Outpatient Coding Quality Educator Specialist - Coding (req - 30697)
Medical coder job in Lakeland, FL
Outpatient Coding Quality Educator Specialist - Coding 30697
Active - Benefit Eligible and Accrues Time Off
Work Hours per Biweekly Pay Period: 80.00
Shift: Monday Friday
Pay Rate: Min $63,793.60 Mid $79,747.20
Under the direction of the facility Coding and Reimbursement Manager, conducts coding quality reviews and audits of chart documentation to assess accuracy, ensure compliance with federal and payer policies, and identifies areas for improvement for hospital outpatient coding. Develops and delivers training on coding accuracy and compliance, staying updated on regulations and providing expert guidance to coders. Provides ongoing coding education and training to coding team and serves as mentor to all new coding team members. Serves as a subject matter expert and resource for coders, providers, and other staff on coding questions, regulatory changes, and best practice. Prepares reports of findings and meets with coders and Coding Leadership to provide education and training on accurate coding practices and compliance issues.
Has thorough knowledge of acute care facility guidelines, modifiers, sequencing rules and the NCCI (National Correct Coding Initiative) edits, OCE (Outpatient Code Editor) edits, Official Guidelines for Coding and reporting for ICD-10-CM/PCS, CPT-4, and HCPCS coding conventions, APC payment classifications and Medicare Conditions of Participation. Will assist the Coding and Reimbursement Manager on preparing presentations and/or interdepartmental feedback.
Responsible for conducting coding and billing training programs for billing and coding specialists. Other duties will include implementing coding department policies and procedures and assisting with reviewing and appealing coding denials.
Position Responsibilities
People At The Heart Of All That We Do
Fosters an inclusive and engaged environment through teamwork and collaboration.
Ensures patients and families have the best possible experiences across the continuum of care.
Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
Safety And Performance Improvement
Behaves in a mindful manner focused on self, patient, visitor, and team safety.
Demonstrates accountability and commitment to quality work.
Participates actively in process improvement and adoption of standard work.
Stewardship
Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
Knows and adheres to organizational and department policies and procedures.
Standard Work: Outpatient Coding Quality Educator Specialist
Actively participates in team development, achieving dashboards, and in accomplishing departmental goals and objectives.
Performs internal quality assessment reviews on outpatient facility coders to ensure compliance with national coding guidelines and the LRH coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes/presentations to staff, as required/when needed.
Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.
Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues. Researches coding opportunities and escalates as needed. Communicates Coding topics and/or question trends to Coding Leadership for global education.
Prepares and presents coding compliance status reports to the Coding and Reimbursement Manager and Health Information Management AVP.
Assists in ensuring coding staff adherence with coding guidelines and policy. Demonstrates and applies expert level knowledge of medical coding practices and concepts.
Coaches and mentors coding staff as they develop and grow their coding skills. Provides skilled coding support through regularly scheduled coding meetings and as the need arises. Provide one-on-one coaching and support to coding professionals, offering constructive feedback and guidance to improve coding accuracy and documentation practices.
Assists Coding Leadership with outpatient coding denials.
Create educational materials, such as manuals, handouts, and multimedia presentations, that effectively communicate complex coding concepts and guidelines.
Orients, develops and coordinates on-the-job training of instructing them on systems and policies and procedures in accordance to coding compliance guidelines.
Experience essential:
5+ years acute care hospital outpatient coding experience and/or coding auditing
5-10 years of educational experience in a facility or consulting setting.
Certification essential:
CCS, CPC, RHIT, or RHIA
Certification preferred:
RHIA
About Us:
Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.
To apply please send your resume to:
Tiffany Hanson at: Tiffany.Hanson@my LRH.org
Records and Agenda Coordinator
Medical coder job in Key Biscayne, FL
The vibrant Village of Key Biscayne, incorporated on June 18, 1991, is in the center 1.25 square miles of a four-mile-long, two-mile-wide barrier island between the Atlantic Ocean and Biscayne Bay. The island is connected via a scenic causeway and bridges to the City of Miami, only seven miles away. Key Biscayne is a thriving residential community of more than 14,800 residents. Together with our residents, we are advancing our safe and secure village; thriving and vibrant community and local marketplace; engaging and active programs and public spaces; accessible, connected, and mobile transportation system; and resilient and sustainable environment and infrastructure.
The Village of Key Biscayne is seeking a Records and Agenda Coordinator. The Records and Agenda Coordinator of the Village Clerk's Office provides highly skilled administrative support and provides assistance in discharging the duties and overall management of the Village Clerk's Office. This position exercises independent judgment in performing special functions under the supervision of the Village Clerk. Work emphasizes daily administrative work, departmental IT initiatives, working with the Village Clerk on emerging technologies and Agenda and Records Management strategies. Work may include customer service functions and interaction with the public and administrative support assignments for the Village Clerk.
Essential Duties and Responsibilities
Records Management
Coordinate the processing and fulfillment of public records requests in compliance with Florida law.
Assist the Village Clerk with the management, retention, scanning, and indexing of permanent public records as part of the Village's records management program.
Maintain multiple systems including lobbyist registrations, advisory board memberships, contracts, resolutions, and ordinances.
File and organize official documents for the Village Council and the Office of the Village Clerk according to departmental procedures.
Council & Meeting Support
Assist in the preparation, posting, and distribution of Village Council electronic agenda packets and required legal notices.
Prepare the Council Chamber and other meeting venues for Village Council meetings.
Attend official meetings to record and transcribe minutes as assigned by the Village Clerk.
Coordinate Council travel arrangements, including airline reservations, hotel accommodations, transportation, and conference registrations.
Administrative Support
Prepare a variety of documents such as correspondence, memoranda, forms, tables, and reports with accuracy and completeness.
Process invoices, checks, and assist with monitoring and preparing the Village Clerk and Council budgets.
Customer Service & Other Duties
Provide excellent customer service in person and by phone, responding to inquiries and concerns or directing them to the appropriate department.
Perform other related duties as assigned by the Village Clerk.
Minimum Qualifications & Requirements
Education & Experience
Bachelor's degree in public administration or a related field from an accredited college or university.
Four (4) years of experience performing high-level administrative, clerical, or secretarial work.
Previous experience in a Municipal or County Clerk's Office is preferred.
Knowledge, Skills & Abilities
Strong computer proficiency, including Microsoft Office Suite (Word, Excel, Outlook, etc.).
Knowledge of automated agenda preparation software and public records management systems.
Familiarity with municipal government operations, services, and responsibilities of the Clerk's Office.
Knowledge of the rules and regulations governing the conduct of Village Council meetings, including Florida Sunshine Law, Florida public records law, and principles/practices of public agency record keeping.
Typing speed of at least 50 wpm.
Capable of transcription, summary minute preparation, and accurate recordkeeping.
Strong organization and time management skills.
Communicate clearly, tactfully, and effectively in English, both orally and in writing; excellent grammar and writing skills required. Ability to communicate in Spanish is a plus.
Read, update, analyze, and maintain various records and files with accuracy.
Quickly learn and apply various electronic document conversion processes and the Village's records management systems.
Operate standard office equipment (computers, printers, copiers, scanners, telephones, etc.).
Work independently, exercise discretion and judgment, and maintain confidentiality and professionalism.
Manage multiple recurring deadlines where accuracy and attention to detail are critical.
Provide flexibility to accommodate occasional evening work.
Certifications & Other Requirements
Notary Public of the State of Florida, or ability to obtain within three (3) months of employment.
Records Management Certification preferred.
Must be legally authorized to work in the United States.
Must possess a valid Florida Driver's License.
Must successfully complete a background investigation, including a national criminal history check.
Requirements may be waived by the Village Clerk.
These job functions should not be construed as a complete statement of all duties; additional job-related tasks may be required.
Must be a non-smoker.
SALARY RANGE: $58,649 - $95,892
POSITION TYPE: Full-Time / Non-Exempt
APPLICATION PROCESS:
Interested and qualified applicants should submit cover letter, resume to: Juan C. Gutierrez, Human Resources Director, Village of Key Biscayne via E-mail: **************************
Village of Key Biscayne is an Equal Opportunity Employer and a Drug/Smoke Free Workplace
Qualified applicants are considered for employment and treated without regard to race, color, religion, sex, disability, marital, or veteran status (except if eligible for veterans' preference).
Coder Inpatient/Outpatient Surgery
Medical coder job in Mobile, AL
Overview Qualifications
Minimum Qualifications:
Minimum 1 year coding experience in an acute care facility
Knowledge of medical terminology, anatomy and physiology, coding conventions (ICD 10 - CM/PC, CPT, and HCPCS), and CMS coding requirements
Computer proficiency, ability to research coding questions and utilize educational resources required
Licensure, Registration, Certification:
Credentialed through American Health Information Management Association (AHIMA) in one of the following:
Registered Health Information Technician (RHIT)
Registered Health Information Administrator (RHIA)
Certified Coding Specialist (CCS)
Certified Outpatient Coder (COC)
Certified Inpatient Coder (CIC)
Certified Professional Coder (CPC)
OR
Credentialed through American Academy of Professional Coders (AAPC) in one of the following:
Certified Outpatient Coder (COC)
Certified Inpatient Coder (CIC)
Certified Professional Coder (CPC)
Desired Qualifications:
Associate degree
Responsibilities
Assigns and sequences code for complex inpatient, outpatient, and surgery accounts according to established regulatory guidelines, industry best practices, and IH policies and procedures.
Auto-ApplyMedical Coder
Medical coder job in Pensacola, FL
Come work at Hixardt Technologies, Inc. (Hixardt) a leading firm in our industry. We are looking to hire an experienced certified Medical Coders that have experience coding for the Department of Veterans Affairs (VA) to help us keep growing. To be effective in performing this job you must be proficient with the VA's coding applications and encounter codes. The majority of the encounters that we need to code are all specialties, ENT, GI, GU, Rheumatology, Ortho, Oncology, Hematology, Cardiology, PT/OT, Chiropractic, Pro Fees Inpatient, and Diagnostic Services, Radiology, and Laboratory Services. If you're hard-working and dedicated, Hixardt is an ideal place to get ahead.
Primary Duties and Responsibilities:
Perform Coding for records pertaining to Inpatient, outpatient, and surgeries performed with a minimum of 95% accuracy and as per turnaround time requirements.
Coders will need to be able to code all types of coding to be able to transition between various types of coding to assist as needed.
Ability to read and interpret health record documentation to identify all diagnoses and procedures that affect the current outpatient encounter visit, ancillary, inpatient professional fees, and surgical episodes.
Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services.
Apply knowledge of Diagnostic, Procedure, Professional, and coding guidelines for inpatient services.
Apply knowledge of Common Procedural Terminology format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly.
Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in Common Procedural Terminology.
Code in accordance with VHA Coding Guidelines.
Requirements:
CPC certification or other coding certification is required.
Experience in surgery coding is required.
Experience coding for the Government.
Exposure to CPT-4, ICD-9, ICD-10, and HCPCS coding.
Ability to work as a team.
Excellent communication skills: both written and verbal.
Current Coding certification with valid proof of certifications.
Security clearance is preferred.
Knowledge of VHA guidelines is preferred.
Qualifications and Experience:
Minimum of two years' experience in Medical Coding for Surgery specialty.
Ability to investigate patient accounts for accuracy and completeness. Ability to demonstrate a high level of problem-solving skills. Ability to work effectively with co-workers and management.
Clinical knowledge gained through education or experience. Computer keyboarding skills and basic computer knowledge including MS Word.
Ability to maintain confidentiality of patient information in accordance with HIPAA guidelines.
Knowledge of Official Guidelines for Coding and Reporting. High level of competence in coding ICD-10-CM/PCS with a high degree of accuracy.
Experience with EHR, Nuance, EM, Cerner, and Vista.
Coder 2 - Clinic, Patient Financial Services
Medical coder job in Jackson, MS
To review and audit Network Provider medical records for documentation and coding compliancy and quality with federal and state laws and regulations. #CB Responsibilities Job Title: Coder 2 - Clinic To review and audit Network Provider medical records for documentation and coding compliancy and quality with federal and state laws and regulations.
* Quality and Performance Improvement
* Research, develops and implements standardized process for quality monitoring of inpatient and outpatient coding and abstracting. Conducts quality audits for coding according to pre-established criteria in coordination with the Coding and Reimbursement Specialist. Assists Management with evaluation of functions and processes of the coding area to determine opportunities to improve the efficiency and quality of the coding area. Implements innovative ideas and process changes.
* Attends meetings as required and strives to improve the quality of meetings by taking an active role in meeting topics. Participates in educational programs, in-services, and training sessions in an effort to share his/her own expertise with others and further the quality of education and personal growth provided to new personnel, volunteers, and interning students.
* Collaboration and Partnership
* Establishes and maintains interdepartmental relationships with Network providers to facilitate cooperation and compliance. Assists the Physician Network, Revenue Management Department and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities of education and process improvement.
* Collaborates with Management to identify and coordinate educational needs based audit results and new technologies. Provide support to the Coding and Reimbursement Specialist of monthly statistics and educational programs to staff on a regular basis. Provides technical assistance to the Systems Specialist for authorized coding database retrieval and identification and resolution of software and system functionality.
* Other Duties As Assigned
* Performs other duties as assigned or requested.
Qualifications
* Associates degree, Bachelor's degree, or coding certification (CCS or CPC) with 3 years' experience OR 5 years' experience in medical coding without degree or certification
* Thorough knowledge of medical terminology, managed care financial agreements; Thorough knowledge of CPT-4, HCPC, and ICD-9 codes
Medical Analyst
Medical coder job in Pensacola, FL
The Medical Analyst plays a key role in supporting the operational, administrative, and quality management functions of ProHealth. This position ensures seamless coordination between our clinical offices, onsite services, and corporate systems. The ideal candidate is detail-oriented, highly organized, and thrives in a fast-paced healthcare environment.
Key Responsibilities
After-Hours & Onsite Management
Coordinate after-hours support and communication.
Manage onsite services, including customer scheduling, MA scheduling, and billing coordination.
DOT Consortium Management
Administer random selections and compliance activities for DOT Consortium clients.
Scheduling & Staffing
Maintain and manage organization-wide staffing schedules.
AEL (American Esoteric Laboratories)
Reconcile monthly billing and address issue management.
Inventory Management
Oversee inventory across all office locations.
Order and distribute supplies and vaccines as needed.
Training & Compliance
Provide technical training for BAT (Breath Alcohol Testing) and Drug Screening procedures.
Ensure all office certifications and licenses (CLIA, Business License, BioMedical Waste, DBPR) are current and posted.
Customer & System Management
Respond promptly to JotForm website submissions.
Manage PMM memberships, including setup, cancellations, and documentation review.
Handle payroll reconciliation and related reporting.
Address issue management across multiple systems, including eScreen, FormFox, and office/equipment maintenance.
Quality Assurance
Perform regular quality checks on billing, Solv, and Practice Fusion data.
Oversee quality control processes for Florida Shots and other clinical systems.
Documentation & SOP Development
Identify opportunities for standardization and create medical-specific SOPs and policies.
Manage and update content on SharePoint (Office Manager and NP sites).
Support office standardization and assist with special projects.
Additional Responsibilities
Provide marketing and customer support assistance as needed.
Manage customer result resubmissions and ensure consistent communication standards across all offices.
Requirements
Qualifications
Strong background in medical operations, data analysis, or healthcare administration preferred.
Excellent attention to detail and problem-solving abilities.
Proficient in Microsoft 365 (SharePoint, Excel, Outlook).
Experience with Solv, Practice Fusion, FormFox, and eScreen systems a plus.
Ability to manage multiple priorities and meet deadlines in a dynamic environment.
Join ProHealth and help us continue delivering high-quality, patient-centered care across our growing network of clinics.
Benefits
What We Offer
Competitive hourly pay
A supportive team and positive work environment
Opportunities to contribute to an innovative wellness program
ProHealth offers competitive benefits for both part time and full time personnel. Benefits include full access to clinic and lab services (at cost), healthcare, vision, dental, life insurance and 401K.
As mandated under Executive order 12989, ProHealth is required to verify employment eligibility of selected candidates through the Department of Labor's - E-Verify.
Disclaimer: All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities. This job description in no way states or implies that these are the only duties to which will be required in this position. Employees will be required to perform other job-related duties as requested by their supervisor/manager (within guidelines and compliance with Federal and State Laws). This should not be considered an employment contract or otherwise alter the “at will” status of employment.
Medical Record Audit / Coding Auditor
Medical coder job in Miami, FL
OUR CLIENT is a contracting and data management services organization dedicated to primary care physicians throughout Florida
IN THIS ROLE YOU are responsible to assist in the development, undertaking and maintenance of a long term comprehensive, clinical coding audit program for inpatient and outpatient activity.
To develop and Implement policies to support the clinical coding audit function
Receive, review and communicate findings on patient billing coding related complaints.
Identify training needs through the audit program of work and liaise with the clinical coding training manager and audit manager to provide the necessary training identified
Conduct routine, risk based, proactive or reactive compliance reviews of procedural and diagnosis coding/billing and medical record documentation performed by clinical service providers
Prepare reports as required relative to these monitoring and review activities.
Work with coding/billing associates to assure compliance on coding, billing, monitoring and review activities.
Monitor, communicate and conduct educational sessions regarding additions and/or revisions to coding and documentation rules and regulations.
TO SUCCEED IN THIS ROLE, YOU HAVE:
High School diploma required, Associate Degree preferred;
Must be a certified professional coder;
Minimum five years hands-on experience in physician coding
Medical Chart Auditor
Medical coder job in Miami, FL
Job Description
Arista Recovery seeks an experienced Medical Chart Auditor (MCA) with a background in medical chart auditing, Utilization Management (UM), or Utilization Review (UR) within mental health or addiction treatment settings. This role requires comfort and proficiency with AI tools to enhance documentation efficiency, improve accuracy, and support compliance. The MCA will work closely with clinical teams to ensure documentation aligns with ASAM standards and payer requirements, fostering a culture of precise, efficient charting.
Duties and Responsibilities:
Medical Record Audits: Conduct thorough audits of patient medical charts, ensuring accurate documentation that meets ASAM standards and payer criteria.
Real-Time Support & AI-Driven Training: Use AI tools to assist clinical staff in real-time, improving efficiency in documentation and compliance.
Compliance Monitoring: Ensure all medical records adhere to ASAM standards, insurance requirements, and HIPAA regulations.
Discrepancy Management: Identify and address documentation inconsistencies, leveraging AI tools to streamline audit processes and enhance efficiency.
Data Analysis: Use AI-driven insights to analyze trends in documentation, identifying opportunities for improved efficiency and accuracy.
Reporting & AI-Enhanced Documentation: Prepare detailed audit reports and utilize AI tools to support accurate, efficient record-keeping.
Quality Improvement Initiatives: Engage in projects to advance documentation accuracy and efficiency, including the integration of AI tools to optimize processes.
Education/Experience/Qualification:
Minimum of 3 years in medical chart auditing, Utilization Management (UM), or Utilization Review (UR) within mental health or addiction treatment.
A Bachelor's degree or certifications like CPMA are preferred but not required if the candidate has relevant experience.
AI Proficiency: Comfortable and proficient with AI tools relevant to documentation, with a focus on enhancing efficiency and accuracy.
Strong knowledge of medical terminology and healthcare documentation standards.
Detail-oriented with analytical skills to detect trends and inconsistencies.
Proficiency in electronic health record (EHR) systems.
Excellent communication and interpersonal abilities
Ability to work both independently and as part of a team in a dynamic environment.
Medical Coding Auditor
Medical coder job in Tampa, FL
Are you an experienced Certified Coder with Managed Care experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you!
Job Description
Job Title: Medical Coding Auditor
Position Summary:
As the Medical Coding Auditor, you would be responsible for reviewing medical and behavioral health care medical records, coding, abstracting, and analyzing inpatient and outpatient medical records.
Hours for this Position: Monday-Friday 8:00am-5:00pm
Advantages of this Opportunity:
Pay $20-$30 per hour, negotiable based on experience
Work for a Fortune 500 company who pride themselves on partnership, integrity, teamwork, and accountability
Be a part of a team who serves the full spectrum of member needs
Weekly deposit options
Great benefits offered
More Insight of Daily Responsibilities:
Verify and validate authorization of services
Coordinate coding and payment issues
Conduct reviews of medical records/documents supporting claims for medical/behavioral services
Identify coding errors, inconsistencies, or abnormal billing patterns
Qualifications
What We Look For:
CCA, CCS, CCS-P, CPC, or CPC-H certification
5+ years of experience in managed care and/or behavioral health care
Additional Information
Want More Information?
Interested in hearing more about this great opportunity? Reach out to Amanda Hammer at 407-636-7030 ext. 201 for immediate consideration.
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
The greatest compliment to our business is a referral. If you know of someone looking for a new opportunity, please pass along my contact information!
Medical Coding Auditor
Medical coder job in Fort Lauderdale, FL
Hybrid-Sunrise, Florida
The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements.
Essential Duties and Responsibilities:
Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment.
Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified.
Coordinates overpayment recoveries with the Fraud Investigative Unit Manager.
Responsible for assisting the Fraud Investigative Unit Manager with potential fraud, waste or abuse investigations requiring medical coding expertise, participating in external audit requests, and special projects as needed.
Coordinates, conducts, and documents audits as needed for investigative purposes.
Prepares written reports or trending data related to findings and facilitates timely turnaround of audit results.
Prepares written summaries of audit results for purposes of reporting potential fraud, waste, abuse and/or overpayment.
Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner.
Identifies potential provider fraud through review of claims data, complaint referrals, and application of rules, healthcare coding practices, and fraud detection software.
Reviews provider billing practices to investigate claims data and compliance with State and Federal laws.
Analyzes provider data and identifies erroneous or questionable billing practices.
Interprets state and federal policies, Florida Medicaid, Children's Health Insurance Program, and contract requirements.
Determines and calculates overpayment/underpayment, appropriately documents and participates in steps to remediate.
Determines priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
Performs all other duties as assigned.
This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
Qualifications:
Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) must have.
Candidates with relevant work experience may be eligible for company-sponsored certification or licensure.
Prior experience in Medicaid claims role and/or post payment medical coding auditor role preferred.
Knowledge of Medicaid rules, claims processing, medical terminology and coding principles and practices.
Knowledge of auditing, investigation, and research.
Knowledge of word processing software, spreadsheet software, and internet software.
Manage time efficiently and follow through on duties to completion.
Skills and Abilities:
Written and verbal communication skills.
Ability to organize and prioritize work with minimum supervision.
Detail oriented.
Ability to perform math calculations.
Analytical and critical thinking skills.
Ability to operate personal computer and general office equipment as necessary to complete essential functions, including using spreadsheets, word processing, database, email, internet, and other computer programs.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions.
Work Schedule:
Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.
Medical Coding and Billing Specialist
Medical coder job in Birmingham, AL
Right at Home is a Home Health company that provides Nursing and Therapy services in the homes of patients throughout Alabama. Right at Home is a Preferred Provider of BlueCross BlueShield of Alabama. Billing Specialist duties and responsibilities Billing Specialists perform many accounting, customer service and organizational tasks to promote the financial health of their organization. These duties and responsibilities often include:
Maintaining the billing and medical coding for BlueCross BlueShield of Alabama
Collaborating with patients or customers, third party institutions and other team members to resolve billing inconsistencies and errors
Creating invoices and billing materials to be sent directly to a customer or patient
Inputting payment history, upcoming payment information or other financial data into an individual account
Finding financial solutions for patients or customers who may need payment assistance
Informing patients or customers of any missed or upcoming payment deadlines
Calculating and tracking various company financial statements
Translating medical code if working in a medical setting
A Billing Specialist uses soft skills, technical abilities and industry-specific knowledge to manage their organization's accounts, including:
Strong communication, including writing, speaking and active listening
Great customer service skills, including interpersonal conversation, patience and empathy
Good problem-solving and critical thinking skills
In-depth knowledge of industry best practices
Basic math, bookkeeping and accounting skills
Organization, time management and prioritization abilities
Ability to be discreet and maintain the security of patient or customer information
Effective computer skills to input to use bookkeeping and account management software in a timely and efficient manner
Understanding of industry-specific policies, such as HIPAA regulations for health care
Compensation: $18.00 per hour
Right at Home's mission is simple...to improve the quality of life for those we serve. We accomplish this by providing the Right Care, and we deliver this brand promise each and every day around the world. However, we couldn't do it without having the Right People. Our care teams are passionate about serving our clients and are committed to providing the personal care and attention of a friend, whenever and wherever it is needed.
That's where you come in. At Right at Home, we help ordinary people who have a passion to serve others become extraordinary care team members. We seek to find people who are compassionate, empathetic, reliable, determined and are focused on improving the quality of life for others.
To our care team members, we commit to deliver the following experiences when you partner with Right at Home:
We promise to help you become the best you can be. We will equip you as a professional by providing best in class training and investing in your professional development.
We promise to coach you to success. We're always available to support you and offer you tips to be the best at delivering care to clients.
We promise to keep the lines of communication open. We will listen to your ideas and suggestions as you are critical to our success in providing the best possible care to clients. We will provide you timely information and feedback about the care you provide to clients.
We promise to celebrate your success. We will appreciate the work you do, recognize above and beyond efforts, and reward you with competitive pay.
This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to Right at Home Franchising Corporate.
Auto-ApplySMRMC Full Time 1373-HIM Coder/Certified Level 2-7181
Medical coder job in McComb, MS
Job Summary: The Health Information Coder is expected to provide exceptional customer care to Southwest Health consumers, visitors, and staff. The HIM Coder is responsible for using coding work queues daily in the electronic health record and selecting the most accurate and applicable codes per coding guidelines. The HIM Coder must communicate with their Coding Supervisor and Billing Staff daily for prompt resolution of coding issues and claim processing issues. The HIM coder is expected to participate in bi-weekly meetings, monthly, quarterly, and yearly coding education through various educational sources. The HIM Coder must maintain coding certifications and continuing education units and must be willing to perform any task assigned by supervisor or Department Head.
Additional Responsibilities:
Reviewing and coding patient encounters of all specialties.
Ensure that all codes are accurately assigned.
Report missing or incomplete documentation to the analysis area or submit queries to providers if necessary.
Meet daily coding productivity and quality standards set forth by the department.
Review charge code entries for accuracy and makes corrections as needed.
Serve as a resource regarding insurance denials and coding questions from the Revenue Cycle team.
Adhere to and follow all coding guidelines and legal requirements to ensure compliance with Federal and State regulations.
General Functions:
Complete required continuing education to maintain coding credentials and license.
Support and assist the Coding Manager of HIM and Revenue Cycle leadership on special projects as requested.
Work directly with other departments and attend all internal/external meetings and training.
Auto-ApplyMedical Records & Referral Coordinator
Medical coder job in Orlando, FL
This person is responsible for assisting medical providers as directed; scanning, and importing all documents received via mail and electronic medical records system.
PRIMARY FUNCTIONS
Make medical records available to practitioners and clinical personnel upon request.
Make requests for summaries of medical care given to our patients by private physicians or medical facilities, keep a record of all correspondence and provide follow-up.
Gather data necessary for all requested patient charts by hospitals, attorneys, etc., including making copies and arranging delivery of such documents.
Electronic records; attach reports of consultation and diagnostic procedures (x-ray, laboratory, consultations, etc.).
Responsible for answering phone calls regarding patient questions related to medical records.
Responsible for accurately scanning and importing all medical records received via mail within 24-48 hours.
Responsible for verifying all documents located in the EMR system have been correctly labeled and imported.
Other responsibilities as assigned.
EDUCATION AND EXPERIENCE
High school diploma or equivalent
3 years medical experience
KNOWLEDGE, SKILLS, AND ABILITIES
Ability to work under pressure.
Computer literacy.
Ability to work well with people.
ADDITIONAL QUALIFICATIONS
Bilingual a plus.
RELATIONSHIP REPORTING
Reports to Medical Records and Referral Manager
PHYSICAL REQUIREMENTS
Ability to sit for extended periods of time.
Ability to view a computer screen for extended periods of time.
Ability to perform repetitive hand and wrist motions for extended periods of time.
Ability to hear and converse in a professional manner at all times.
Thank you
Auto-ApplyMedical Records
Medical coder job in Mobile, AL
Medical Records Staff - Mobile County
Seeking experienced Electronic Medical Records team member. Job duties include filing charts, organizing records, fielding inquiries and faxing charts in a fast paced environment. The candidate who qualifies for this position must have a working knowledge of medical terminology, an understanding of release of information and knowledge of HIPAA regulations. Excellent benefits, competitive salary and pleasant working environment.
Location: Mobile
Benefits:
Health and Dental Insurance
Paid Time Off, Paid Holidays, Paid Sick Days
Retirement Plan
Medical Record Review Specialist I
Medical coder job in Pensacola, FL
Job Description
Medical Record Review Specialist -
Join the Retrev Team!
Are you passionate about detail, driven by accuracy, and fluent in medical terminology? Retrev is looking for highly organized and detail-oriented professionals to join our growing team of Medical Record Review Specialists.
In this role, you'll bridge the worlds of medicine and law-using your knowledge of medical records to help our partner law firms build strong, evidence-based cases. You'll review and summarize medical documentation, identifying key facts and patterns which support claim evaluations and case preparation.
Depending on the project, you may complete simple bookmarking and highlighting tasks or create comprehensive chronologies and summaries of medical events. Each project requires precision, efficiency, and the ability to stay focused while meeting timelines.
???? Please note: This is a sedentary, computer-based role requiring consistent focus and daily use of digital systems.
What We're Looking For
Strong understanding of medical terminology and medical record structures
Ability to distinguish between different report types (operative, pathology, imaging, etc.)
Exceptional attention to detail and commitment to accuracy
Ability to manage deadlines and switch between multiple project types
What You'll Bring
Proficiency in evaluating medical records and navigating various document types
Ability to process material across varied medical subjects with intense attention to detail
Excellent organizational and time management skills
Strong sense of confidentiality - Retrev is a HIPAA-compliant facility
Ability to work independently in a quiet office environment with minimal supervision
What You'll Do
Review and summarize medical records according to project guidelines - focusing on factual data only (no diagnoses or opinions)
Track time spent on each project per departmental procedures
Meet deadlines established by both clients and internal teams to ensure satisfaction and quality
Support team and departmental goals with flexibility and professionalism
Perform other duties as assigned
Qualifications & Experience
High school diploma or equivalent required; associate degree preferred
Background in the medical field (education or work experience) preferred
Computer savvy and advanced working knowledge of Microsoft Suite applications, including Outlook, Teams, Excel, and Word, along with Adobe Acrobat
Legal experience or familiarity preferred
Demonstrated professional communication skills, both written and verbal
We value our team members and provide a comprehensive benefits package, including
Affordable medical, dental, and vision insurance
HSA/FSA account opportunities
Teladoc Virtual Care, free membership
$40,000 Life & AD&D insurance, fully paid by the company
7 paid holidays per year
Paid Time Off - accrued from day one!
Retirement Plan with company matching
If you're ready to apply your medical knowledge in a meaningful way and make a real difference, we'd love to hear from you!
Coder Inpatient, Marshall Medical Center South, HIM, Full Time, Days
Medical coder job in Boaz, AL
The following statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements, which may be inherent in the position.
An inpatient coder is responsible for utilizing coding policies and procedures in evaluating the diagnostic and procedural information within the medical record for determination of accurate DRG or APC assignment for reimbursement of services rendered and for verifying/abstracting clinical information into the organization's health database.
An inpatient coder functions under the direct authority and supervision of the Coding Supervisor and Director of the Health Information Management Department.
Some of the many skills performed
Coding of diagnoses and procedures for:
Inpatients
Observation
Other Outpatient Service Types, if appropriate
Qualifications
EDUCATION:
High school graduate or equivalent
2 years or more in Health Information Management
1-2 years' experience in inpatient coding
LICENSURE/CERTIFICATION:
RHIA, RHIT, or CCS certification preferred
Certification must be obtained within one (1) year of employment
About Us
Lake Guntersville, a mountain-lakes jewel, is located approximately 30 miles from metro Huntsville - and is home to Marshall Medical Centers.
Marshall Medical Centers, an affiliate of the Huntsville Hospital Health System, serves the residents of Marshall County and the surrounding area (population approximately 125,000). With two hospitals, eight outpatient locations and a highly-trained team of physicians practicing 28 specialties, Marshall Medical is a confident, convenient choice for local healthcare. Residents can remain close to home and receive excellent care - often provided by those who are neighbors and friends.
Marshall Medical Center South is a 150-bed hospital in Boaz, Alabama, and opened in 1956. Marshall Medical Center North, in Guntersville, opened in 1990 - and - is a 90-bed facility. In addition to the two hospitals, the Gary R. Gore Medical Complex is conveniently located mid-county and is home to several outpatient clinics and a 22,000 square foot comprehensive Cancer Care Center.
Named by the Joint Commission as a “Top Quality Performer” among America's hospitals, Marshall Medical Centers' patients can be assured they are being treated in an environment where a premium is placed on quality and best practices.
Auto-ApplyMedical Records Clerk - PRN
Medical coder job in Fort Myers, FL
Now Hiring - Medical Records Clerk - PRN
Type: PRN
Hours: Varies
Radiology Regional is one of the largest physician-driven diagnostic imaging providers, with 13 imaging centers, in Southwest Florida. We are seeking a dynamic person with a passion to care for others in the communities we serve. For over 50 years we have earned trust and confidence because of their patient care experience.
Job Summary:
Receives and follows directives and instructions from the medical records supervisor.
Processes presented incoming requests for medical records, retrieve and prepare records for transport, records requests following procedure and forwards to appropriated location for delivery.
Assists when needed, with answering the telephones, records, relays, delivers and completes messages.
Maintains records relevant to assigned tasks on all released or returned internal medical records.
Performs basic computer functions: navigates and interprets basic information in company's computer systems to facilitate daily procedures and assigned basic clerical functions.
Operates office equipment as necessary; including computer terminals, printers, phone systems, fax machines and copy machines.
Maintains adequate office inventory for assigned area and advises immediate supervisor or team leader of re-orders points.
Assists in all medical records clerical and courier areas, and is required to have a minimal to adequate working knowledge of these areas.
And much more!
Requirements
Ability to process incoming requests for medical records.
Good telephone skills to assist, when needed, with answering the telephones.
Maintains records relevant to assigned tasks on all released or returned internal medical records.
Must be able to operate office equipment as necessary; including computer terminals, printers, phone systems, fax machines and copy machines.
High School Diploma or GED required
Computer and medical records knowledge preferred
Minimum six (6) months practical clerical experience
Radiology Regional is an Equal Opportunity Employer.
Referrals & Medical Records Clerk
Medical coder job in Fort Lauderdale, FL
JOB RESPONSIBILITIES Route clients/patients to the appropriate areas within the agency. Answer phones, check and return voice messages in a timely basis. Update patient demographics in agency data system as appropriate. Referrals/Authorization:
Verify patient insurance carrier/coverage to ensure proper processing of referrals.
Respond to all correspondence and task (via letter, email, faxes) in a timely manner.
Record and maintain patient health records in agency's database and other data systems.
Process referrals for patient specialist visits including in house specialist and outside providers (via insurance portals, phone calls, etc.)
Coordinate appointments for patients with specialists.
Ensure updates are made in EHR regarding appointments made for specialist, patient attendance and/or comments, etc.
Process additional information requested by insurance companies for authorizations (medical records, documentation from providers, etc.).
Assist in authorization denials and appeals on behalf of the patient and document outcomes in record system.
Identify alternative solutions, as determined necessary by providers, for denied authorizations.
Ensure external 3rd party documentation (i.e. labs, consultation reports, etc.) is collected and entered in the patient's electronic health records (EHR).
Ensure proper and timely closing of tasks as it relates to referrals and open orders via EHR.
Medical Records:
Receive and document medical records requests from outside agencies (Social Security Administration, legal offices, outside providers or patient request)
Prepare invoices for payments of medical records request.
Prepare medical records as requested by printing from EHR and prepping for faxing or mailing.
Ensure documentation for new patients is collected and recorded in patient's electronic health records (EHR).
Ensure patient documentation is fully completed and recorded in agency's database.
Ensure appropriate assignment to the provider upon receiving records and closure of task by the provider, once the records are obtained.
Quality Assurance/Compliance:
Assist in ensuring that the medical office (front desk and waiting area) is kept clean and tidy at all times.
Ensure online training is current as required (My LearningPointe and other trainings).
Ensure that medical operations fully comply with agency and HIPAA requirements.
Safety:
Ensure proper hand washing according to the Centers for Disease Control and Prevention guidelines.
Understands and appropriately acts upon assigned role in Emergency Code System.
Understands and performs assigned role in agency's Continuity of Operations Plan (COOP).
Culture of Service: 3 C's
Compassion
Greet internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone, and nonverbal language.
Listen to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring, and understanding of the request and providing appropriate options or resolutions.
Competency
Provide services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered
Commitment
Take initiative and anticipate internal or external customer needs by engaging them in the process and following up as needed
Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided
Safety
Ensure proper handwashing according to the Centers for Disease Control and Prevention guidelines.
Understands and appropriately acts upon the assigned role in Emergency Code System.
Understands and performs assigned roles in the organization's Continuity of Operations Plan (COOP).
Contact Responsibility
The responsibility for external contacts is constant and critical.
Physical Requirements
This work requires the following physical and sensory activities: constant sitting, hearing/ visual acuity, talking in person, and on the phone. Frequent, walking, standing, sitting, and bending. Work is performed in-office setting.
Other
Participates in health center developmental activities as requested.
Other duties as assigned.
Job Knowledge and Skills:
Bilingual (English Spanish) is preferred. Computer knowledge should include Microsoft Outlook, Word, and Excel. Excellent problem solving, communication, organizational and teamwork skills are required. The ability to work with a multicultural and diverse population is required.
Release of Information Specialist {MOB - Providence}
Medical coder job in Mobile, AL
Requirements
Minimum Knowledge, Skills, Experience Required
High School Diploma (GED) required; degree preferred
Prior experience with ROI fulfillment preferred
Demonstrated attention to detail
Demonstrated ability to prioritize, organize, and meet deadlines
Demonstrated documentation and communication skills
Demonstrated ability to maintain productivity and quality performance
Basic knowledge of medical records and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) preferred
Prior experience with EHR/EMR platforms preferred
Prior experience with Windows environment and Microsoft Office products
Displays strong interpersonal skills with team members, clients, and requestors
Must have strong computer skills and Microsoft Office skills
Prior experience with operations of equipment such as printers, computers, fax
machines, scanners, and microfilm reader/printers, etc. preferred
Must be detailed oriented, self-motivated and can stay focused on tasks for extended periods of time.
Must be able to read, write, speak, and comprehend English. Bilingual skills are desirable.
Medical Records Clerk
Medical coder job in Florida
Job DescriptionJOB AD: Medical Records Clerk Aspen Medical has an exciting opportunity for MRCs to partner with us in providing quality medical care to patients within a transitional setting. MRCs, alongside fellow team members, will be fully entrusted to ensure that the utmost competent care and safety is consistently delivered with compassion to the patient population.
The medical teams will be located within a secure medical facility, where such services include, but are not limited to the following:
Medical Screening (New Arrivals)
Comprehensive Screening
Sick Call
24-Hour Emergency Medical and Mental Health Treatment
Women's Medical Care
Aspen Medical will provide additional EMS, Diagnostic and Laboratory, and other ancillary services. All clinic service delivery services will be provided in accordance with US clinical standards and compliance measures.
Citizenship:
*All Aspen Medical staff must be US citizens or Green Card holders. Sponsorship will not be available
.
Requirements:
Education:
High School diploma or General Educational Development (GED)
equivalency. Basic medical terminology required
Certification:
Registered Health Information Technician (RHIT) or Registered
Health Information Administrator American Heart Association certification in Basic Life Support (BLS)
Experience:
A minimum of one year of recent, relevant, related experience
Language Proficiency:
Fluency in Spanish is highly desired but not required
Core Duties:
Initiates and maintains medical records in accordance with prescribed directives
Files military forms documenting patient care into the official medical record
Searches for missing paperwork or records; requests information pertaining to
patient treatment to place in the medical record
Prepares reports regarding record statistics as necessary. Participates in records review as part of the facility's quality assurance program and in accordance with Exhibit 5, Version 1.0 (4 Oct 22) accreditation standards
Retires medical records in accordance with regulatory guidelines.
*Pay rate details and associated work schedules will be outlined during the interview phase.
Aspen Medical is committed to a diverse and inclusive workplace. We are an equal opportunity employer, and Aspen Medical does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. For individuals with disabilities who would like to request accommodation, please contact *************************.
By joining Aspen Medical, you will join a responsive mission-driven organization where you will be a vital member of a small, dynamic team supported by a large international corporation.
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