarity with Medicare, Medicaid, and commercial payer requirements preferred.
Strong attention to detail and analytical skills.
Excellent communication and organizational skills.
Ability to work independently and collaboratively in a team environment.
Working Conditions:
Office-based environment with regular business hours (Monday through Friday, 8am to 5pm).
May require occasional overtime during peak periods.
If you meet the qualifications and are passionate about accurate medical coding, we invite you to apply for this rewarding position in our healthcare team.
$35k-45k yearly est. 60d+ ago
Qualified Professional (QP)
Ralph Scott Lifeservices 3.8
Medical coder job in Burlington, NC
Job DescriptionDescription:
PRIMARY DUTY, PURPOSE, AND OBJECTIVES:
The Qualified Professional (QP) is responsible for the clinical oversight and supervision of assigned services. This includes planning, monitoring, and preparation of billing documentation for billable services for assigned individuals. The QP meets criteria for Qualified Professional and performs clinical duties related to programming and records. Provides day-to-day oversight of staff and works to ensure seamless delivery of services.
JOB DUTIES, FUNCTIONS, AND RESPONSIBILITIES:
Essential Functions:
Familiar with all applicable federal, state, and local standards related to specified services and Ralph Scott Lifeservices, Inc. Policies and Procedures.
Maintains current and comprehensive knowledge of individuals, their issues, conditions, goals, and services.
Implements, monitors, and documents outcomes set forth in the person-centered plan.
On a weekly basis, monitors programs and data for accuracy, completeness, and progress. Provides written documentation and progress notes.
Provides direct monitoring of planned outcomes for individuals as well as performance of staff by on-site presence in assigned Apartment location(s) and direct contact with individuals on a schedule determined and/or approved by supervisor.
Works closely with Care Coordinators to ensure that needed services are being provided.
Provides monthly written clinical and administrative supervision of paraprofessionals.
Provides ongoing in-service training on the person-centered plan and current services
Reviews all documentation for assigned individuals.
Responsible for program plans, billing differentiation, and authorizations for assigned individuals.
Serves as an advocate for individuals receiving services.
Assures that work is done smoothly, efficiently and as scheduled according to the authorizations.
Schedule staff to adhere to established schedule and meet requirements for supporting residents.
Coordinate transportation for scheduled activities and appointments
Notify and coordinate with RSL maintenance as required for maintenance needs.
Operate within the established program budget.
Routine Required Functions:
Provides direct monitoring of planned outcomes for individuals as well as performance of staff by regular on-site presence in work locations.
Rotates “On-Call” responsibilities.
Participates in in-service training for professional development.
Will complete a minimum of 4 hours per year of professional training approved in advance by his/her supervisor over and above required training or updates of required training.
Serves as relief staff in emergencies.
Participates in Person Centered Planning activities for individuals.
Participates in Peer Council activities on a regular rotation. Maintains an active awareness of cultural competency of individuals and other employees and works to accommodate that diversity in work, training, and leisure activities.
Is familiar with RSL Policy and Procedure Manual and with the RSL Bloodborne Pathogens/TB/Infectious Disease Plans, Policies for Individuals Receiving Services, OSHA, and HIPPA.
Routinely follows safe work practices in all functions of the job.
Performs other duties as requested by his/her supervisor.
MEASURES FOR SUCCESS:
At Ralph Scott Lifeservices, care and compassion are at the core of our mission. We are committed to excellence, quality services and collaboration, recognizing that every team member plays a vital role in our success.
Employee's work performance positively supports the mission and culture of the organization.
Work is done competently, efficiently, and within budget.
Compliance is maintained with regulatory and accreditation standards.
Needs of individuals served are addressed and met; and, as often as possible, services are provided beyond minimum standards required.
Relevant concerns are presented to supervisory staff for review and resolution.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Working knowledge of developmental disabilities.
Ability to communicate both orally and in writing.
Proficient in Windows operating systems with competency in Microsoft Office Suite (Word, Excel) and/or Google Workspace (Docs, Sheets); efficient in managing email and Google Calendar; skilled in basic data entry and organizing digital files.
Ability to understand and apply operating policies and licensing and certification standards.
Ability to plan and supervise the work of others.
Working knowledge of simple budgeting.
Ability to work flexible work hours including evenings and weekends.
MINIMUM QUALIFICATIONS, EDUCATION AND EXPERIENCE:
A four-year degree in human services field, and must meet the criteria for a Qualified Professional as outlined in 10A NCAC 27G.014, and have an additional two years clinical and supervisory experience.
Must have own transportation for travel on RSL business.
Requirements:
$37k-49k yearly est. 29d ago
Senior Coder - Outpatient
Highmark Health 4.5
Medical coder job in Raleigh, NC
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.
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Req ID: J270102
The average medical coder in Cary, NC earns between $37,000 and $76,000 annually. This compares to the national average medical coder range of $37,000 to $70,000.
Average medical coder salary in Cary, NC
$53,000
What are the biggest employers of Medical Coders in Cary, NC?
The biggest employers of Medical Coders in Cary, NC are: