Medical coder jobs in North Dakota

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. The Senior Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. **Activities include:** + Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation. + Handles complex coding reviews and will resolve complex issues with sensitivity. Including but not limited to claim reviews for legal, compliance or rework projects. + Provide detailed written summary of medical record review findings. + Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. + Review and discuss cases with Medical Directors to validate decisions. + Independently research and accurately apply state or CMS guidelines related to the audit. + Assist with investigative research related to coding questions, state and federal policies. + Identify potential billing errors, abuse, and fraud. + Identify opportunities for savings related to potential cases which may warrant a prepayment review. + Maintain appropriate records, files, documentation, etc. + Uses department resources regularly and follows workflows with no assistance or intervention to perform daily work to meet metrics. + Mentor New Coders, providing training, coding, and record review guidance. + Collaboration with investigators, data analytics and plan leadership on SIU schemes. + Act as management back-up and supports the team when the manager is out of the office. + Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement. **Required Qualifications** + AAPC Coding certification - Certified Professional Coder (CPC) + 3+ years of experience in medical coding or documentation auditing. + Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10. + CMS 1500 and UB04 data elements + Experience with researching coding and policies. + Experience with Microsoft products; including Excel and Word + Prior experience auditing others' work and providing feedback. + Experience mentoring others. + Must be able to travel to provide testimony if needed. **Preferred Qualifications** + 3+ years or more previous experience with Behavioral Health coding/auditing of records + Licensed Clinical Social Worker (LCSW) + Licensed Independent Social Worker (LISW) + Licensed Master Social Worker (LMSW) + Licensed Professional Counselor (LPC) + Excellent communication skills + Excellent analytical skills + Strong attention to detail and ability to review and interpret data. **Education** + AAPC Certified Professional Coder Certification (CPC) + GED or High School diploma **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $112,200.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 12/06/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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As a Healthcare Revenue Cycle / HIM Manager, your responsibilities will include: 1. Supporting a remote team for daily operations of the healthcare revenue cycle / healthcare coding department. 2. Identifying and implementing strategies to accelerate the revenue cycle by reducing accounts receivable days, improving cash flow, and enhancing profitability. 3. Managing account reconciliation, pre-collection, and post-collection activities to ensure accuracy and timeliness. 4. Identifying and resolving issues that affect revenue cycle performance using analytical and problem-solving skills. 5. Collaborating with cross-functional teams, including billing, coding, and clinical operations, to ensure the effectiveness of the revenue cycle process. 6. Training and mentoring staff on revenue cycle processes and best practices. 7. Staying abreast with the latest trends and regulations in the healthcare industry to ensure compliance and operational efficiency. 8. Developing and implementing policies and procedures to enhance operational efficiency and improve revenue cycle performance. 9. Providing regular reports and updates to senior management about the status and performance of the revenue cycle. 10. This individual will manage routine client meetings to obtain updates on initiatives and address any issues. Qualifications: The ideal candidate for the Healthcare Revenue Cycle / HIM Manager will have the following qualifications: 1. A minimum of 7 years of experience in healthcare revenue cycle management, including account reconciliation, pre-collection, and post-collection. 3. Strong knowledge of healthcare financial management and medical billing processes. 4. Exceptional analytical and problem-solving skills with a strong attention to detail. 5. Proficient in using healthcare billing software and revenue cycle management tools, with a strong background in Oracle Health (Cerner) software. 6. Strong leadership skills with the ability to manage and motivate a team. 7. Excellent communication and interpersonal skills with the ability to interact effectively with all levels of the organization. 8. Strong knowledge of federal, state, and payer-specific regulations and policies. 9. Ability to work in a fast-paced environment and manage multiple priorities. **Responsibilities** Analyzes business needs to help ensure Oracle's solution meets the customer's objectives by combining industry best practices and product knowledge. Effectively applies Oracle's methodologies and policies while adhering to contractual obligations, thereby minimizing Oracle's risk and exposure. Exercises judgment and business acumen in selecting methods and techniques for effective project delivery on small to medium engagements. Provides direction and mentoring to project team. Effectively influences decisions at the management level of customer organizations. Ensures deliverables are acceptable and works closely with the customer to understand and manage project expectations. Supports business development efforts by pursuing new opportunities and extensions. Collaborates with the consulting sales team by providing domain credibility. Manages the scope of medium sized projects including the recovery of remedial projects. Disclaimer: **Certain US customer or client-facing roles may be required to comply with applicable requirements, such as immunization and occupational health mandates.** **Range and benefit information provided in this posting are specific to the stated locations only** US: Hiring Range in USD from: $87,000 to $178,100 per annum. May be eligible for bonus and equity. Oracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle's differing products, industries and lines of business. Candidates are typically placed into the range based on the preceding factors as well as internal peer equity. Oracle US offers a comprehensive benefits package which includes the following: 1. Medical, dental, and vision insurance, including expert medical opinion 2. Short term disability and long term disability 3. Life insurance and AD&D 4. Supplemental life insurance (Employee/Spouse/Child) 5. Health care and dependent care Flexible Spending Accounts 6. Pre-tax commuter and parking benefits 7. 401(k) Savings and Investment Plan with company match 8. Paid time off: Flexible Vacation is provided to all eligible employees assigned to a salaried (non-overtime eligible) position. Accrued Vacation is provided to all other employees eligible for vacation benefits. For employees working at least 35 hours per week, the vacation accrual rate is 13 days annually for the first three years of employment and 18 days annually for subsequent years of employment. Vacation accrual is prorated for employees working between 20 and 34 hours per week. Employees working fewer than 20 hours per week are not eligible for vacation. 9. 11 paid holidays 10. Paid sick leave: 72 hours of paid sick leave upon date of hire. Refreshes each calendar year. Unused balance will carry over each year up to a maximum cap of 112 hours. 11. Paid parental leave 12. Adoption assistance 13. Employee Stock Purchase Plan 14. Financial planning and group legal 15. Voluntary benefits including auto, homeowner and pet insurance The role will generally accept applications for at least three calendar days from the posting date or as long as the job remains posted. Career Level - IC4 **About Us** As a world leader in cloud solutions, Oracle uses tomorrow's technology to tackle today's challenges. We've partnered with industry-leaders in almost every sector-and continue to thrive after 40+ years of change by operating with integrity. We know that true innovation starts when everyone is empowered to contribute. That's why we're committed to growing an inclusive workforce that promotes opportunities for all. Oracle careers open the door to global opportunities where work-life balance flourishes. We offer competitive benefits based on parity and consistency and support our people with flexible medical, life insurance, and retirement options. We also encourage employees to give back to their communities through our volunteer programs. We're committed to including people with disabilities at all stages of the employment process. If you require accessibility assistance or accommodation for a disability at any point, let us know by emailing accommodation-request_************* or by calling *************** in the United States. Oracle is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability and protected veterans' status, or any other characteristic protected by law. Oracle will consider for employment qualified applicants with arrest and conviction records pursuant to applicable law.

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40Salary Range: $19.00 - $30.50 Union Position: No Department Details • Flexible hours- so our employees can get personal tasks done at their leisure. • Variety of hours per day to select from: five 8 hrs, four 9hrs + one 4hr, or four 10's. • Multiple specialty coding- so the coder can learn a vast majority of areas. • Working remotely in the comfort of your own home. • Optional overtime approved frequently. Summary Assigns codes to diagnoses and procedures for outpatient medical records using current International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding classification systems. Coding assignments are made for the purposes of reimbursement, research, compliance with federal and state regulations/guidelines and for severity of illness. Job Description Meet productivity and quality standards. Requires ongoing review and adherence to a multitude of regulatory requirements that are constantly changing. Applies professional knowledge and uses critical thinking skills to assign codes to meet various payment groupings and medical necessity. Works extensively with electronic medical record. Prior coding classification education required. Previous hospital coding experience highly desirable. Prior computer and/or encoder software experience desirable. Work requires extreme attention to detail and work which meets high ethical standards, logical thinking and the ability to acquire an intricate knowledge of system software and hardware. Knowledge of components of the medical record. Extensive knowledge of anatomy, physiology, disease processes and medical terminology. Familiar with operative terms and pharmacology. Work extensively with protected health information and is required to adhere to HIPAA privacy and security regulations and policies related to same. Qualifications Associate's degree in health information technology. Bachelor's degree in Health Information Management (HIM) preferred. Extensive knowledge of anatomy, physiology, disease processes and medical terminology. Familiar with operative terms and pharmacology. Maintain certification in Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) by fulfilling continuing education requirements. New graduates eligible for certification must complete the certification examination at the earliest testing dates following employment, and all subsequent dates thereafter until the exam is satisfactorily completed. If an employee fails the exam two consecutive times, there will be an evaluation by the Department Director who will determine one of the following: (A) Continue employment if overall job performance is satisfactory. If allowed to continue employment, failure to pass the exam on the third opportunity will result in immediate termination. (B) If performance is not satisfactory, the employee may be terminated. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call ************** or send an email to ************************.

**Job Summary and Responsibilities** CHI St. Alexius is looking for a Full Time EMR Process Improvement Coordinator to join the team! This position is responsible for supporting and overseeing the functions of the Clinic HIM department. Is responsible for process improvement, management of staff, is the department's electronic systems coordinator on numerous e-systems and is responsible for ensuring the integrity of the Clinc HIM department. **What You'll Do:** Maintain HIM staff job results by coaching, counseling, disciplining, planning, and appraising job results. Prep documents, scan, index, and verify documents in the electronic medical record (EMR). Understand and follow Release of Information policy and procedures. Maintain a cooperative relationship among health care teams by communicating information, responding to requests, building rapport, and participating in team problem-solving methods. Manage workqueues, failed faxes, and chart corrections. Work with the OnBase Admin IT team for scanning. Assist with training new employees. **Job Requirements** **Required Education:** **High School Diploma or GED** **Preferred Education:** **Associate's Degree in HIM or a related business degree.** **Experience:** **Minimum of three years' experience, with at least two years in the medical field.** **Where You'll Work** Since 1885, CHI St. Alexius Health has been dedicated to leading health care in this region by enriching the lives of patients through the highest quality of care. We seek to continue our tradition of success and innovation with individuals dedicated to delivering the highest level of expertise and quality. Together we can continue to grow and support the legacy of CHI St. Alexius Health for many years to come. CHI St. Alexius Health is a regional health network with a tertiary hospital in Bismarck, the system also consists of critical access hospitals (CAHs) in Carrington, Dickinson, Devils Lake, Garrison, Turtle Lake, Washburn and Williston and numerous clinics and outpatient services. CHI St. Alexius Health manages four CAHs in North Dakota - Elgin, Linton, and Wishek, as well as Mobridge Regional Medical Center in Mobridge, S.D. CHI St. Alexius Health offers a comprehensive line of inpatient and outpatient medical services, including: a Level II Trauma Center, primary and specialty physician clinics, home health and hospice services, durable medical equipment services, a fitness and human performance center and ancillary services throughout western and central North Dakota. CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. CommonSpirit Health is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care. **Pay Range** $15.51 - $20.74/hour We are an equal opportunity/affirmative action employer.

Responsible for reviewing outpatient medical records for proper coding assignment. Essential Functions and Responsibilities as Assigned: * Accurately assigns codes (CPT-4 and HCPCS) to outpatient medical records based on documentation in the medical record. * Accurately verifies, modifies, and abstracts patient data to meet the requirements of data integrity and organization specific protocols and requirements. * Understands the coding and classification system(s) revision cycle (ICD-10-CM and MSDRG annually) and takes the initiative to understand coding and classification system changes that impact coding, compliance, and reimbursement requirements. * Utilizes the multiple electronic and hard copy resources available to assist in understanding and accurately assigning coding and classification codes. * Works closely with the providers to identify the appropriate ICD-10, CPT and HCPCS codes in selecting the patients' care plans, associated orders for treatment and any co-morbid conditions. Provides education on the appropriate documentation to support all codes captured by the providers in the electronic health record. * Other related duties as assigned. Qualifications: Required: * High school diploma * One year outpatient coding experience * Current AHiMA registration or certification Preferred: * Certified Professional Coder (CPC) #LI-MNM * Additional Information * Schedule: Full-time * Requisition ID: 25005660 * Daily Work Times: 8am - 4:30pm * Hours Per Pay Period: 80 * On Call: No * Weekends: No

Job Summary and Responsibilities CHI St. Alexius is looking for a Full Time EMR Process Improvement Coordinator to join the team! This position is responsible for supporting and overseeing the functions of the Clinic HIM department. Is responsible for process improvement, management of staff, is the department's electronic systems coordinator on numerous e-systems and is responsible for ensuring the integrity of the Clinc HIM department. What You'll Do: Maintain HIM staff job results by coaching, counseling, disciplining, planning, and appraising job results. Prep documents, scan, index, and verify documents in the electronic medical record (EMR). Understand and follow Release of Information policy and procedures. Maintain a cooperative relationship among health care teams by communicating information, responding to requests, building rapport, and participating in team problem-solving methods. Manage workqueues, failed faxes, and chart corrections. Work with the OnBase Admin IT team for scanning. Assist with training new employees. Job Requirements Required Education: High School Diploma or GED Preferred Education: Associate's Degree in HIM or a related business degree. Experience: Minimum of three years' experience, with at least two years in the medical field. Where You'll Work Since 1885, CHI St. Alexius Health has been dedicated to leading health care in this region by enriching the lives of patients through the highest quality of care. We seek to continue our tradition of success and innovation with individuals dedicated to delivering the highest level of expertise and quality. Together we can continue to grow and support the legacy of CHI St. Alexius Health for many years to come. CHI St. Alexius Health is a regional health network with a tertiary hospital in Bismarck, the system also consists of critical access hospitals (CAHs) in Carrington, Dickinson, Devils Lake, Garrison, Turtle Lake, Washburn and Williston and numerous clinics and outpatient services. CHI St. Alexius Health manages four CAHs in North Dakota - Elgin, Linton, and Wishek, as well as Mobridge Regional Medical Center in Mobridge, S.D. CHI St. Alexius Health offers a comprehensive line of inpatient and outpatient medical services, including: a Level II Trauma Center, primary and specialty physician clinics, home health and hospice services, durable medical equipment services, a fitness and human performance center and ancillary services throughout western and central North Dakota. CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. CommonSpirit Health is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care.

This individual is responsible for directing health information management functions and activities of the organization, including medical record oversight, coding, transcription, release of information, and privacy of patient information. In addition, this individual serves as the HIPAA Privacy Officer. The director of medical records is appointed by the governing body (or responsible individual). Excellence in Practice: Organizes plans, directs and supervises department functions and activities to comply with established policies and procedures. Participates in the design, implementation and maintenance of the hospital electronic health record. Recruits and oversees staff within the department; develops job descriptions for departmental employees and works effectively with staff in the conduct of department operations. Establishes health information management policies and procedures on release of information, confidentiality, information security, patient privacy of information, information storage and retrieval, and record retention. Develops short- and long-range goals and objectives within the department in conjunction with the annual budget and monitors progress for the continued improvement of hospital services and operations. Serves as privacy officer for the organization; oversees patient rights to inspect, amend, restrict access to, and receive an accounting of disclosures of his/her patient health information; tracks access to protected health information. Communicates with and maintains effective working relationships with physicians. Maintains accurate and pertinent data and statistical information that satisfies the requirements of Medicare/Medicaid, auditors, Department of Health, etc. Provides education and training to employees and medical staff in areas relevant to health information management policies and procedures. Essential Job Requirements: Education: Registered Health Information Technician (RHIT) credential is required. Experience: A minimum of 3 years experience in health information management is required, supervisory experience is preferred. Also required is experience in working with computers and health information software and electronic medical records. License Requirements: RHIT credential

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. This is an entry level position responsible for processing all release of information (ROI), specifically medical record requests, in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associates must at all times safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations. **Position Highlights** **This is a Remote Role** + Full Time: Mon-Fri 8:00am -4:30pm CST + Phone support + Ability working in a high-volume environment. + Processing medical record requests such as: Insurance requests, DDS Requests, Workers Comp Request, Subpoenas + Documenting information in multiple platforms using two computer monitors. + Proficient in Microsoft office (including Word and Excel) **Preferred Skills** + Knowledge of HIPAA and medical terminology + Familiar with different EHR and Billing Systems + Experience working with subpoenas **We offer:** + Comprehensive onsite/virtual training program followed by job shadowing with an assigned mentor + Company equipment will be provided to you (including computer, monitor, virtual phone, etc.) + Full Benefits: PTO, Health, Vision, and Dental Insurance and 401k Savings Plan and tuition Assistance **You will:** + Receive and process requests for patient health information in accordance with Company and Facility policies and procedures. + Maintain confidentiality and security with all privileged information. + Maintain working knowledge of Company and facility software. + Adhere to the Company's and Customer facilities Code of Conduct and policies. + Inform manager of work, site difficulties, and/or fluctuating volumes. + Assist with additional work duties or responsibilities as evident or required. + Consistent application of medical privacy regulations to guard against unauthorized disclosure. + Responsible for managing patient health records. + Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. + Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. + Ensures medical records are assembled in standard order and are accurate and complete. + Creates digital images of paperwork to be stored in the electronic medical record. + Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately. + Answering of inbound/outbound calls. + May assist with patient walk-ins. + May assist with administrative duties such as handling faxes, opening mail, and data entry. + Must meet productivity expectations as outlined at specific site. + May schedules pick-ups. + Other duties as assigned. **What you will bring to the table:** + High School Diploma or GED. + Ability to commute between locations as needed. + Able to work overtime during peak seasons when required. + Basic computer proficiency. + Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis. + Professional verbal and written communication skills in the English language. + Detail and quality oriented as it relates to accurate and compliant information for medical records. + Strong data entry skills. + Must be able to work with minimum supervision responding to changing priorities and role needs. + Ability to organize and manage multiple tasks. + Able to respond to requests in a fast-paced environment. **Bonus points if:** + Experience in a healthcare environment. + Previous production/metric-based work experience. + In-person customer service experience. + Ability to build relationships with on-site clients and customers. + Comfortable bringing new ideas, process improvement suggestions, and feedback to internal stakeholders. Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $15-$18.32 USD 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, (************************************************************** Id=**********48790029&layout Id=**********48795462) 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 Privacy Policy (**************************************** .

Job Description Job Title: Medical Records Clerk/Coder Department: Medical Records/Health Information Management (HIM) Reports To: Supervisor of Medical Records Assign diagnostic and procedure codes, check records for completeness, correct claim charges, and keep updated on coding guidelines, scan records, assist patients and coworkers, perform release of information functions. Qualifications and Requirements: 1. License and Certifications Preferred: RHIA, RHIT, CCA, CCS 2. Educational Requirements: • Must be able to read, write, speak and understand English • High School Education • Health Information Management degree preferred 3. Experience Requirements: Computer experience with Microsoft Word and Microsoft Excel 4. Special Skills or Training: • Knowledge of medical coding, medical terminology, and medical record technology. • Skills in English grammar, composition and communication. • Skills in establishing and maintaining working relationships with staff. • Ability to maintain confidentiality. 5. Physical Requirements: • Prolonged sitting and standing; walking, bending, lifting, grasping, fine hand coordination • Ability to use office equipment such as computer, copy machine, scanner, label maker, telephone and printer. Essential Duties and Responsibilities: 1. Code diagnoses and procedures on clinic, nursing home, inpatient, emergency room, and outpatient records, using the ICD-10-CM, CPT and HCPCS coding books. 2. Check completed records, including lab orders and medication charges, to be sure all diagnoses have been listed by the provider and that all reports are in the record and all entries are properly signed. 3. Confirm the listing of diagnoses and query the provider if there are changes to be considered. 4. Make note of discrepancies, errors, or omissions on records and work with staff for corrections. 5. Maintain helpful and cooperative relationships with staff and other employees in the facility and staff and other employees of other healthcare institutions. 6. Fax, email, or mail copies of records for which there is a request with proper authorization. 7. Locate and retrieve records requested by authorized staff. 8. Scan documents into electronic medical record. 9. Maintain Resident and Patient Confidentiality. 10. Know and comply with Residents' Rights rules. 11. Treat Residents, Patients, Visitors and Co-workers with kindness, dignity and respect at all times. 12. Attend and participate in orientation, training, mandatory education, in-services, staff meetings and education courses as instructed to further improve knowledge and skills. 13. Promote teamwork; encourage others to work to the best of their ability; assist with training of new co-workers, if needed. 14. Have a positive attitude; accept change willingly; follow facility rules, regulations and job assignments; accept suggestions well for work improvement; perform well with minimum supervision; do what is requested without complaint; cooperate with supervisor and show respect at all times; speak well of company and job. 15. Lack of absences and tardiness; give timely notice of absences; take allowed time for breaks. 16. Follow company dress code.

MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a Clinical Reimbursement Specialist. Clinical Reimbursement Specialist (CRS) The Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts About Us: At Key Rehab, we're shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We're all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses. We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today's healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations. Whether you're looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you're valued and supported every step of the way. We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being: Competitive salaries with bonus opportunities Ample opportunities for promotion, transfer, and advancement Work that is meaningful, fulfilling, and provides high job satisfaction Reasonable working hours promoting work-life balance Continuing education (CE) opportunities for ongoing professional development Generous paid time off Comprehensive health, dental, and life insurance packages 401K with discretionary matching Mileage and licensure reimbursements Flexible Spending Account (FSA) and Health Savings Account (HSA) options Responsibilities Serve as a trusted advisor to healthcare agencies and facilities, offering expert guidance and insights to optimize their operations. Assist clients in assessing, planning, developing, and implementing systems and processes related to reimbursement, tailored to the specific needs and contracts established with each client. Provide consulting services and technical expertise, including interim MDS management, ensuring providers receive the support they need to achieve optimal outcomes. Stay up-to-date on professional standards of clinical care, federal and state regulations, QM measures, and the RAI process to ensure the delivery of accurate, compliant, and effective solutions. Deliver high-quality, professional services that encompass reimbursement optimization, staff education, in-depth research, system analysis, creative problem-solving, and the presentation of actionable recommendations to clients. Identify and address training needs, developing and conducting training sessions or in-service programs as requested by clients to enhance staff competency and performance. Operate within the defined scope of work, maintaining strict adherence to client agreements and expectations. Uphold client confidentiality and ensure full compliance with HIPAA regulations, safeguarding sensitive information throughout the engagement. Qualifications Minimum Qualifications: Bachelor's degree in nursing from an accredited college or university, with at least five (5) years of clinical experience, including 3+ years specializing in the RAI process. Current and unrestricted RN ,along with active RAC-CT certification, ensuring adherence to industry standards and best practices. Possesses exceptional critical thinking skills, with the proven ability to make informed decisions, demonstrate sound clinical judgment, and apply expert knowledge in quality improvement concepts and processes. Demonstrates strong leadership abilities and excels in interpersonal communication, fostering collaboration, and guiding teams to achieve optimal clinical outcomes. Key Rehab is an equal opportunity employer/service provider. .

Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: New Member Onboarding, member plan benefits education, and the development/maintenance of Member Materials. Knowledge/Skills/Abilities * Conducts direct outreach to new Medicare members to provide personal assistance with their new MAPD, DSNP, and MMP plans. Serves as an advocate to ensure members are well informed about plan benefits, provider options and how to use their new plan benefits. * Serve as the member's navigator during the onboarding process and address any plan questions and anticipate any issues that may arise. Determine the nature of the member's needs and interests; inform members of their plan resources and benefits with a focus on the member's area of interest/needs; and follow up with member to ensure needs are met and member is having a positive plan experience. Develop relationship with member to be the go-to person with any future issues or questions. * Log all contacts in a database. * Participate in Member engagement work groups as needed to ensure Medicare member needs are being anticipated and addressed. * Participates in regular member benefits training with health plan, including the member advocate/engagement role. Job Qualifications REQUIRED EDUCATION: High School diploma. REQUIRED EXPERIENCE: 2 years experience in customer service, consumer advocacy, and/or health care systems. Experience conducting intake, interviews, and/or research of consumer or provider issues. Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager. Basic understanding of managed healthcare systems and Medicare. PREFERRED EDUCATION: Associate's or Bachelor's Degree in Social Work, Human Services, or related field. PREFERRED EXPERIENCE: Experience with Medicare and Medicare managed plans such as MAPD, DSNP, and MMP. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $34.88 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Activities include: - Conduct a comprehensive medical record review to ensure billing is consistent with medical record. - Provide detailed written summary of medical record review findings. - Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. - Review and discuss cases with Medical Directors to validate decisions. - Assist with investigative research related to coding questions, state and federal policies. - Identify potential billing errors, abuse, and fraud. - Identify opportunities for savings related to potential cases which may warrant a prepayment review. - Maintain appropriate records, files, documentation, etc. - Ability to travel for meetings and potential to testify **Required Qualifications** + AAPC Coding certification - Certified Professional Coder (CPC) + 3+ years of experience in medical coding or documentation auditing. + Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements + Experience with researching coding, state regulations and policies. Working experience with Microsoft Excel + Must be able to travel to provide testimony if needed. **Preferred Qualifications** + 2 years or more previous experience with Behavioral Health coding/auditing of records + Licensed Clinical Social Worker (LCSW) + Licensed Independent Social Worker (LISW) + Licensed Master Social Worker (LMSW) + Prior auditing experience + Excellent analytical skills + Strong attention to detail and ability to review and interpret data + Excellent communication skills **Education** + GED or equivalent + AAPC Certified Professional Coder Certification (CPC) **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $43,888.00 - $102,081.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 12/06/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

If you are interested in serving your community and making an impact, we're looking for you!

Where You'll Work Since 1885, CHI St. Alexius Health has been dedicated to leading health care in this region by enriching the lives of patients through the highest quality of care. We seek to continue our tradition of success and innovation with individuals dedicated to delivering the highest level of expertise and quality. Together we can continue to grow and support the legacy of CHI St. Alexius Health for many years to come. CHI St. Alexius Health is a regional health network with a tertiary hospital in Bismarck, the system also consists of critical access hospitals (CAHs) in Carrington, Dickinson, Devils Lake, Garrison, Turtle Lake, Washburn and Williston and numerous clinics and outpatient services. CHI St. Alexius Health manages four CAHs in North Dakota - Elgin, Linton, and Wishek, as well as Mobridge Regional Medical Center in Mobridge, S.D. CHI St. Alexius Health offers a comprehensive line of inpatient and outpatient medical services, including: a Level II Trauma Center, primary and specialty physician clinics, home health and hospice services, durable medical equipment services, a fitness and human performance center and ancillary services throughout western and central North Dakota. CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. CommonSpirit Health is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care. Job Summary and Responsibilities CHI St. Alexius is looking for a Full Time EMR Process Improvement Coordinator to join the team! This position is responsible for supporting and overseeing the functions of the Clinic HIM department. Is responsible for process improvement, management of staff, is the department's electronic systems coordinator on numerous e-systems and is responsible for ensuring the integrity of the Clinc HIM department. What You'll Do: Maintain HIM staff job results by coaching, counseling, disciplining, planning, and appraising job results. Prep documents, scan, index, and verify documents in the electronic medical record (EMR). Understand and follow Release of Information policy and procedures. Maintain a cooperative relationship among health care teams by communicating information, responding to requests, building rapport, and participating in team problem-solving methods. Manage workqueues, failed faxes, and chart corrections. Work with the OnBase Admin IT team for scanning. Assist with training new employees. Job Requirements Required Education: High School Diploma or GED Preferred Education: Associate's Degree in HIM or a related business degree. Experience: Minimum of three years' experience, with at least two years in the medical field. Not ready to apply, or can't find a relevant opportunity? Join one of our Talent Communities to learn more about a career at CommonSpirit Health and experience #humankindness.

This individual is responsible for directing health information management functions and activities of the organization, including medical record oversight, coding, transcription, release of information, and privacy of patient information. In addition, this individual serves as the HIPAA Privacy Officer. The director of medical records is appointed by the governing body (or responsible individual). Excellence in Practice: Organizes plans, directs and supervises department functions and activities to comply with established policies and procedures. Participates in the design, implementation and maintenance of the hospital electronic health record. Recruits and oversees staff within the department; develops job descriptions for departmental employees and works effectively with staff in the conduct of department operations. Establishes health information management policies and procedures on release of information, confidentiality, information security, patient privacy of information, information storage and retrieval, and record retention. Develops short- and long-range goals and objectives within the department in conjunction with the annual budget and monitors progress for the continued improvement of hospital services and operations. Serves as privacy officer for the organization; oversees patient rights to inspect, amend, restrict access to, and receive an accounting of disclosures of his/her patient health information; tracks access to protected health information. Communicates with and maintains effective working relationships with physicians. Maintains accurate and pertinent data and statistical information that satisfies the requirements of Medicare/Medicaid, auditors, Department of Health, etc. Provides education and training to employees and medical staff in areas relevant to health information management policies and procedures. Essential Job Requirements: Education: Registered Health Information Technician (RHIT) credential is required. Experience: A minimum of 3 years experience in health information management is required, supervisory experience is preferred. Also required is experience in working with computers and health information software and electronic medical records. License Requirements: RHIT credential Powered by JazzHR BH1BzrrSj2

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. **Position Highlights** : + Temporary Full-Time: Monday-Friday 8:00AM-4:30 PM EST + Location: This role will be performed at one location (Remote) + Comfortable working in a high-volume production environment. + Processing medical record requests by taking calls from patients, insurance companies and attorneys to provide medical status. + Documenting information in multiple platforms using two computer monitors. **You will:** + Receive and process requests for patient health information in accordance with Company and Facility policies and procedures. + Maintain confidentiality and security with all privileged information. + Maintain working knowledge of Company and facility software. + Adhere to the Company's and Customer facilities Code of Conduct and policies. + Inform manager of work, site difficulties, and/or fluctuating volumes. + Assist with additional work duties or responsibilities as evident or required. + Consistent application of medical privacy regulations to guard against unauthorized disclosure. + Responsible for managing patient health records. + Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. + Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. + Ensures medical records are assembled in standard order and are accurate and complete. + Creates digital images of paperwork to be stored in the electronic medical record. + Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately. + Answering of inbound/outbound calls. + May assist with patient walk-ins. + May assist with administrative duties such as handling faxes, opening mail, and data entry. + Must meet productivity expectations as outlined at specific site. + May schedules pick-ups. + Other duties as assigned. **What you will bring to the table:** + High School Diploma or GED. + Ability to commute between locations as needed. + Able to work overtime during peak seasons when required. + Basic computer proficiency. + Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis. + Professional verbal and written communication skills in the English language. + Detail and quality oriented as it relates to accurate and compliant information for medical records. + Strong data entry skills. + Must be able to work with minimum supervision responding to changing priorities and role needs. + Ability to organize and manage multiple tasks. + Able to respond to requests in a fast-paced environment. **Bonus points if:** + Experience in a healthcare environment. + Previous production/metric-based work experience. + In-person customer service experience. + Ability to build relationships with on-site clients and customers. + Comfortable bringing new ideas, process improvement suggestions, and feedback to internal stakeholders. Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $15-$18.32 USD 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, (************************************************************** Id=**********48790029&layout Id=**********48795462) 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 Privacy Policy (**************************************** .

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: Day (United States of America) Scheduled Weekly Hours: 32Salary Range: 21 - 25.50 Union Position: No Department Details Join our team as a Health Information Management Technician! - $21+ per hour depending on experience - 5 days a week, 32 hours per week - Eligible for medical, dental, and vision 5 days a week, shorter weekday Summary Understands the necessity for timely completion of medical record documentation by analyzing medical records for missing documentation and signatures. Compares the documentation in the medical record against required standards and enters deficiencies for providers in the electronic medical record system. May be assigned other HIM functions to support departmental workflows. Job Description Understands regulatory standards for accurate medical records. Performs record analysis by abstracting and recognizes the relation of a complete medical record. Applies knowledge of disease processes, anatomy, physiology, medical terminology, state laws and other regulatory standards in the analysis of the medical record. Utilizes job specific software in analysis and monitoring functions. Maintains software system competence including the electronic medical record (EMR) and document imaging at a high level. Completes admission and discharge related functions including retrieval of previous medical records. Scans and captures documents in an extremely timely manner, and confirms capture clarity and quality. Indexes medical record documents using document imaging software. Completes document imaging accuracy checks and audits. Monitors timeliness and completion of various medical record components to assure Federal/State regulatory compliance. Enters and maintains medical professional information in the EMR. Requires knowledge and application of coding guidelines and regulations in the assignment of diagnosis codes and sequencing specific to location and department guidelines. Assigns codes to appropriate medical diagnoses based on review of supporting documentation, and ensures these are captured for timely and accurate billing for all payers. Maintain application of facility policies and standards of practice to assure release of information requests (ROI) are appropriate and meet legal regulations. Processes ROI requests within requested timeframes. Prepares and generates reports as requested. Will work extensively with protected health information and is required to adhere to health insurance portability and accountability act (HIPAA) privacy and security regulations and policies related to the same. Handles requests for release of information according to policies, and maintain security of health information and medical records. Supports and educates others on managing private information. Prepares and participates in Health Department survey activity. Supports providers and other clinicians on EMR usage and workflows. Qualifications Associate's degree in Health Information or Medical Record Technology preferred. Experience in health care or long-term care preferred. Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call ************** or send an email to ************************.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. The Senior Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Activities include:Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation. Handles complex coding reviews and will resolve complex issues with sensitivity. Including but not limited to claim reviews for legal, compliance or rework projects. Provide detailed written summary of medical record review findings. Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. Review and discuss cases with Medical Directors to validate decisions. Independently research and accurately apply state or CMS guidelines related to the audit. Assist with investigative research related to coding questions, state and federal policies. Identify potential billing errors, abuse, and fraud. Identify opportunities for savings related to potential cases which may warrant a prepayment review. Maintain appropriate records, files, documentation, etc. Uses department resources regularly and follows workflows with no assistance or intervention to perform daily work to meet metrics. Mentor New Coders, providing training, coding, and record review guidance. Collaboration with investigators, data analytics and plan leadership on SIU schemes. Act as management back-up and supports the team when the manager is out of the office. Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement. Required QualificationsAAPC Coding certification - Certified Professional Coder (CPC)3+ years of experience in medical coding or documentation auditing. Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10. CMS 1500 and UB04 data elements Experience with researching coding and policies. Experience with Microsoft products; including Excel and WordPrior experience auditing others' work and providing feedback. Experience mentoring others. Must be able to travel to provide testimony if needed. Preferred Qualifications3+ years or more previous experience with Behavioral Health coding/auditing of records Licensed Clinical Social Worker (LCSW) Licensed Independent Social Worker (LISW) Licensed Master Social Worker (LMSW) Licensed Professional Counselor (LPC) Excellent communication skills Excellent analytical skills Strong attention to detail and ability to review and interpret data. EducationAAPC Certified Professional Coder Certification (CPC) GED or High School diploma Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$46,988. 00 - $112,200. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.