Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
JOB SUMMARY:
The Coding Specialist III will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the needs of hospital data retrieval for billing and reimbursement.
Coding Specialist III validate MSDRG and/or APC calculations in order to accurately capture the diagnoses/procedures documented in the clinical record. Coding Specialist III performs documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coding Specialist III may interact with client staff and providers.
JOB ACCOUNTABILITIES:
Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types which may include but is not limited to: Acute Inpatient, Observation/Rehabilitation/Psychiatric/SNF; Ambulance and Ambulatory Surgery; Wound Care, Emergency Department, Ancillary (Diagnostic) / Recurring; Interventional Radiology; Hospital Clinic
Review and analyze clinical records to ensure that MSDRG/APC assignments accurately reflect the diagnoses/procedures documented in the clinical record.
Abstract clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures and discharge disposition is selected.
Complete assigned work functions utilizing appropriate resources.
May act as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.
Maintain strict patient and provider confidentiality in compliance with HIPPA
Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.
Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.
Support Savista's Compliance Program by demonstrating adherence to all relevant compliance policies and procedures as evidenced by in-service attendance and daily practice; notifying management when there is a compliance concern or incident; demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information; promoting confidentiality and using discretion when handling patient and/or client information.
Performs other related duties as assigned or requested.
QUALIFICATIONS:
Candidates must successfully pass pre-employment skills assessment. Required:
An active AHIMA (American Health Information Association) credential including but not limited to RHIA, RHIT, CCS, CCA, or an active AAPC (American Academy of Professional Coders) credentials COC (formerly CPC-H), CCS-P, or CPC or related specialty credential.
Three (3) years of recent and relevant hands-on coding experience with all record types:
- Acute Inpatient, Observation/Rehabilitation/Psychiatric/SNF; Ambulance and Ambulatory Surgery; Wound Care, Emergency Department, Ancillary (Diagnostic) / Recurring; Interventional Radiology; Hospital Clinic; Physician Pro Fee; Technical Fee; Evaluation and Management.
Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets.
Ability to consistently code at 95% threshold for both accuracy and quality while maintaining client-specific and/or Precyse production and/or quality standards
Proficient computer knowledge including basic MS Office knowledge. Basic MS Office knowledge includes data entry, sort, filter, copy, paste and password protect functions in Excel and/or Word programs. Basic MS Outlook knowledge is opening and responding to emails and accepting and scheduling meetings using the Outlook calendar.
Must display excellent interpersonal and problem-solving skills with all levels of internal and external customers
Preferred:
Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
Recent and relevant experience in an active production coding environment strongly preferred
Experience with multiple Electronic Medical Record software applications including but not limited to EPIC, Cerner and Meditech.
Experience with multiple Encoder software applications including but not limited to 3M and TruCode.
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $28.00 - $34.00 an hour. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
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$28-34 hourly Auto-Apply 60d+ ago
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Coder II - Certified
Crisp Regional 4.2
Medical coder job in Cordele, GA
Under the leadership of the Physician Coding Manager, the Coding Technician is an active member of the Physician Services team that delivers professional coding and support consistent with the strategic vision, goals, philosophy and direction of physician services department and CRHS. The Coding Technician is responsible for accurately coding medical practice records. This is done for the purpose of reimbursement, research and compliance with federal regulations according to diagnoses, operations and procedures using ICD-10-CM and CPT classification systems.
Basic Qualifications:
Education:
High school graduate
Associate degree preferred.
AAPC or AHIMA Coder Certification.
Experience:
Practical experience of >2 years in healthcare preferred.
Typing/computer skills required; must be able to use ICD-10-CM/CPT code books.
Must be knowledgeable in general coding rules/regulations and proficient in ICD-10-CM and CPT coding.
Licensure, Registrations & Certifications:
CPC or other AHIMA coding certification required.
Additional specialty coding or billing certification preferred.
Essential Job Responsibilities:
Accurately codes diagnoses and procedures with standard ICD-10-CM/CPT for medical practice records.
Data entry of correct/complete diagnoses codes and procedure codes for final billing of medical office claims.
Query physician(s) if needed for clarification of diagnosis and office procedures if not in medical record.
Handle general denials of accounts based on the codes.
Review charts/records for accounts as requested.
Perform other duties as assigned by supervisor.
$45k-56k yearly est. 43d ago
Coder-Certified I
SPCP/Southeast Medical Group
Medical coder job in Alpharetta, GA
Job DescriptionDescription:
Southeast Primary Care Partners is seeking a dedicated and detail-oriented Certified Coder to join our dynamic team. The successful candidate will play a crucial role in accurately coding healthcare claims for reimbursements, ensuring compliance with federal regulations, and contributing to the efficiency and effectiveness of our healthcare services. Certified Coder reviews medical records to assure proper billing. Participates in audits to evaluate if all selected codes are accurate and develops methodologies to improve coding issues identified. Codes must meet QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines).
Requirements:
Key Responsibilities:
Review patients' medical records to extract relevant information needed for billing and coding.
Apply appropriate ICD-10, CPT, and HCPCS Level II code assignments to ensure accurate and timely billing.
Work closely with healthcare providers and billing teams to clarify discrepancies, ensure documentation compliance, and verify the accuracy of coded data.
Stay current with coding guidelines, trends, and federal regulations to ensure up-to-date knowledge and compliance.
Conduct regular audits to ensure coding accuracy, address any discrepancies, and provide feedback and education to clinical staff as needed.
Assist the billing department in the resolution of coding-related denials and rejections, including preparing appeals as necessary.
Participate in educational sessions, workshops, and meetings to enhance coding knowledge and skills.
Requirements:
Certification as a medicalcoder from an accredited organization (e.g., CPC).
>1yr of coding experience in a primary care setting.
Proficiency in ICD-10, CPT, and HCPCS Level II coding standards.
In-depth knowledge of medical terminology, pharmacology, and disease processes.
Strong analytical and problem-solving skills.
Excellent attention to detail and organizational skills.
Solid communication skills, both written and verbal.
Ability to work independently and collaboratively within a team environment.
Familiarity with Electronic Health Record (EHR) systems and medical billing software.
Preferred:
Experience with coding audits and compliance reviews.
Knowledge of federal regulations regarding medical coding and billing.
Key physical and mental requirements:
Ability to lift up to 50 pounds
Ability to push or pull heavy objects using up to 50 pounds of force
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
FLSA Classification: Non-exempt
Southeast Primary Care Partners is an Equal Opportunity Employer. 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.
12/2024
$37k-52k yearly est. 27d ago
Entry -Level Medical Coder
Revel Staffing
Medical coder job in Atlanta, GA
We are seeking a motivated Entry -Level MedicalCoder / Billing Assistant to join the administrative team. This position offers a great pathway into the healthcare field for individuals interested in medical billing and coding. Hybrid work is possible after the training period.
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 HIPAA 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.
$37k-52k yearly est. 42d ago
Medical Coding specialist
Careperks
Medical coder job in Tucker, GA
Join Our Team as a Medical Coding SpecialistJob Description
CarePerks LLC, a leading healthcare organization in Tucker, GA, is seeking a detail-oriented and experienced Medical Coding Specialist to join our team. As a Medical Coding Specialist, you will play a crucial role in ensuring accurate patient records and billing processes within our organization.
Key Responsibilities:
Assigning appropriate medical codes to diagnosis and procedures
Reviewing patient information for accuracy and completeness
Ensuring compliance with all coding guidelines and regulations
Communicating with healthcare providers to clarify documentation
Resolving any coding-related denials or discrepancies
Qualifications:
Minimum of 2 years of medical coding experience
Certification in medical coding (e.g. CPC, CCS)
Proficiency in ICD-10-CM and CPT coding
Strong knowledge of medical terminology and anatomy
Excellent attention to detail and organizational skills
If you are a dedicated Medical Coding Specialist looking to make a meaningful impact in the healthcare industry, we invite you to apply for this position at CarePerks LLC.
About CarePerks LLC
CarePerks LLC is a trusted healthcare organization based in Tucker, GA, dedicated to providing high-quality and compassionate care to our patients. Our team of healthcare professionals works tirelessly to improve the health and well-being of those we serve. At CarePerks LLC, we are committed to excellence in all that we do, and we value integrity, respect, and teamwork in our daily operations.
$37k-52k yearly est. 60d+ ago
Medical Coding specialist
Careperks LLC
Medical coder job in Tucker, GA
Join Our Team as a Medical Coding SpecialistJob Description
CarePerks LLC, a leading healthcare organization in Tucker, GA, is seeking a detail-oriented and experienced Medical Coding Specialist to join our team. As a Medical Coding Specialist, you will play a crucial role in ensuring accurate patient records and billing processes within our organization.
Key Responsibilities:
Assigning appropriate medical codes to diagnosis and procedures
Reviewing patient information for accuracy and completeness
Ensuring compliance with all coding guidelines and regulations
Communicating with healthcare providers to clarify documentation
Resolving any coding-related denials or discrepancies
Qualifications:
Minimum of 2 years of medical coding experience
Certification in medical coding (e.g. CPC, CCS)
Proficiency in ICD-10-CM and CPT coding
Strong knowledge of medical terminology and anatomy
Excellent attention to detail and organizational skills
If you are a dedicated Medical Coding Specialist looking to make a meaningful impact in the healthcare industry, we invite you to apply for this position at CarePerks LLC.
About CarePerks LLC
CarePerks LLC is a trusted healthcare organization based in Tucker, GA, dedicated to providing high-quality and compassionate care to our patients. Our team of healthcare professionals works tirelessly to improve the health and well-being of those we serve. At CarePerks LLC, we are committed to excellence in all that we do, and we value integrity, respect, and teamwork in our daily operations.
#hc181434
$37k-52k yearly est. 2d ago
Coder II
Southwell, Inc.
Medical coder job in Tifton, GA
DEPARTMENT: CODING FACILITY: Tift Regional Medical Center WORK TYPE: Full Time SHIFT: Daytime Under the supervision of the Coding Supervisors and Manager, the Coder II assigns codes to discharge records for inpatients, outpatients and emergency room patients based on diagnoses and operative procedures.
RESPONSIBILITIES:
* Selection/sequencing of principal and secondary diagnosis done correctly at least 98% of the time.
* Uses manual or computer encoder for appropriate coding system (ICD-9-CM or CPT) to assign code to completely describe physician documentation of diagnosis or procedure.
* If diagnosis is unclear, contacts documentation specialists for query.
* Ensures corrections made by physician and other medical personnel are properly recorded and complete.
* Enters coded information in computer system for billing purposes.
* Meets minimum standard of 98% productivity requirements.
* Assists case managers in coding and reimbursement issues.
* Abstracts designated statistical data from patient record and enters the information into the abstract database.
* Abstracts all appropriate data at least 98% of the time.
* Releases confidential information only in accordance with hospital policy.
* Assures security of departmental files in accordance with departmental policy.
* Codes records according to industry standards without regard to reimbursement.
* Knows emergency procedures for fire, safety, hazardous material utility system failure, and disasters.
* Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. ("TRHS") policies as they presently exist and as they change or are modified.
* Understands and adheres to: TRHS' compliance standards as they appear in TRHS's Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
* Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
* Offers suggestions on ways to improve operations of department and reduce costs.
* Attends all mandatory education programs.
* Improves self-knowledge through voluntarily attending continuing education/certification classes.
* Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
* Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
* Volunteers/participates on hospital committees, functions, and department projects.
* Manages resources effectively.
* Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
* Makes good use of time so as to not create needless overtime.
EDUCATION:
* High School Diploma or Equivalent
CREDENTIALS:
* Certified Coding Associate
* Certified Professional Coder
* REGISTERED HEALTH INFORMATION TECHNOLOGIST
* Certified Coding Specialist
* REGISTERED HEALTH INFORMATION ADMINISTRATOR
OTHER INFORMATION:
In addition to high school diploma or equivalent, Certified Coding Associate (CCA), Certified Professional Coder (CPC), or Registered Health Information Technologist (RHIT) credential is required. At least 2 years of coding experience is preferred. A score of 85% or higher on internal coding test required.
Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.
$38k-52k yearly est. 60d+ ago
Medical Coder
Apex Spine and Neurosurgery LLC
Medical coder job in Suwanee, GA
Job Description
The MedicalCoder / Coder PAR at Apex Spine and Neurosurgery is responsible for reviewing clinical documentation and assigning accurate CPT, ICD-10, and HCPCS codes for spine, neurosurgical, and interventional pain management services. This role ensures compliant, complete, and timely coding to support revenue integrity, authorization accuracy, and efficient claims processing in accordance with CMS and payer guidelines.
Key Responsibilities
Review operative reports, clinic notes, imaging, and diagnostic studies to accurately assign CPT, ICD-10, and HCPCS codes for spine and neurosurgical procedures.
Code surgical and procedural services including (but not limited to): spine surgeries, decompressions, fusions, discectomies, laminectomies, injections, nerve blocks, ablations, and other interventional pain procedures.
Ensure compliance with CMS guidelines, NCCI edits, payer-specific policies, and internal coding standards.
Communicate directly with physicians and advanced practice providers to clarify documentation and ensure accurate coding and medical necessity.
Support prior authorization (PAR) processes by reviewing documentation, validating codes, and ensuring alignment with payer requirements.
Enter codes into the EHR/billing system and confirm documentation supports all billed services.
Collaborate with billing and authorization teams to resolve coding edits, denials, and discrepancies.
Assist with internal and external audits, compliance reviews, and coding workflow improvements.
Stay current with annual CPT/ICD updates, CMS rules, spine and neurosurgery coding changes, and payer policy updates.
Participate in provider education related to documentation requirements, surgical reporting, and medical necessity standards.
Qualifications
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.
Minimum of 3-5 years of medical coding experience, preferably in spine surgery, neurosurgery, orthopedics, interventional pain management, or a related surgical specialty.
Strong working knowledge of CPT, ICD-10, HCPCS, NCCI edits, and CMS guidelines.
Experience reading and interpreting operative reports and procedural documentation.
Familiarity with EMR/EHR systems and coding/billing software.
Excellent attention to detail, organization, and problem-solving skills.
Strong communication skills with providers, clinical staff, and revenue cycle teams.
$37k-52k yearly est. 7d ago
Medical Coder - Wound Care
Pinnacle Wound Management
Medical coder job in Gainesville, GA
MedicalCoder - Wound Care (Long -Term Care)
About Us Pinnacle Wound Management is a physician -led wound care provider dedicated to improving healing outcomes for patients in skilled nursing and long -term care facilities. We partner with facilities to deliver advanced wound care at the bedside, supported by thorough documentation, EMR integration, and compliance with payer guidelines.
We are seeking a MedicalCoder with wound care experience to join our team. This role is critical in ensuring timely, accurate coding and billing for patient encounters and cellular tissue product usage across multiple facilities.
Key Responsibilities
Accurately review and code wound care services performed in long -term care and post -acute settings, ensuring compliance with ICD -10, CPT, HCPCS, and payer requirements
Code independently without reliance on a provider superbill, using clinical notes and documentation as the source of truth
Release daily coding batches to support timely revenue cycle processing
Code red -label (cellular tissue) products and ensure proper documentation of lot numbers and graft application details
Assist and work closely with the billing team to correct coding errors and resolve claim rejections/denials
Generate detailed coding reports and batch logs for submission to the Director of Operations
Collaborate with the billing and operations teams to reconcile coding discrepancies and ensure compliance
Monitor payer and CMS updates impacting wound care coding, documentation, and compliance
Maintain coding accuracy, productivity standards, and adherence to compliance regulations
Qualifications
Certification strongly preferred: CPC (Certified Professional Coder), CCS, or equivalent
Minimum 2 years of experience in medical coding; wound care or long -term care experience highly preferred
Strong knowledge of ICD -10, CPT, and HCPCS coding guidelines
Ability to code directly from clinical notes/documentation without superbill support
Experience coding cellular tissue/red -label products a plus
Proficient in generating coding reports, logs, and error correction documentation
Detail -oriented with excellent organizational skills and ability to manage coding batches daily
Comfortable working independently with minimal supervision
What We Offer
Competitive compensation package
Opportunity to specialize in wound care and advanced procedures in the long -term care space
Supportive team environment focused on compliance and patient -centered outcomes
$37k-52k yearly est. 35d ago
Medical Coder
Four Winds Health 4.0
Medical coder job in Newnan, GA
Job Description
A MedicalCoder for WellStreet Urgent Care is responsible for supporting all aspects of the Revenue Cycle for our Urgent Care Centers.
Responsibilities • Coding for our Urgent Care Centers using our internal software
• Knowledge of ICD-10 Coding and compliance
• Experience using an encoder
• Setting up insurance plans within our software
• Working with the Revenue Cycle Management to identify & resolve issues related to coding and the process flow
• Interfacing with clinic staff on billing & coding issues.
• Comply with all legal requirements regarding coding procedures and practices
• Conduct audits and coding reviews to ensure all documentation is accurate and precise
• Assign and sequence all codes for services rendered
• Collaborate with billing department to ensure all bills are satisfied in a timely manner
• Communicate with insurance companies about coding errors and disputes
• Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients regarding coding procedures
• Adhere to productivity standards
Minimum Qualifications
• 3+ years of experience in medical billing
• Epic experience required
• Urgent Care and Occupational Health Billing experience is a plus
• High School diploma or equivalent
Required Skills
• Active CPC, RHIT, CCS or COC Certification
• Knowledge of insurance payers, insurance verification, the AR/revenue billing lifecycle and appealing denied claims
• Excellent Computer skills - expertise in MS word suite including Word, Excel and PowerPoint. Experience in using one or more Practice Management Systems/Billing Software Energy, enthusiasm and the ability to work under pressure in a high volume, fast paced, unstructured start-up environment
• Ability to work within a team environment and maintain a positive attitude
• Excellent documentation, verbal and written communication skills
• Extremely organized with a strong attention to detail
• Motivated, dependable and flexible with the ability to handle periods of stress and pressure
• All other duties as assigned.
WellStreet Urgent Care is committed to providing the highest quality patient and customer care. In addition to the above requirements, WellStreet is looking for team members with the following qualities: • A positive attitude toward patients, families, and coworkers. • Willingness always to go the extra mile to create an outstanding experience for customers and to train and lead the center team to do the same. • A desire to work in concert with others in an upbeat and supportive atmosphere while reinforcing the WellStreet mission to provide uncompromising service. • A compelling desire to serve others, improve your community's health, and have fun every day.
INDmisc
$37k-44k yearly est. 26d ago
HCC Risk Adjustment Coder - Full Time
Datavant
Medical coder job in Atlanta, GA
Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format.
Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care.
By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare.
As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation into precise codes that reflect the complexity and severity of a patient's health status.
You will:
Review, analyze, and code diagnostic information in a patient's medical record based on client specific guidelines for the project.
The coder will ensure compliance with established ICD-10 CM, third party reimbursement policies, regulations and accreditation guidelines.
Coders must meet and maintain a 95% coding accuracy rate.
Any other task requested by leadership.
What you will bring to the table:
AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC, or CRC).
A minimum of 2 years HCC coding experience, while certified.
Full understanding and knowledge of ICD-10, medical terminology, medical abbreviations, pharmacology and disease processes.
Ability to be flexible in the work environment.
Ability to work in a fast paced production environment while maintaining high quality.
Must be able to follow instructions, meet deadlines and work independently.
Excellent written and verbal communication skills, problem solve, ability to work in a remote environment, and time management skills.
Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data.
Must be able to use Microsoft Office with no training.
Ability to be able work on multiple client projects simultaneously, if needed.
This position has a base pay of $19.60/hour plus the option to earn up additional incentives, starting at $3.00 per chart based on quality and production.
To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion.
This job is not eligible for employment sponsorship.
Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here. Know Your Rights, explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, Datavant does not and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay.
At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not affect your application or hiring process in any way.
Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, by selecting the ‘Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here. Requests for reasonable accommodations will be reviewed on a case-by-case basis.
For more information about how we collect and use your data, please review our .
$19.6 hourly Auto-Apply 23d ago
Lead Medical Coder and Auditor [PR0001D]
Evoke Consulting 4.5
Medical coder job in Fort Stewart, GA
ProSidian is looking for “Great People Who Lead” at all levels in the organization. Are you a talented professional ready to deliver real value to clients in a fast-paced, challenging environment? ProSidian Consulting is looking for professionals who share our commitment to integrity, quality, and value.
ProSidian is a management and operations consulting firm with a reputation for its strong national practice spanning six solution areas including Risk Management, Energy & Sustainability, Compliance, Business Process, IT Effectiveness, and Talent Management. We help clients improve their operations.
Linking strategy to execution, ProSidian assists client leaders in maximizing company return on investment capital through design and execution of operations core to delivering value to customers. Visit ***************** or follow the company on Twitter at ************************* for more information.
Job Description
ProSidian Seeks a Lead MedicalCoder and Auditor (Full-Time) in CONUS - Fort Stewart, GA to support an engagement for a branch of the United States Armed Forces' Regional Health Command who's mission is to provide a proactive and patient-centered system of health with the focus on athe medical readiness of all Soldiers and for those entrusted to the care for a medically-ready force. The Armed Forces' overall mission is "to fight and win our Nation's wars, by providing prompt, sustained, land dominance, across the full range of military operations and the spectrum of conflict, in support of combatant commanders". The Regional Health Command's Readiness Mission includes dental care of active duty Soldiers, public health services, veterinary services, and providing management and support to wounded, ill and injured Soldiers assigned to its seven warrior transition units.
The ProSidian Engagement Team Members work to provide health coding services to a branch of the United States Armed Forces' Regional Health Command- Atlantic (RHC-A) military treatment facilities and provide services to MTFs located in the National Capital Region and the following RHC-A Medical Treatment Facility (MTFs) locations: AL | PR | FL | GA | KY | DC | MD | PA | VA | NY | NC | SC. Additionally, the vendor may be required to provide coding services to other military services (i.e. U.S. Navy, U.S. Air Force). The ProSidian Contract Service Providers (CSP) will work in conjunction with other health care providers, professionals, and non-contract personnel.
MD - Medical Billing & Coding Candidates shall work to support requirements as a Lead MedicalCoder and Auditor and review health record documentation for assignment of proper diagnosis and procedure codes utilizing system edits, Military Health System specific, and commercial coding guidance. This position will review and accurately code/audit office and hospital procedures for reimbursement. Review coding and abstracting on all patient types assigned to include the following: inpatient, ambulatory surgery, observation, ER, clinic and diagnostics in order to assure 96% coder accuracy (or as stipulated by contract). Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks.
Receive and review patient charts and documents for accuracy
Ensure that all codes are current and active
Report missing or incomplete documentation
Meet daily coding production
Review medical records and other source documents and collect clinical data according to specifications and guidelines provided by MHS
Accurately enter data into abstraction software using a personal computer, keyboard and/or mouse
Update and maintain document lists
Performs accurate charge entries
Ensure proper coding on provider documentation
Serves as resource regarding insurance resolutions and coding questions
Handles co-pays, balances, and charge posting
Follow all DoD and DHA directives, guidance, instructions, policies, procedures, rules, and standards relating to protection of patient information and privacy practices.
Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations
Maintain security and confidentiality of medical records and Protected Health Information (PHI)
Performs additional duties assigned by Coding Manager as needed
Qualifications
The Lead MedicalCoder and Auditor shall have consecutive employment in a position with comparable responsibilities within the past five (5) years, Must be able to use a computer to communicate via email; and proficient in Microsoft Office Products (Word/Excel/Power point) and related tools and technology required for the position.
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The main responsibility of a medicalcoder is to review clinical statements and assign standard codes using CPT , ICD-10-CM, and HCPCS Level II classification systems, etc. No healthcare facility can function effectively without medical billers, making certified professionals crucial in the healthcare industry.
Must Have A Minimum Of 2 Yrs Certification Of One Of The Following: a) American Health Information Management Association (AHIMA) Credentials: RHIA - Risk Health Information Administration | RHIT - Registered Health Information Technician | CCA - Certified Coding Associate | CCS- Certified Coding Specialist and/or b) American Academy of Professional Coders (AAPC): CPC - Certified Professional Coder | COC - Certified Outpatient Coder | CIC - Certified Inpatient Coder | CRC - Certified Risk Coder
Work products shall be thorough, accurate, appropriately documented, and comply with established criteria. The candidate shall ensure that duties are performed in a competent and professional manner that meets milestones/delivery schedules as outlined. Keys Skillset Attributes Required To be successful are Attention to Detail | Discretion | Computer Skills | Office Skills | Organizational Skills | Writing Skills | Operations | Coding | Quality | Compliance | Analytical abilities - to understand and analyze patients' health records, Strong morals, Social skills, Tech savvy.
High school degree or equivalent; Bachelor's degree in related field preferred
Medical Coding Certificate; RHIT or CPC by AAPC or AHIMA license; meet state licensure requirements
Maintain coding certification and attends in-service training as required
Two (2) years of medical coding experience
Understanding of medical terminology, anatomy and physiology
Ability to work independently or as an active member of a team
Strong computer skills in data entry, coding, and knowledge of Electronic Medical Record software; Microsoft Office Suite
Accurate and precise attention to detail
Knowledge of medical terminology, anatomy, physiology, and pathophysiology is preferred.
Outstanding oral and written communications skills
Clinical background and previous chart abstraction experience is also preferred.
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The main responsibility of a medicalcoder is to review clinical statements and assign standard codes using CPT , ICD-10-CM, and HCPCS Level II classification systems, etc. No healthcare facility can function effectively without medical billers, making certified professionals crucial in the healthcare industry.
Work products shall be thorough, accurate, appropriately documented, and comply with established criteria. The candidate shall ensure that duties are performed in a competent and professional manner that meets milestones/delivery schedules as outlined. Keys Skillset Attributes Required To be successful are Attention to Detail | Discretion | Computer Skills | Office Skills | Organizational Skills | Writing Skills | Operations | Coding | Quality | Compliance | Analytical abilities - to understand and analyze patients' health records, Strong morals, Social skills, Tech savvy.
TRAVEL: Travel as coordinated with the technical point of contact and approved in writing by the Contracting Officer in advance, is allowed, in accordance with Federal Travel Regulations.
LOCATION: Work shall be conducted CONUS - Fort Stewart, GA
Excellent oral and written communication skills
Attention to detail
Analytical and evaluation skills
Proficient with Microsoft Office Products (Microsoft Word, Excel, PowerPoint, Publisher, & Adobe)
U.S. Citizenship Required
Additional Information
As a condition of employment, all employees are required to fulfill all requirements of the roles for which they are employed; establish, manage, pursue, and fulfill annual goals and objectives with at least three (3) Goals for each of the firms Eight Prosidian Global Competencies [1 - Personal Effectiveness | 2 - Continuous Learning | 3 - Leadership | 4 - Client Service | 5 - Business Management | 6 - Business Development | 7 - Technical Expertise | 8 - Innovation & Knowledge Sharing (Thought Leadership)]; and to support all business development and other efforts on behalf of ProSidian Consulting.
CORE COMPETENCIES
Teamwork -
ability to foster teamwork collaboratively as a participant, and effectively as a team leader
Leadership -
ability to guide and lead colleagues on projects and initiatives
Business Acumen -
understanding and insight into how organizations perform, including business processes, data, systems, and people
Communication -
ability to effectively communicate to stakeholders of all levels orally and in writing
Motivation -
persistent in pursuit of quality and optimal client and company solutions
Agility -
ability to quickly understand and transition between different projects, concepts, initiatives, or work streams
Judgment -
exercises prudence and insight in decision-making process while mindful of other stakeholders and long-term ramifications
Organization -
ability to manage projects and activity, and prioritize tasks
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OTHER REQUIREMENTS
Business Tools -
understanding and proficiency with business tools and technology, including Microsoft Office. The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
Business Tools -
understanding and proficiency with business tools and technology, including Microsoft Office. The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
Commitment -
to work with smart, interesting people with diverse backgrounds to solve the biggest challenges across private, public and social sectors
Curiosity -
the ideal candidate exhibits an inquisitive nature and the ability to question the status quo among a community of people they enjoy and teams that work well together
Humility -
exhibits grace in success and failure while doing meaningful work where skills have impact and make a difference
Willingness -
to constantly learn, share, and grow and to view the world as their classroom
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BENEFITS AND HIGHLIGHTS
ProSidian Employee Benefits and Highlights:
Your good health and well-being are important to ProSidian Consulting. At ProSidian, we invest in our employees to help them stay healthy and achieve work-life balance. That's why we are also pleased to offer the Employee Benefits Program, designed to promote your health and personal welfare. Our growing list of benefits currently include the following for Full Time Employees:
Competitive Compensation:
Pay range begins in the competitive ranges with Group Health Benefits, Pre-tax Employee Benefits, and Performance Incentives. For medical and dental benefits, the Company contributes a fixed dollar amount each month towards the plan you elect. Contributions are deducted on a Pre-tax basis.
Group Medical Health Insurance Benefits:
ProSidian partners with BC/BS, to offer a range of medical plans, including high-deductible health plans or PPOs. ||| Group Dental Health Insurance Benefits: ProSidian dental carriers - Delta, Aetna, Guardian, and MetLife.
Group Vision Health Insurance Benefits:
ProSidian offers high/low vision plans through 2 carriers: Aetna and VSP.
401(k) Retirement Savings Plan:
401(k) Retirement Savings Plans help you save for your retirement for eligible employees. A range of investment options are available with a personal financial planner to assist you. The Plan is a pre-tax Safe Harbor 401(k) Retirement Savings Plan with a company match.
Vacation and Paid Time-Off (PTO) Benefits:
Eligible employees use PTO for vacation, a doctor's appointment, or any number of events in your life. Currently these benefits include Vacation/Sick days - 2 weeks/3 days | Holidays - 10 ProSidian and Government Days are given.
Pre-Tax Payment Programs:
Pre-Tax Payment Programs currently exist in the form of a Premium Only Plan (POP). These Plans offer a full Flexible Spending Account (FSA) Plan and a tax benefit for eligible employees.
Purchasing Discounts & Savings Plans:
We want you to achieve financial success. We offer a Purchasing Discounts & Savings Plan through The Corporate Perks Benefit Program. This provides special discounts for eligible employees on products and services you buy on a daily basis.
Security Clearance:
Due to the nature of our consulting engagements there are Security Clearance requirements for Engagement Teams handling sensitive Engagements in the Federal Marketplace. A Security Clearance is a valued asset in your professional portfolio and adds to your credentials.
ProSidian Employee & Contractor Referral Bonus Program:
ProSidian Consulting will pay up to 5k for all referrals employed for 90 days for candidates submitted through our Referral Program.
Performance Incentives:
Due to the nature of our consulting engagements there are performance incentives associated with each new client that each employee works to pursue and support.
Flexible Spending Account:
FSAs help you pay for eligible out-of-pocket health care and dependent day care expenses on a pre-tax basis. You determine your projected expenses for the Plan Year and then elect to set aside a portion of each paycheck into your FSA.
Supplemental Life/Accidental Death and Dismemberment Insurance:
If you want extra protection for yourself and your eligible dependents, you have the option to elect supplemental life insurance. D&D covers death or dismemberment from an accident only.
Short- and Long-Term Disability Insurance:
Disability insurance plans are designed to provide income protection while you recover from a disability.
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ADDITIONAL INFORMATION -
See Below Instructions On The Best Way To Apply
ProSidian Consulting is an equal opportunity employer and considers qualified applicants for
employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, or Vietnam era, or other eligible veteran status, or any other protected factor. All your information will be kept confidential according to EEO guidelines.
ProSidian Consulting has made a pledge to the Hiring Our Heroes Program of the U.S. Chamber of Commerce Foundation and the “I Hire Military” Initiative of The North Carolina Military Business Center (NCMBC) for the State of North Carolina. All applicants are encouraged to apply regardless of Veteran Status.
Furthermore, we believe in "
HONOR ABOVE ALL
" - be successful while doing things the right way. The pride comes out of the challenge; the reward is excellence in the work.
FOR EASY APPLICATION USE OUR CAREER SITE LOCATED ON http://*****************/ OR SEND YOUR RESUME'S, BIOS, AND SALARY EXPECTATION / RATES TO ***********************.
ONLY CANDIDATES WITH REQUIRED CRITERIA ARE CONSIDERED
.
Be sure to place the job reference code in the subject line of your email. Be sure to include your name, address, telephone number, total compensation package, employment history, and educational credentials.
$51k-65k yearly est. Easy Apply 1h ago
Outpatient Coding/Abstracting Specialist - FT (73986)
Hamilton Health Care System 4.4
Medical coder job in Dalton, GA
Codes, analyzes, and abstracts all scanned or imaged emergency room, outpatient surgery and observation electronic medical records according to established classification system and enters the abstracted information into the hospital financial system via a CRT. Identifies documents of poor quality. Ensures all scanned documents are positioned correctly. Identifies the documents that are incorrect. Ensures each document is indexed to the correct patient/encounter. Refers identified issues to appropriate scanning/QC staff for correction.
The individual must be detailed oriented and be able to work independently. Must demonstrate initiative and ability to work with physicians and other healthcare providers with cooperation and flexibility. The team member has access to patient medical information, involved in ensuring the integrity of the legal medical record and must strictly uphold patient confidentiality. This position serves as a resource for other members of the organization in regards to code assignment issues and related policies and procedures regarding required documentation. Reviews assigned work queue(s) daily and ensure timely processing of assignments in each queue.
$46k-57k yearly est. 35d ago
Medical Coder I/II
Mercer University 4.4
Medical coder job in Macon, GA
Application Instructions: External Applicants: Please upload your resume on the Apply screen. Your application will automatically populate your resume details, and you may verify and update data on the My Information page. IMPORTANT: Please review the job posting and load ALL documents required in the job posting to the Resume/CV document upload section at the bottom of the My Experience application page. Use the Select Files button to add multiple documents including your Resume/CV, references, cover letter, and any other supporting documents required in the job posting. The "My Experience" page is the only opportunity to add your required supporting document attachments. You will not be able to modify your application after you submit it.
Current Mercer University Employees: Apply from your existing Workday account. Do not apply from the external careers website. Log in to Workday and type Jobs Hub in the search bar. Locate the position and click Apply.
Job Title:
MedicalCoder I/II
Department:
Mercer Medicine
College/Division:
School Of Medicine
Primary Job Posting Location:
Macon, GA 31207
Additional Job Posting Locations:
(Other locations that this position could be based)
Job Details:
Mercer Medicine is searching for a MedicalCoder for the Macon, Georgia clinic.
Responsibilities:
The MedicalCoder I/II will evaluate medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the patient encounters. Provide technical guidance to physicians and other department staff in identifying and resolving issues or errors. This coder will work under minimal supervision.
Qualifications:
High school diploma/GED.
Coder I: At least one year of coding experience or 6 months of coding experience with an accompanying certificate from an accredited facility/institution.
Coder II: AHIMA or AAPC certification is required along with 1 year of experience using ICD and CPT in a physician practice, hospital, or clinic.
Knowledge/Skills/Abilities:
* Know and understand the relationship between CPT and ICD and the assignment of codes in order to accurately bill for physician services.
* Ability to effectively communicate with all levels of health care providers in order to query for specific coding information.
* Resolves any questions concerning diagnoses, procedures, clinical content of record or code selection through research and communication to bill at correct level of reimbursement.
* Knowledge of Medicare and Medicaid [CMS] regulations for reimbursement and timeliness of claims submission.
* Maintain confidentiality of patient information, employee information and other information covered by regulations and professional ethics.
* Understanding of billing cycle and its effect on revenue.
* Understanding of commercial insurance contractual adjustments and balance billing.
Background Check Contingencies:
* Criminal History
Document Attachments:
* Resume
* Cover letter
* List of three professional references with contact information
Why Work at Mercer University
Mercer University offers a variety of benefits for eligible employees including comprehensive health insurance (for self and dependents), generous retirement contributions, tuition waivers, paid vacation and sick leave, technology discounts, schedules that allow for work-life balance, and so much more!
At Mercer University, a Bear is more than a mascot: it's a frame of mind that begins with a strong desire to make the most out of your career. Mercer Bears do not settle for mediocrity or the status quo. If you're seeking an environment where your passion and determination are embraced, then you want to work at Mercer University.
For more information, please visit: **********************************
Scheduled Weekly Hours:
40
Job Family:
Staff Clinical Services Non-exempt
EEO Statement:
EEO/Veteran/Disability
$38k-47k yearly est. Auto-Apply 60d+ ago
Electronic Medical Record Analyst - NHDC
Mynorthsidecareer
Medical coder job in Gainesville, GA
Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
Responsibilities
Conducts and participates in activities including, but not limited to the supports, implements, and provides ongoing maitenance of physician practice systems.
Qualifications
1. B.S. Degree in business, healthcare, or related field, OR Three (3) plus years healthcare systems experience
2. Knowledge of Healthcare industry and physician office workflow including back office
3. Problem solving and organizational skills.
4. Ability to communicate clearly and effectively.
PREFERRED
BS/BA degree in related field.
Work Hours: 8AM-5PM Weekend Requirements: No On-Call Requirements: No
$63k-89k yearly est. Auto-Apply 3d ago
Medical Coding Appeals Analyst
Elevance Health
Medical coder job in Atlanta, GA
Sign On Bonus: $1,000 **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. **Alternate locations may be considered if candidates reside within a commuting distance from an office.**
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
This position is not eligible for employment based sponsorship.
**Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.**
PRIMARY DUTIES:
+ Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
+ Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
+ Translates medical policies into reimbursement rules.
+ Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
+ Coordinates research and responds to system inquiries and appeals.
+ Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
+ Perform pre-adjudication claims reviews to ensure proper coding was used.
+ Prepares correspondence to providers regarding coding and fee schedule updates.
+ Trains customer service staff on system issues.
+ Works with providers contracting staff when new/modified reimbursement contracts are needed.
**Minimum Requirements:**
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
**Preferred Skills, Capabilities and Experience:**
+ CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$63k-87k yearly est. 4d ago
Medical Coding Appeals Analyst
Carebridge 3.8
Medical coder job in Atlanta, GA
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$53k-75k yearly est. Auto-Apply 60d+ ago
Certified Peer Specialist-Parent
Community Service Board of Middle Georgia-Peo, Ltd.
Medical coder job in Swainsboro, GA
The Community Service Board of Middle Georgia is dedicated to providing those we serve with quality innovative behavioral healthcare in a recovery-based environment. CSB of Middle Georgia is recognized as a state leader in comprehensive behavioral healthcare providing integrated cost-effective services. CSB of Middle Georgia is located in Dublin, Georgia, and the agency currently serves residents of Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wheeler, and Wilcox counties in Georgia; and in our Ogeechee Behavioral Health Division, serving residents of Burke, Emanuel, Glascock, Jefferson, Jenkins, and Screven counties in Georgia. We value Quality, Professionalism, Person-Centered, Recovery, Teamwork, Improvement, Accountability, Management of Practicing Information, Wellness, and Financial Stability.
Job Description:
The Community Service Board of Middle Georgia is looking for a Certified Peer Specialist - Parent to join their team. This role builds trusting, mutually supportive relationships with families, offers encouragement and guidance, and helps them connect to team members and resources within the IC3 program. Working collaboratively as part of a multidisciplinary team, the Child Peer Specialist uses shared experiences to empower families, strengthen engagement, and support positive outcomes for children and caregivers.
LOCATION: Emanuel County & Surrounding Areas
Responsibilities of the Certified Peer Specialist - Parent
Hold certification as a Certified Peer Specialist- Parent OR be the parent/guardian of a child with lived experience with Serious Emotional Disturbance (SED) OR Serious Mental Illness (SMI) and be willing to become certified.
Ability to use lived experience to support families in IC3 program.
Ability to work effectively in a team environment.
Ability to establish and maintain relationships with peers based on mutuality and common connection.
Ability to use common connections to support families.
Ability to link to others involved in the team. Perform other job duties as assigned by supervisor.
Here are some of the things we require:
High School Diploma or GED
Valid Georgia Driver's License
Effective verbal and written communication skills
Strong interpersonal skills and the ability to work effectively with diverse communities
Ability to work independently and in collaboration with others
Experience with Microsoft 365 Office Products
Ability to organize, prioritize and meet deadlines accordingly
Benefits of Working with CSB of Middle GA:
As a member of our team, you will enjoy our total rewards package to help secure your financial future and preserve your health and well-being, including:
Medical, Dental & Vision Plan Options!
Generous Paid-Time Off Policy with Flexibility Companywide!
401(k) Plan with Company Match!
Short- & Long-Term Disability Plans!
Access to our Employee Assistance Program (EAP)!
Paid Training Time!
Opportunities for Career Growth & Advancement!
Paid Lunch Breaks* & So Much More!
At this time, CSB of Middle Georgia will not sponsor a new applicant for employment authorization for this position.
*Please note that paid lunches are only for select positions that must assist individuals with eating needs at typical meal periods*
** Final pay rate will be dependent on a combination of qualifications such as experience and education. **
Full Time 8:00am to 5:00pm
$45k-67k yearly est. Auto-Apply 30d ago
Certified Peer Specialist
Gateway Csb Peo LLC
Medical coder job in Savannah, GA
Job Summary : Certified Peer Specialist is a person who has progressed in their own recovery and promotes self-determination, personal responsibility, empowerment inherent in self-directed recovery, and assists individuals with mental illness in the individual's recovery process. Provides structured activities within a peer support that promote socialization, recovery, wellness, self-advocacy, wellness, self-advocacy, development of natural supports, and maintenance of community living skills; understanding of what creates recovery and how to build environments conducive to recovery. Participates in regular interdisciplinary staff meetings with the interdisciplinary team to best help consumer, including Behavioral Health Specialists, Staff Psychiatrist, Registered Nurses, quality assurance specialists, and paraprofessional. ACT is an Evidence Based Practice that is person-centered, recovery-oriented, and a highly intensive community-based service for individuals who have serious and persistent mental illness. The individual's mental health condition has significantly impaired his or her functioning in the community. The service utilizes a multidisciplinary mental health team from the fields of psychiatry nursing, psychology, social work, substance use disorders, and vocational rehabilitation; additionally, a Certified Peer Specialist is an active member of the ACT Team providing assistance with the development of natural supports, promoting socialization, and the strengthening of community living skills. Services emphasize social inclusiveness though relationship building and the active involvement in assisting individuals to achieve a stable and structured lifestyle. ACT is a unique treatment model in which the majority of mental health services are directly provided internally by the ACT program in the recipient's natural environment. ACT services are individually tailored with each individual to address his/her preferences and identified goals, which are the basis of the Individualized Recovery Plan (IRP).
Essential Functions : Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Productivity
Meet the minimum direct time requirements of individual billed hours/target staff hours 100% per year.
Daily attendance must be at least 70% of clinical guidelines per facilitator.
Maximum face to face ratio 30 individuals to 1 Certified peer Specialist
Documentation and Compliance
Records services accurately that relate directly to the treatment outcomes, within approved timeframes. Completes required clinical documentation according to agency standards.
Maintain all documentation in accordance with applicable policies, laws and instructions.
Ensure that all services provided are within the guidelines and document care in compliance with agency requirements and standards.
Ensure that all notes are in Care Logic and signed within 24 hours of service delivery.
Maintain a minimum chart audit score of 70% or better for all consumers on case-load.
Ensure all weekly reports are addressed and corrected as necessary within timeframe specified by supervisor.
Billed Staff Hours in comparison to Target Staff Hours must be at least at 100%.
Treatment plans and orders for services must be signed on the same day as admission or change.
Services must be authorized prior to the delivery of services, with the exception of the intake appointment which should be authorized within 5 business days of service delivery.
Services must be authorized prior to the delivery of services, with the exception of the intake appointment which should be authorized within 5 business days of service delivery.
Failed Activities and Failed Claims must be resolved and cleared in less than 10 days.
Quality Improvement Internal Audit scores must be at least 90%.
At least 85% of your active caseload must receive at least 1 face-to-face service within the quarter.
Staff cancellation rates must be less than 5%.
Must be in compliance with Human Resources requirements with all trainings (including Relias).
Community Outreach
Collaborate with behavioral health providers and the community through regular meetings in order to engage and transition consumers throughout systems of inpatient and or community care.
Corporate Responsibilities
Treat those we serve, co-workers and supervisors with respect.
Provide high quality customer service focused on outcomes of improved health.
Carry out job responsibilities in a competent and ethical manner.
Utilize our resources effectively, efficiently and without abuse.
Contribute to an environment that encourages passion, creativity and team work.
Required Knowledge & Skills:
Knowledge of working knowledge of the nature of serious mental illness; self-help techniques, provides enhance consumers empowerment skills and successful community living, community resources and information on specific topics, as assigned.
Knowledge of consumers' rights; agency and federal policies, procedures and guidelines.
Knowledge of client record documentation requirements; and implementation of client services plan development.
Knowledge of crisis intervention protocol.
Knowledge of peer individual and group therapy techniques
Observe, record and report on an individual's functioning;
Ability to read and understand assessments, evaluations, observation, and use in developing treatment plan.
Ability to assist consumers cultivate their independence, self-confidence, and self-esteem.
Ability to empower other individuals with disabilities to explore new options, resources, relationships, feelings, attitudes and rights.
Ability to effectively interact and communicate with consumers and their families in diverse populations.
Ability to communicate effectively, verbally and in writing, to maintain confidentiality, and to work independently under general supervision.
Ability to demonstrate strong interpersonal and “Listening” skills.
Ability to Establish and prioritize goals and objectives of assigned program.
Ability to assist consumers with successfully acquiring all income, entitlement benefits and health insurance for which the individual is eligible.
Ability to facilitate relationships between Gateway, consumer families/legal guardians and various social service community resources, such as housing assistance, healthcare, job training and placement and substance abuse support groups.
Competencies:
Communication
Accountability/Responsibility
Cooperation/Teamwork
Creative Thinking
Customer Service
Dependability
Flexibility
Initiative
Job Knowledge
Judgement
Professionalism
Quality/Quantity of Work
Goal Orientation
Required Education & Experience:
High school diploma/equivalent
Certification by Georgia Certified Peer Specialist Project
Requires a minimum of 40 hours of CPS training
Supervisory Responsibilities : None
Work Environment :
This job operates in a variable business settings with trips into the community. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. This role provides basic employment support which requires employee to perform in loud/quiet environments, outdoors/indoors, etc. Some medium travel between Gateway sites and in the community is required.
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.
Employee is frequently required to walk, sit, stand or kneel and occasionally required to climb or balance and stoop. Employee must frequently lift and/or move up to 15 pounds. Must have the ability to sit for long periods of time at a computer. Employee frequently uses fine hand/eye coordination, hearing and visual acuity. Lighting and temperature are adequate, and there are not hazardous or unpleasant condition caused by noise, dust, etc. Employee must be able to travel between Gateway sites. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Gateway CSB promotes a drug/alcohol free work environment through the use of mandatory pre-employment drug testing.
$45k-67k yearly est. Auto-Apply 38d ago
Central Supply/Medical Records
Journey Care Team of Georgia LLC 3.8
Medical coder job in Stone Mountain, GA
Job Description
About Us
Welcome to Journey, where the community is at the heart of everything we do. We believe that true success starts with strong local leadership, supported by a dedicated home office team. Our journey began with a vision to create opportunities that empower individuals to make a positive impact right in their own backyard.
Our Vision
Change the world, one heart at a time.
Our Mission
Our Mission is to consistently achieve exceptional quality outcomes by leading a world-class Care Team. Our empowered and dedicated Care Team strives to exceed the expectations of our residents in every interaction. Being a part of your journey is our privilege.
The Heartbeat of Journey
Our local leaders are the driving force behind our success. They're not just managers; they're passionate advocates for their communities. They understand the needs and goals of the residents and families they serve. They're your neighbors, your friends, and your partners in progress. Together, we work tirelessly to create meaningful change and lasting legacies.
Required Qualifications:
High school diploma or equivalent preferred.
One year of experience in shipping and receiving.
Minimum 2 years of administrative experience is preferred.
Working knowledge of medical terminology, anatomy and physiology, coding, and other aspects of health information preferred.
Major Duties and Responsibilities:
Inventory Management: Maintain accurate inventory records, organize storage areas, and ensure supplies are readily available across nursing units.
Supply Ordering & Receiving: Order supplies from approved vendors, receive shipments, and route packing slips to department heads.
Supply Distribution: Collect, fill, and deliver supply requisitions to designated units while ensuring smooth daily operations.
Records Management: Organize, file, and maintain resident health information manually and electronically, ensuring records are complete and accurately assembled.
Compliance and Privacy: Safeguard health information in accordance with established policies, procedures, and privacy regulations.
Information Retrieval and Communication: Retrieve and deliver records as needed, assist with inquiries, and prepare documentation for insurance, Medicare, Medicaid, and other stakeholders.
What We Offer
Competitive pay
Quarterly raises
401(k) with Voya Financial
United Healthcare Insurance
Free Life Insurance
Company-provided smartphones for full-time care team members
Opportunities for professional development and continuing education
If you're ready to make a difference in the lives of others and join a team that truly cares, we'd love to have you apply.
Together, let's change lives one heart at a time.
#JointheJourney
We are committed to equal opportunity. If you have a disability under the Americans with Disabilities Act or similar law, and you need an accommodation during the application process or to perform these job requirements, please contact HR.