*Candidate Must come onsite one week for training in Doral, FL
Our Client is seeking an experienced ASC ProFee Coder to support a newly opened surgery center with a growing case volume and current backlog. This is a contract-to-hire opportunity with immediate interviews.
Schedule
Monday-Friday, 8:00 AM-5:00 PM EST
No weekends
Flexibility for appointments as needed
Coding Scope
ASC Professional Fee & Facility coding
Specialties include:
Anesthesiology
General Surgery
ENT
Orthopedics
Ophthalmology
Gynecology
Urgent Care
Cardiology
No GI coding required
Systems
Epic
IMO
EncoderPro
Onsite Requirement
One-time onsite visit in Doral, FL (5 days) for equipment pickup and orientation
Client covers hotel and gas; candidate responsible for transportation
Requirements
Must reside in Florida
Must have experience coding for an Ambulatory Surgical Center
Ability to fully abstract from paper charts/books if needed
AAPC or AHIMA certification required
Strong communication skills for a remote environment
Bilingual (Spanish/English) a plus, not required
Role Details
Contract-to-hire
Pay rate: up to $32/hr
Accuracy standard: 95-100%
Client-provided equipment
Start date: ASAP
Interview: Virtual (Teams), interviewing immediately
$32 hourly 3d ago
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Records and Agenda Coordinator
Village of Key Biscayne
Medical coder job in Key Biscayne, FL
The vibrant Village of Key Biscayne, incorporated on June 18, 1991, is in the center 1.25 square miles of a four-mile-long, two-mile-wide barrier island between the Atlantic Ocean and Biscayne Bay. The island is connected via a scenic causeway and bridges to the City of Miami, only seven miles away. Key Biscayne is a thriving residential community of more than 14,800 residents. Together with our residents, we are advancing our safe and secure village; thriving and vibrant community and local marketplace; engaging and active programs and public spaces; accessible, connected, and mobile transportation system; and resilient and sustainable environment and infrastructure.
The Village of Key Biscayne is seeking a Records and Agenda Coordinator. The Records and Agenda Coordinator of the Village Clerk's Office provides highly skilled administrative support and provides assistance in discharging the duties and overall management of the Village Clerk's Office. This position exercises independent judgment in performing special functions under the supervision of the Village Clerk. Work emphasizes daily administrative work, departmental IT initiatives, working with the Village Clerk on emerging technologies and Agenda and Records Management strategies. Work may include customer service functions and interaction with the public and administrative support assignments for the Village Clerk.
Essential Duties and Responsibilities
Records Management
Coordinate the processing and fulfillment of public records requests in compliance with Florida law.
Assist the Village Clerk with the management, retention, scanning, and indexing of permanent public records as part of the Village's records management program.
Maintain multiple systems including lobbyist registrations, advisory board memberships, contracts, resolutions, and ordinances.
File and organize official documents for the Village Council and the Office of the Village Clerk according to departmental procedures.
Council & Meeting Support
Assist in the preparation, posting, and distribution of Village Council electronic agenda packets and required legal notices.
Prepare the Council Chamber and other meeting venues for Village Council meetings.
Attend official meetings to record and transcribe minutes as assigned by the Village Clerk.
Coordinate Council travel arrangements, including airline reservations, hotel accommodations, transportation, and conference registrations.
Administrative Support
Prepare a variety of documents such as correspondence, memoranda, forms, tables, and reports with accuracy and completeness.
Process invoices, checks, and assist with monitoring and preparing the Village Clerk and Council budgets.
Customer Service & Other Duties
Provide excellent customer service in person and by phone, responding to inquiries and concerns or directing them to the appropriate department.
Perform other related duties as assigned by the Village Clerk.
Minimum Qualifications & Requirements
Education & Experience
Bachelor's degree in public administration or a related field from an accredited college or university.
Four (4) years of experience performing high-level administrative, clerical, or secretarial work.
Previous experience in a Municipal or County Clerk's Office is preferred.
Knowledge, Skills & Abilities
Strong computer proficiency, including Microsoft Office Suite (Word, Excel, Outlook, etc.).
Knowledge of automated agenda preparation software and public records management systems.
Familiarity with municipal government operations, services, and responsibilities of the Clerk's Office.
Knowledge of the rules and regulations governing the conduct of Village Council meetings, including Florida Sunshine Law, Florida public records law, and principles/practices of public agency record keeping.
Typing speed of at least 50 wpm.
Capable of transcription, summary minute preparation, and accurate recordkeeping.
Strong organization and time management skills.
Communicate clearly, tactfully, and effectively in English, both orally and in writing; excellent grammar and writing skills required. Ability to communicate in Spanish is a plus.
Read, update, analyze, and maintain various records and files with accuracy.
Quickly learn and apply various electronic document conversion processes and the Village's records management systems.
Operate standard office equipment (computers, printers, copiers, scanners, telephones, etc.).
Work independently, exercise discretion and judgment, and maintain confidentiality and professionalism.
Manage multiple recurring deadlines where accuracy and attention to detail are critical.
Provide flexibility to accommodate occasional evening work.
Certifications & Other Requirements
Notary Public of the State of Florida, or ability to obtain within three (3) months of employment.
Records Management Certification preferred.
Must be legally authorized to work in the United States.
Must possess a valid Florida Driver's License.
Must successfully complete a background investigation, including a national criminal history check.
Requirements may be waived by the Village Clerk.
These job functions should not be construed as a complete statement of all duties; additional job-related tasks may be required.
Must be a non-smoker.
SALARY RANGE: $58,649 - $95,892
POSITION TYPE: Full-Time / Non-Exempt
APPLICATION PROCESS:
Interested and qualified applicants should submit cover letter, resume to: Juan C. Gutierrez, Human Resources Director, Village of Key Biscayne via E-mail: **************************
Village of Key Biscayne is an Equal Opportunity Employer and a Drug/Smoke Free Workplace
Qualified applicants are considered for employment and treated without regard to race, color, religion, sex, disability, marital, or veteran status (except if eligible for veterans' preference).
$28k-38k yearly est. 4d ago
Coding Specialist
Gastro Health 4.5
Medical coder job in Miami, FL
Do you love to care for patients in a warm and welcoming environment?
Gastro Health is currently looking for an enthusiastic full-time Coding Specialist to join our team!
Gastro Health is a great place to work and advance in your career. You'll find a collaborative team of coworkers and providers, as well as consistent hours - and we enjoy paid holidays per year plus paid time off.
In this role, the you will work closely with Manager, Coding Operations and management team. The Team Lead will ensure that the company core values are being met.
Job Description
Drop claims for office, hospital, nutrition, pathology, biologics, imaging, pediatricians, anesthesia, and endoscopy center for accurate processing by payers
Review medical documentation from EMR and hospital systems for accurate coding and billing to insurance companies
Apply current billing and coding guidelines
Evaluate that charges provided by the physicians support the level being billed based on the documentation
Prepare claims with necessary fields for processing, such as linking authorizations to charges, code blood work, and assigning appropriate modifiers as needed
Provide feedback to office managers and physicians regarding clinical documentation to ensure compliance with coding guidelines and reimbursement reporting requirements
Manage claims for auditing purposes, including placing them on hold and billing once the process is complete
Email office managers and physicians where updates are needed to operative reports
Minimum Requirements
High School Diploma or GED equivalent
Must have CPC or equivalent certification
Extensive knowledge of patient registration, coding, billing, regulatory requirements, billing compliance, business operations, financial systems and financial reporting.
Certified coder AAPC or AHIMA
Excellent communication skills both verbal and written.
Able to analyze data and quickly identify process-based issues for remediation.
Maintains confidentiality in all matters that include Patient Health Information and employee data.
Hands-on participation in process/workflow design including team member involvement across the department.
Intermediate experience with Microsoft Excel and Office products is required.
Target Oriented and Coding team resolution mindset
Prior experience collaborating with a remote team is highly preferred.
Gastro Health is the largest gastroenterology multi-specialty group in the country. We are over 300 physicians strong with over 100 locations throughout the nation, including Florida, Alabama, Ohio, Maryland, Washington, Virginia, and Massachusetts. We employ the finest gastroenterologists, pediatric gastroenterologists, colorectal surgeons, and allied health professionals. Gastro Health is always looking for talented individuals who share our mission to provide outstanding medical care and an exceptional healthcare experience.
This position offers a great work/life balance!
We are growing rapidly and support internal advancement
We offer competitive compensation
401(k) retirement plans
Profit-Sharing
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance
Disability insurance
Pet insurance
We offer a comprehensive benefits package to our eligible employees, which includes: Cigna healthcare, dental, vision, life insurance, 401k, profit-sharing, short & long-term disability, HSA, FSA, and PTO plus 7 paid holidays.
Gastro Health is proud to be an Equal Opportunity Employer. We do not discriminate based on race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
We thank you for your interest in joining our growing Gastro Health team!
$55k-65k yearly est. Auto-Apply 60d+ ago
Acute Care Inpatient Coding Specialist
HCA Healthcare 4.5
Medical coder job in Miami, FL
**Introduction** Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Acute Care Inpatient Coding Specialist Parallon
**Benefits**
Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
+ Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
+ Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
+ Free counseling services and resources for emotional, physical and financial wellbeing
+ 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
+ Employee Stock Purchase Plan with 10% off HCA Healthcare stock
+ Family support through fertility and family building benefits with Progyny and adoption assistance.
+ Referral services for child, elder and pet care, home and auto repair, event planning and more
+ Consumer discounts through Abenity and Consumer Discounts
+ Retirement readiness, rollover assistance services and preferred banking partnerships
+ Education assistance (tuition, student loan, certification support, dependent scholarships)
+ Colleague recognition program
+ Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
+ Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Learn more about Employee Benefits (**********************************************************************
**_Note: Eligibility for benefits may vary by location._**
We are seeking an Acute Care Inpatient Coding Specialist for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!
**Job Summary and Qualifications**
Coding Integrity Specialist (CIS) III reviews and evaluates hospital inpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM and ICD-10- PCS codes. Performs coding and/or code/DRG validation across multiple entities. Applies all appropriate coding guidelines and criteria for code selections. Adheres to Company and HSC Coding Compliance policies and procedures for the assignment of complete, accurate, timely, and consistent codes for diagnoses and procedures.
**What you will do in this role:**
+ Assigns, sequences, validates, and/or edits codes/DRGs and abstracted data (e.g., physician, discharge disposition, query tracking) for inpatient records for multiple facilities using ICD-10CM and ICD-10-PCS to include:
+ Diagnosis description with appropriate 3-7 digit code assignment with corresponding Present On Admission (POA)
+ Procedure description with appropriate 7 digit ICD-10-PCS code, date and surgeon
+ Admitting Diagnosis
+ Discharge disposition
+ Where applicable, completes the coding portion of the IRF-PAI
+ Maintains or exceeds established accuracy standards
+ Maintains or exceeds established productivity standards
+ Utilizes the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGs
+ Initiates, reviews, and/or edits physician queries in compliance with Company and HSC policy where appropriate
+ As needed, may periodically be asked to perform Coding Account Resolution Specialist III (CARS III) duties
+ Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
+ Follows all applicable coding guidance in assigning, sequencing, validation, and/or editing of codes/DRGs
+ Meets all educational requirements as stated in current Company and HSC policy
+ Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
+ Other duties as assigned
**Qualifications:**
+ High School graduate or GED equivalent preferred, undergraduate (associate or bachelors) degree in HIM/HIT preferred.
+ Minimum 1 year of acute care hospital inpatient coding required, 3 years preferred
+ RHIA, RHIT or CCS preferred
Please visit our Parallon HCA Healthcare Coding Landing Page for more information on Coding Opportunities.
CLICK HERE for more information on Parallon HCA Coding (*********************************************************************
"
**Parallon** provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"
"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you find this opportunity compelling, we encourage you to apply for our Acute Care Inpatient Coding Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. **We are interviewing - apply today!**
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
$57k-70k yearly est. 32d ago
Surgical Coder
PRM Management Company
Medical coder job in West Palm Beach, FL
Full-time Description
Job Title: Surgical Coder
Department: Revenue Cycle Management
Reports To: RCM Director
The Surgical Coder is responsible for accurately reviewing, analyzing, and assigning the appropriate CPT, ICD-10-CM, and HCPCS codes for surgical and procedural documentation in patient medical records. This role ensures coding compliance with all applicable regulations and guidelines to optimize reimbursement and maintain the integrity of clinical and financial data.
Key Responsibilities:
Review operative reports and clinical documentation to assign appropriate CPT, ICD-10-CM, and HCPCS Level II codes.
Ensure accurate capture of modifiers and adherence to payer-specific coding guidelines.
Verify that all coded information supports medical necessity and aligns with regulatory requirements (e.g., CMS, AMA, and payer-specific policies).
Query physicians for clarification or additional documentation when necessary.
Maintain current knowledge of coding guidelines, compliance requirements, and regulatory updates.
Collaborate with billing, compliance, and revenue cycle teams to resolve coding and claim issues.
Participate in internal audits and quality assurance reviews.
Meet productivity and accuracy benchmarks as established by the department.
Protect patient confidentiality in accordance with HIPAA standards.
Requirements
Education and Experience:
High school diploma or equivalent required
Minimum of 3 years of surgical coding experience (ambulatory surgery, hospital outpatient, or inpatient) preferred.
Certifications (required):
Certified Professional Coder (CPC) - AAPC, or
Certified Coding Specialist (CCS) - AHIMA, or
Certified Outpatient Coder (COC) - AAPC
Skills and Competencies:
Strong knowledge of medical terminology, anatomy, and surgical procedures.
Proficiency in CPT, ICD-10-CM, and HCPCS Level II coding systems.
Familiarity with electronic health record (EHR) systems and coding software.
Excellent analytical, organizational, and communication skills.
High attention to detail and ability to work independently with minimal supervision.
Salary Description $20 - $27 per hour
$20-27 hourly 2d ago
Coder Inpatient
Omega HMS
Medical coder job in Boca Raton, FL
We are seeking a detail-oriented and experienced Inpatient coder to join our team. The coder must have three years of post-certification experience, some CAC experience, and Cerner Power Chart experience. Essential Job Functions * Responsible for abstracting, coding, sequencing, and interpreting clinical information from inpatient, outpatient, emergency department, pro-fee, and clinical medical records.
* Responsible for assigning correct principal diagnoses, secondary diagnoses, and principal procedure and secondary procedure codes with attention to accurate sequencing.
* Utilizes technical coding principles and DRG/APC reimbursement expertise to assign appropriate codes.
* Abstracts and codes pertinent medical data into multiple software programs and/or encoders. Follows official coding guidelines to review and analyze health records.
* Maintains compliance with external regulatory and accreditation requirements as well as state and federal regulations.
* Extract pertinent data from the patient's health record and determine appropriate coding for reports and billing documents.
* Identifies codes for reporting medical services and procedures performed by physicians. Enters codes into various computer systems, depending on the various clients.
* Track and document productivity in specified systems and maintain productivity levels as defined by the client.
* Maintain a 95% quality rating.
* Perform duties in compliance with the Company's policies and procedures, including but not limited to those related to HIPAA and compliance.
The coder must be currently working and have three years of post-certification experience in Inpatient coding.
eCAC experience is a requirement
Cerner power chart experience is a requirement.
Train on MS4 and eCAC Abstracting.
Must have the following certificates and/or licenses: RHIA, RHIT, and CCS,
$40k-54k yearly est. 45d ago
Coder Outpatient
Omega Healthcare Management Services
Medical coder job in Boca Raton, FL
Outpatient coder with 2 + years of experience in coding outpatient recurring/series account concentrating on wound clinic, infusion clinic, trauma clinic, but physical therapy, occupational therapy, speech pathology, and anticoagulation clinics will also be part of the mix Epic and 3M 360 experience is required. Schedule is 8 hours Mon - Fri with 75% of shift between client's regular business hours of 8am and 5pm CST.
2 + years of experience in coding outpatient recurring/series accounts
Epic Experience
3M 360 Experience
Able to work M-F with the majority of the shift between 8a-4p CST
Able to pick up new workflows and technology easily
Able to ramp up productivity in 4 weeks
Maintain 95% accuracy in all coding
Good written and verbal communication
$40k-54k yearly est. Auto-Apply 5d ago
Entry -Level Medical Coder
Revel Staffing
Medical coder job in Miami, FL
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.
$40k-54k yearly est. 41d ago
Medical Coder - Wound Care
Pinnacle Wound Management
Medical coder job in Miami, FL
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
$40k-54k yearly est. 34d ago
Medical Coder
On The Go HR 3.9
Medical coder job in Miami, FL
Client Summarization:
TelevisitMD is a virtual practice/business in a box for doctors. TelevisitMD delivers patients, medical coverage, virtual workspace, EHR, E-prescribing, and virtual telehealth visit tools and functions that enable flexibility for the patient and the providers allowing remote visits, replacing the current brick and mortar practices and throwing away the "ball and chain" that come with it
.
We are seeking a MedicalCoder who will assist us in coding medical documentation for insurance claims and for our databases. The MedicalCoder will assign required current procedural terminology, healthcare standard procedure coding system, clinical modification, international classification of diseases, and American Society of Anesthesiologists codes. You will decide which codes and functions should be assigned in each instance. This can or will include diagnostic and procedural information, significant reportable elements, and other complex classifications.
Background Qualifications- Education and/or Experience:
Minimum of 2 years of experience as a medicalcoder
Must be a Certified Professional Coder (AAPC) or Certified Coding Specialist (AHIMA)
Excellent computer skills including typing speed and accuracy
Experienced working with coding software
Skills Needed:
A strong understanding of physiology, medical terms, and anatomy
Excellent written and verbal communication skills
Strong people skills
Ability to maintain a high level of integrity and confidentiality of medical information
Attention to detail
Essential Responsibilities:
Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
Complying with medical coding guidelines and policies
Receiving and reviewing patients' charts and documents for verification and accuracy
Following up and clarifying any information that is not clear
Examining documents for missing information
Liaising with physicians and other parties to clarify information
Assigning CPT, HCPCS, ICD-10-CM, and ASA codes
Performing chart audits
Advising and training physicians and staff on medical coding
Research and analyze data needs for reimbursement
Ensuring all medical records are filed and processed correctly
Additional day-to-day tasks will be discussed during the interview process. Which will be updated on the job description once discussed.
Salary, Benefits, and Perks:
Range- $52,000
1099 Contract with the possibility of W2 employment after 90-day review
Must be available for communication and meetings from 9 am to 6 pm EST, Monday thru Friday
Remote. Must be US Citizen residing in the United States
This opportunity is for someone looking to work for a small business that offers flexibility. But gives you the opportunity to maintain growth and empathy in the workplace
$52k yearly 60d+ ago
Inpatient Coder, Full Time
Hialeah Hospital
Medical coder job in Hialeah, FL
Job Description
Medical Record Coder is responsible for timely review of patient records in order to identify an appropriate selection of ICD-9-CM/CPT codes that will accurately reflect the reason for admission, extent of care received, and level of severity of illness. Coder is further responsible for insuring that all data elements required for federal and state reporting are collected and included in the patient's demographic record. Accounts for each Inpatient and Outpatient records in order that all are coded. Enters coded data into computer to facilitate the billing process.
Position Qualification:
Preferred: 2-3 years Inpatient coding experience preferred.
EDUCATION: RHIA, RHIT, CCS preferred or completion of ICD-9/CPT 4 coding programs.
TRAINING: Orientation and training under supervision of Director and Coding Manager until competency is observed.
ABILITIES AND SKILLS: Requires eye hand coordination with good manual dexterity. Must be able to look at computer CRT most of the day and must be computer knowledgeable. Must have excellent command of the English language, both oral and written. Must be organized. Requires frequent but limited contact with physicians.
EXPERIENCE: 2-3 years coding experience preferred.
Licenses/Certifications:
LICENSE AND/OR CERTIFICATION: RHIA, RHIT, or CCS preferred.
$40k-54k yearly est. 4d ago
Medical Code II - 016063
Interamerican Medical Center Group LLC 4.2
Medical coder job in Hialeah, FL
The MedicalCoder II position performs adequate coding services to the organization for achievement of reimbursement and compliance with correct coding guidelines. This individual requires skills in the sequencing of diagnosis/procedure codes to optimize reimbursement.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Responsible for the evaluation of medical documentation for proper assignment of ICD10-CM/CPT-4 codes and the preparation of claims.
Seeks clinical documentation and makes coding recommendations to physicians based on their overall medical observation and documentation of medical records.
Provide Physician training on MRA/HEDIS coding and medical documentation guidelines.
Ensures medical records for accuracy and completion through pre audit and post audit processes to adequately code for all services to achieve reimbursement in accordance with correct coding guidelines.
Completion of 30 medical record abstracts daily and provides coding recommendations to physicians.
Provides PCP MRA/HEDIS coding support, education, and training.
Monitor coding changes to ensure most current information is available.
Assists with chart reviews/audits performed by health plans.
Looks for new problem areas, trends, etc.
Works HCC/HEDIS Care Gap Reports.
Expected to maintain up to date coding innovations that can improve their workflow.
Maintenance, reconciliation, and completion of PCP coding recommendations-Level 1 claims that have been corrected by physician.
Other duties as assigned.
EXPERIENCE AND REQUIRED SKILLS
High School Diploma or equivalent required.
CPC & ICD10 Certification required.
Minimum of 3 years of medical coding experience with acquired progressive responsibility preferred.
Proficient in official coding guidelines, ICD-10CM, CPT-4 and HCPCS.
Strong organizational skills and high attention to detail.
Strong collaboration and relationship building skills.
Required to have a command of the English language and be proficient with grammar, spelling and verbal skills to communicate with patients, providers, and staff in written and oral communication.
Must be proficient be proficient in Microsoft Office and knowledge with computers, scanners, etc.
Experience with Patient Financial Systems and Electronic Medical Records.
Good communication skills.
Ability to learn new tasks and concepts.
Bilingual English/Spanish preferred.
IMC Health provides equal employment opportunity to all applicants and employees. No person is to be discriminated against in any aspect of the employment relationship due to race, religion, color, sex, age, national origin, disability status, genetics, citizenship status, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
$42k-54k yearly est. Auto-Apply 60d+ ago
Inpatient Coder 1
Jackson Health System 3.6
Medical coder job in Miami, FL
Miami, FL Full-Time Health Information Management HIM Inpatient Coder 1 is responsible for reviewing the clinical documentation contained in the in-patient health records to accurately assign and sequence ICD-9 diagnostic and ICD-9 procedure codes to inpatient records for use in reimbursement and data collection.
Responsibilities
* Has the knowledge and experience to code In-patient medical records using ICD-9 and/or ICD-10 code set.
* Ensures all accounts are coded correctly, which will provide an accurate MS-DRG or APR-DRG for appropriate reimbursement.
* Ensures all accounts are coded within 4 days of the patient's discharge date, meeting productivity standards according to AHIMA Guidelines depending on record type.
* Verifies patient information to identify any discrepancies and ensures that all codes and any other abstracted information is applied to the appropriate patient's encounter.
* While reviewing the record for coding purposes, serves as a quality reviewer, and identifies any documents not belonging to the patient, or the correct patient's encounter.
* Ensures the accuracy when using the appropriate modifiers while coding out patient's encounters.
* Assesses documentation and if necessary queries the physician for additional information when indicated to clarify a diagnosis, symptom or any reason for services provided, according to Coding Guidelines and Coding Clinics.
* Makes sure all codes are utilized to reflect the care rendered to the patient which in return will ensure patient safety, accuracy of data retrieval and provides the organization with accurate reimbursement for the care provided to the patient.
* Recognizes and reports unusual circumstances and/or information with possible risk factors to the Coding Associate Administrator or the Coding Director.
* Meets continuing education requirements established by American Health Information Management Association (AHIMA) and/or American Association of Professional Coders (AAPC) to maintain appropriate certification and competency in job skills and knowledge.
* Is actively involved in all ICD-10-CM-PCS education sessions provided by JHS, and any other outside entity approved by JHS.
* Shows competency according to education received.
* Adheres to the Standards of Excellence at all times, and respects the rights, privacy and property of others at all times including the confidentiality of information, according to Administrative Policies HIPAA Guidelines and all applicable laws and regulations.
* Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
* Performs other related duties as assigned.
Experience
Generally requires 0 to 3 years of related experience.
Education
High School diploma is required.
Skill
* Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
* Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure.
* Ability to understand and follow instructions.
* Ability to exercise sound and independent judgment.
* Knowledge and skill in use of job appropriate technology and software applications.
Credentials
Employee hired AFTER June, 2015 must be credentialed with an HIM/Coding Credentials and/or Certification by AHIMA or AAPC.
Unit Specific Credential
Working Conditions
Physical Requirements - Job function is sedentary in nature and requires sitting for extended periods of time. Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).
Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).
$43k-52k yearly est. 9d ago
Medical Coder
Medusind 4.2
Medical coder job in Miami, FL
At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with a rich domain expertise and robust compliance norms.
Our four-prong approach of an excellent management team coupled with detailed eye for processes,
experienced manpower, and cutting edge technology helps us deliver superior, cost effective services to our clients across the globe.
Job Description
SUMMARY:
This position is a member of a team that is responsible for coding review, coding education, and charge entry. The goal of the team is to ensure correct coding, timely charge entry, billing compliance, and to provide on-going coding education to providers and staff.
RESPONSIBILITIES:
Stays up-to-date on coding rules and CPT/ICD/HCPCS codes.
Stays up-to-date on 3rd party payer rules and integrates those rules into daily work.
Review for accuracy all charge slips submitted by the Medusind clients and hospital departments.
Make corrections based on the medical documentation.
Assist the department manager with collecting data for trends to help develop training plans for clients and providers.
Assist billing office in addressing billing concerns from the Collections team as necessary.
Perform random audits on charts.
Data entry of the charges in a timely and accurate fashion.
Perform other duties as assigned.
Participate in continuing education sessions.
Foster and maintain excellent relationships with Medusind clients.
Qualifications
KNOWLEDGE, SKILLS, AND ABILITIES:
Minimum of five years experience working with CPT, ICD-10 and HCPCS codes.
A strong understanding of coding requirements.
Must either possess a CPC certification or a CCS certification.
1 year Radiology, Neurology and Medicare Part B coding experience.
Knowledge of computer applications and Microsoft Office processing.
Additional Information
All your information will be kept confidential according to EEO guidelines.
$37k-49k yearly est. 1d ago
MRA Coding Specialist
Healthy Partners Inc.
Medical coder job in Miramar, FL
Entry level position intended to support the achievement of the goals of the organization and execute essential functions under the close supervision of the Senior MRA/HEDIS Specialist and/or Director of MRA; Identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
Review medical record information to identify all appropriate coding based on CMS HCC categories.
Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
Support and participate in process and quality improvement initiatives.
PRINCIPLE RESPONSIBILITIES:
Review medical record information to identify all appropriate coding based on CMS HCC categories
Complete appropriate paperwork/documentation/system entry regarding claim/encounter information
Monitor coding changes to unsure that most current information is available
Review and prepare charts for affiliates or medical centers
Work HCC suspect reports and submit to the Director for review
Accurately coding and submitting encounters on a timely basis after supervisor review
Due to the nature of this position, it is understood that coding requirements are expected to change; therefore, participation in affiliated classes and individual efforts to maintain current knowledge of these changes is required
KEY COMPETENCIES:
Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments and takes responsibility for the impact of one's actions.
Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed careplan.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces changes and constructively resolves barriers and constraints.
Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that places the insurance plan and medical center overall success first.
EXPERIENCE/SKILL REQUIREMENTS/EDUCATION:
At least one of the following:
One (1) year prior medical coding and/or billing experience, or
Two (2) years prior medical assistant experience, or
CPC, CPC-A or CCS-P, CRC Coding Certification, or
Pending completion of externship for coding certification
Familiar with Microsoft Word and Excel
Familiarity with primary care medical charts
Strong organization and process management skills
Strong collaboration and relationship building skills
High attention to detail
Excellent written and verbal communication skills
Ability to learn new tasks and concepts
Healthy Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
$40k-54k yearly est. Auto-Apply 60d+ ago
Medical Coder // Miami, FL 33126
Mindlance 4.6
Medical coder job in Miami, FL
Mindlance is a national recruiting company which partners with many of the leading employers across the country. Feel free to check us out at *************************
Job Description
Business MedicalCoder
Visa GC/Citizen
Location 5775 Blue Lagoon Dr. Miami, FL 33126
Division Healthcare
Contract 3 Months
Qualifications
Role
· Review of denial on adjudicated claim that is classified as a code edit denial.
· Request and review supporting documentation (medical records) when needed.
· Once review is complete contact provider by phone to provide rationale as to whether we will overturn (pay) the denial or if it is upheld.
Qualifications
· CPC, CRC.CCS-P Coding Certification
· CPC-A with coding experience
· Knowledge/experience of CPT, ICD-9, and ICD-10 coding
· Comfortable with making outbound calls to provider offices
If you are available and interested then please reply me with your “Chronological Resume” and call me on **************.
Additional Information
Thanks & Regards,
Ranadheer Murari | Team Recruitment | Mindlance, Inc. | W: ************
*************************
Broward Health Corporate ISC Shift: Shift 1 FTE: 1.000000 Assigns procedures, evaluation and management (E/M) coding, and diagnoses codes as documented in the medical records all within the professional coding guidelines, centers for Medicare and Medicaid (CMS) guidelines, and policies to obtain reimbursement. Meets deadlines to expedite the billing process and to facilitate data availability for providers to ensure the timeliness of claim submissions. Reviews outpatient and inpatient medical records and accurately codes diagnostic and procedural information following coding guidelines and regulations.
Education:
Essential:
* High School Diploma or GED
Experience:
Essential:
* Two Years
Credentials:
Essential:
* Certified Professional Coder
* Specialized Credentialing through AAPC
Visit us online at ********************* or contact Talent Acquisition
* Bonus Exclusions may apply in accordance with policy HR-004-026
Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race, color, national origin, gender, gender identity or gender expression, pregnancy, sexual orientation, religion, age, disability, military status, genetic information or any other characteristic protected under applicable federal or state law.
$32k-43k yearly est. 28d ago
Medical Review Clinical Appeals Auditor (RN) - SNF/MDS
Performant 4.7
Medical coder job in Plantation, FL
ABOUT MACHINIFY:
In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence.
ABOUT THE OPPORTUNITY:
Hiring Range: $75,000 to 85,000
The Medical Review Clinical Appeals Auditor (RN) - SNF/MDS is responsible for conducting Appeals reviews of new evidence presented by auditee's, disputing all or part of the findings from medical review audit work completed by the medical review clinical audit team members, as well as communicate and support the identification of potential training opportunities or enhancements to training and/or concept review guideline materials and tools. The Appeals Auditor is also responsible for consistently achieving or exceeding productivity goals and quality standards and serves as a subject matter expert, providing supplemental escalation support, and may perform special project activity as needed.
Key Responsibilities
Performs clinical reviews on medical records to maintain subject matter expertise.
Conducts Appeals reviews on medical review audit work completed by the medical review clinical and documentation audit team members, as new evidence is presented by auditees.
Objectively and accurately documents Appeals results in accordance with department quality policies and procedures, scoring and reporting all Appeals results and routes the result appropriately within audit platform based upon how the Appeal review resulted in a full or partial upholding of the audit finding or with a full or partial overturn.
Reviews audit documentation and conducts research, analyzes claims data, applies knowledge of client SOW, applicable concept guidelines, policies, and regulations as necessary to determine if audit result is accurate and includes complete details to support findings.
Provides correction to narrative rationale to correspond with audit determination and flags patterns of concern to audit leadership for real-time intervention, preventing an accumulation of improper findings.
Contributes to the continuous improvement feedback process and suggests any edits to documentation, enhancements review guidelines, and reporting as may be necessary in accordance with department process and audit leadership direction.
May support findings during the appeals process, if needed.
May perform primary audit activity as assigned by management.
Monitors, tracks, and reports on all work conducted in accordance with Appeals process and management direction.
May prepare reports for management that includes a variety of data and trends at the individual, department, and client program level, as well as date range or concept based/trended, or other characteristic that will provide valuable business insights.
Consults with internal resources as necessary.
Become subject matter expert for assigned business segment(s).
Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends.
Participates in and contributes to applicable department meetings.
Successfully completes, retains, applies, and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position.
Proactively contributes to continuous improvement of activities and sets positive example.
Contributes collaboratively to identifying opportunities for improvement of audit results and continuous improvement initiatives.
May support training material/tools and best practices development.
May identify/make recommendations to management for supplemental team/concept type training.
May support training activities for new audit staff or provide supplemental training for existing staff as needed.
Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results.
Receives feedback and adjusts work priority as necessary.
Serves as positive role model and example for other audit staff and conducts work in accordance with company policies, government regulations and law.
Performs job duties with high level of professionalism and maintains confidentiality.
Perform other incidental and related duties as required and assigned to meet business needs.
Knowledge, Skills and Abilities Needed
Demonstrated ability to perform claim payment audits with high quality and production results, as well as successful application of skills to conduct quality assurance review of audit work completed by others.
Must be able to manage multiple assignments effectively, create documentation outlining findings, Appeals review results and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members.
Experience with CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding may be necessary.
Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules and regulations, may be necessary.
Experience with utilization management systems or clinical decision-making tools such as Millimen Care Guidelines (MCG) or InterQual.
Working knowledge of encoder may be necessary.
Reimbursement policy and/or claims software analyst experience may be necessary.
Familiarity with interpreting electronic medical records (EHR)
Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing.
Demonstrated ability to consistently apply sound judgment and good effective decision making.
Understands Medical Review Audit and Quality Assurance objectives, activities, and key drivers in achieving operational goals.
Ability to efficiently and effectively run reports, analyze information, identify meaningful trends, and identify potential solutions.
Strong communication skills, both verbal and written; ability to communicate effectively and professionally at all levels within the organization, both internal external.
Demonstrated ability to collaborate effectively in a variety of settings and topics.
Excellent editing and proofreading skills.
Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively.
Excellent time management and delivers results balancing multiple priorities.
Strong analytical skills; synthesizes complex or diverse information; collects and researches data; uses experience to compliment data.
Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve complex issues.
Demonstrated ability to identify areas of opportunity and create efficiencies in workflows and procedures.
Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions.
Ability to create documentation outlining findings and/or documenting suggestions.
Strong general computer skills, including, but not limited to Desktop and MS Office applications (Intermediate-to-Advanced Excel Skills), application reporting tools, and case management system/tools to review and document findings.
Advanced technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools.
Ability to be flexible and thrive in a high pace environment with changing priorities.
Adaptable to applying skills to diverse operational activities to support business needs.
Self-starter with the ability to work independently in remote setting with minimum supervision and direction in the form of objectives.
Serves as a positive role model; and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams.
Capability of working in a fast-paced environment, flexibility with assignments and the ability to adapt in a changing environment.
Required and Preferred Qualifications
Active unrestricted RN license in good standing and diversified nursing experience providing direct care in an inpatient or outpatient setting, is required.
At least 5+ years relevant experience in a provider or payer environment demonstrating breadth and depth of auditing knowledge/skills for the position. Less than 5 years may be considered for internal candidates based upon demonstrated skills and results.
Not currently sanctioned or excluded from the Medicare program by OIG.
Must have strong technical aptitude and intermediate to advanced skills using Excel.
One or more years of experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, bundled payment methodologies and/or medical billing experience for an Insurance Company or hospital or other appropriate medical provider may be required.
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions.
Prior experience in role with responsibility for conducting primary audit, utilization management or prior-authorization work, or review of audit work performed by others (QA function, appeals function, lead, supervisory role, etc.)
Prior experience in payer edit development and/or reimbursement policy a plus.
Prior experience working in remote setting is strongly preferred. Must be comfortable solving minor/intermediate technical issues, with or without immediate remote assistance.
WHAT WE OFFER:
Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.
Physical Requirements & Additional Notices:
If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.
The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.
Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
Regularly sit/stand 8 or more hours per day.
Occasionally lift/carry/push/pull up to 10lbs.
Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:
Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.
Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.
Other requirements may apply.
All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further.
Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.
THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
$75k-85k yearly Auto-Apply 45d ago
Medical Record Audit / Coding Auditor
CRD Careers
Medical coder job in Miami, FL
OUR CLIENT is a contracting and data management services organization dedicated to primary care physicians throughout Florida
IN THIS ROLE YOU are responsible to assist in the development, undertaking and maintenance of a long term comprehensive, clinical coding audit program for inpatient and outpatient activity.
To develop and Implement policies to support the clinical coding audit function
Receive, review and communicate findings on patient billing coding related complaints.
Identify training needs through the audit program of work and liaise with the clinical coding training manager and audit manager to provide the necessary training identified
Conduct routine, risk based, proactive or reactive compliance reviews of procedural and diagnosis coding/billing and medical record documentation performed by clinical service providers
Prepare reports as required relative to these monitoring and review activities.
Work with coding/billing associates to assure compliance on coding, billing, monitoring and review activities.
Monitor, communicate and conduct educational sessions regarding additions and/or revisions to coding and documentation rules and regulations.
TO SUCCEED IN THIS ROLE, YOU HAVE:
High School diploma required, Associate Degree preferred;
Must be a certified professional coder;
Minimum five years hands-on experience in physician coding
$47k-73k yearly est. 60d+ ago
Medical Coding Auditor
Community Care Plan
Medical coder job in Sunrise, FL
Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements.
Essential Duties and Responsibilities:
* Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment.
* Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified.
* Coordinates overpayment recoveries with the Fraud Investigative Unit Manager.
* Responsible for assisting the Fraud Investigative Unit Manager with potential fraud, waste or abuse investigations requiring medical coding expertise, participating in external audit requests, and special projects as needed.
* Coordinates, conducts, and documents audits as needed for investigative purposes.
* Prepares written reports or trending data related to findings and facilitates timely turnaround of audit results.
* Prepares written summaries of audit results for purposes of reporting potential fraud, waste, abuse and/or overpayment.
* Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner.
* Identifies potential provider fraud through review of claims data, complaint referrals, and application of rules, healthcare coding practices, and fraud detection software.
* Reviews provider billing practices to investigate claims data and compliance with State and Federal laws.
* Analyzes provider data and identifies erroneous or questionable billing practices.
* Interprets state and federal policies, FloridaMedicaid, Children's Health Insurance Program, and contract requirements.
* Determines and calculates overpayment/underpayment, appropriately documents and participates in steps to remediate.
* Determines priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
* Performs all other duties as assigned.
This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
Qualifications:
* MedicalCoder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) must have.
* Candidates with relevant work experience may be eligible for company-sponsored certification or licensure.
* Prior experience in Medicaid claims role and/or post payment medical coding auditor role preferred.
* Knowledge of Medicaid rules, claims processing, medical terminology and coding principles and practices.
* Knowledge of auditing, investigation, and research.
* Knowledge of word processing software, spreadsheet software, and internet software.
* Manage time efficiently and follow through on duties to completion.
Skills and Abilities:
* Written and verbal communication skills.
* Ability to organize and prioritize work with minimum supervision.
* Detail oriented.
* Ability to perform math calculations.
* Analytical and critical thinking skills.
* Ability to operate personal computer and general office equipment as necessary to complete essential functions, including using spreadsheets, word processing, database, email, internet, and other computer programs.
* Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
* Ability to write reports, business correspondence, and procedure manuals.
* Ability to effectively present information and respond to questions.
Work Schedule:
Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.
Background Screening Notice:
In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.
The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.
Additional information is available at:
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How much does a medical coder earn in Tamarac, FL?
The average medical coder in Tamarac, FL earns between $35,000 and $62,000 annually. This compares to the national average medical coder range of $37,000 to $70,000.
Average medical coder salary in Tamarac, FL
$46,000
What are the biggest employers of Medical Coders in Tamarac, FL?
The biggest employers of Medical Coders in Tamarac, FL are: