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Medical language specialist full time jobs
- 12 jobsMortgage Recording Specialist
Upstart Services
Columbus, OH
About Upstart Upstart is the leading AI lending marketplace partnering with banks and credit unions to expand access to affordable credit. By leveraging Upstart's AI marketplace, Upstart-powered banks and credit unions can have higher approval rates and lower loss rates across races, ages, and genders, while simultaneously delivering the exceptional digital-first lending experience their customers demand. More than 80% of borrowers are approved instantly, with zero documentation to upload. Upstart is a digital-first company, which means that most Upstarters live and work anywhere in the United States. However, we also have offices in San Mateo, California; Columbus, Ohio; and Austin, Texas. Most Upstarters join us because they connect with our mission of enabling access to effortless credit based on true risk. If you are energized by the impact you can make at Upstart, we'd love to hear from you! The Team: As part of Upstart's Home Lending Operations, the Post Closing team ensures a seamless and compliant experience for our home equity line of credit borrowers after closing. We focus on executing high-quality, time-sensitive operational processes that directly impact the accuracy and integrity of loan documentation and servicing workflows. As a Mortgage Recording Specialist, you'll be part of a collaborative team that works closely with internal stakeholders and external partners to uphold loan servicing standards and drive operational excellence. As the Mortgage Recording Specialist at Upstart, you will manage the accurate and timely recording of HELOC loan documents, a critical step in ensuring compliant and efficient loan servicing. This role prepares, reviews, and submits RON and mail-in packages for county recording, verifies post-recording data, and updates internal systems with precision. By maintaining high standards of documentation quality and proactively resolving issues, the Mortgage Recording Specialist helps safeguard the integrity of our servicing operations. How you'll make an impact Ensure complete and accurate review of signed HELOC documentation packages prior to recording. Confirm all elements of mail-in packages (mortgage/deed, physical check, return materials, FedEx labels) are properly assembled and addressed. Prepare electronic and mail-in recording documents for submission, validating county-specific requirements, riders, and appropriate payment methods Monitor Simplifile to ensure recording statuses transition to final confirmed state by county. Validate post-recording documentation, including recording stamps, dates, book/page/instrument numbers, and update internal systems accordingly. Upload recorded instruments to Vesta and ensure all notes and metadata are accurately reflected across systems Serve as a point of quality control to guarantee documentation compliance and operational accuracy during the post-closing process Remediate and cure any rejected recording documents from counties as needed. Minimum Qualifications Experience in home lending loan processing or mortgage servicing Understanding of end-to-end HELOC loan origination processes Excellent analytical, organizational, and communication skills High attention to detail and comfort working with data in operational environments High School Diploma or GED Ability to work standard hours (9 AM - 5:30 PM EST) Proficiency with loan origination systems and general productivity software. Reside within 60 miles of Columbus, OH, and be able to work from the office at least two days per week. Preferred Qualifications Previous post closing / recording or servicing mortgage experience. Ability to work effectively with limited direct guidance on routine activities Strong organizational and time management skills with the ability to prioritize tasks effectively Comfortable operating in a fast-paced, ambiguity-prone environment Demonstrated ability to take ownership of issues and drive resolution with patience and efficiency Position location This role is available in the following locations: Columbus, Ohio Time zone requirements The team operates on the East coast time zones. In-Office requirements. You will be required to work from the Columbus, Ohio office 2 days per week (must be within a 60 mile radius). Depending on business needs, agents may be asked to work from the office more often. Travel requirements As a digital first company, the majority of your work can be accomplished remotely. The majority of our employees can live and work anywhere in the U.S but are encouraged to to still spend high quality time in-person collaborating via regular onsites. The in-person sessions' cadence varies depending on the team and role; most teams meet once or twice per quarter for 2-4 consecutive days at a time. What you'll love: Competitive Compensation (base + bonus & equity) Comprehensive medical, dental, and vision coverage with Health Savings Account contributions from Upstart 401(k) with 100% company match up to $4,500 and immediate vesting and after-tax savings Employee Stock Purchase Plan (ESPP) Life and disability insurance Generous holiday, vacation, sick and safety leave Supportive parental, family care, and military leave programs Annual wellness, technology & ergonomic reimbursement programs Social activities including team events and onsites, all-company updates, employee resource groups (ERGs), and other interest groups such as book clubs, fitness, investing, and volunteering Catered lunches + snacks & drinks when working in offices This is a Non-Exempt position. Employees in this position are paid an hourly pay rate, on a bi-weekly basis, and are eligible to receive overtime pay for any hours worked over 40 in a work week, or over 8 in a work day if required by state law. Columbus, OH - Anticipated Hourly Rate Range$25.48-$25.48 USD Upstart is a proud Equal Opportunity Employer. We are dedicated to ensuring that underrepresented classes receive better access to affordable credit, and are just as committed to embracing diversity and inclusion in our hiring practices. We celebrate all cultures, backgrounds, perspectives, and experiences, and know that we can only become better together. If you require reasonable accommodation in completing an application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please email candidate_accommodations@upstart.com ************************************************$25.5-25.5 hourly Auto-Apply 16d agoTrauma Coder
Ohio Health
Pickerington, OH
We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. Summary: This position performs coding and abstracting functions for Trauma Patients including Emergency Department, Observation, Observation in a bed and the inpatient setting. Responsibilities And Duties: 60% * Assigns appropriate admit, & principal and secondary diagnoses and/or procedure codes by reading documentation present in medical record and applying knowledge of correct coding guidelines as appropriate for hospital service and/or patient type while maintaining 95% quality and meeting and maintaining the minimum Coder productivity requirements. * Assign Present on Admission POA indicator to all inpatient account diagnoses as required by official coding guidelines. * Accurately Assign ICD10 diagnosis/procedure codes, AIS scoring at the minimum standards of 95% quality and meeting and maintaining the minimum Coder productivity requirements. Review Diagnosis and CC/MCC for maximum SOI/ROM Clinical understand of laboratory and radiology values Knowledge of quality outcomes indicators Work with CDS to improve physician documentation and case mix index Assign Principal Diagnosis accurately at least 95% or better * Monitor and appropriately assign codes when appropriate * Responsible for recognizing when it is necessary to obtain further clarification from physician when documentation is inadequate, ambiguous, or unclear for coding purposes. * Assists providers and supervisors with reviewing accounts denied by NTDB and other governing bodies for appropriate documentation to support original coding. 35% * Abstracts all data elements necessary to complete NTDB and TQIP requirements and meet hospital-reporting requirements. * In the event of insufficient, missing, or conflicting documentation, follows department policy for follow up and physician query. * Identifies problem cases in EPIC and forwards to appropriate staff for follow up. 5% * Verifies demographics, account number, service and identify missing or incorrect forms in each record. The major duties, responsibilities and listed above are not intended to be all-inclusive of the duties, responsibilities and to be performed by employees in this job. Employee is expected to all perform other duties as requested by supervisor. Minimum Qualifications: Additional Job Description: SPECIALIZED KNOWLEDGE Associate's degree or 1-3 years of coding experience in an acute care/hospital setting. Specialized Knowledge: AIS Scoring, ICD-10CM and PCS classification systems, Advanced Anatomy & Physiology, Pathophysiology, Pharmacology, Medical Terminology, inpatient documentation schemes. Knowledge of Hospital Acquired Conditions (HAC), Present on Admission (POA), Severity of Illness (SOI), Risk of Mortality (ROM), and Quality outcome indicators. Knowledge of operative reports, clinical lab, and radiology results for physician queries. Knowledge of Clinical Documentation improvement programs. Knowledge of NTDB and TQIP abstracting elements. Work Shift: Day Scheduled Weekly Hours : 40 Department Trauma Services Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment$34k-43k yearly est. Auto-Apply 1d agoMedical Claims Specialist
Centerprise
Loveland, OH
Job Description Centerprise Inc. is seeking to hire a Medical Claims Specialist to join our team. The Medical Claims Specialist performs a variety of billing and administrative tasks including claim submission, claim correction, insurance follow-up and appeals and insurance verification. They will also assist with all other billing and finance duties as needed. ABOUT THE COMPANY: Centerprise is a professional services organization providing consulting and Revenue Cycle Management services to Federally Qualified Health Centers (FQHCs). We are located outside Cincinnati, Ohio, and conduct business nationally. Centerprise is a company on the rise! We are very excited to say that we currently employ 25 staff members, and we are steadily growing! We take great pride in focusing on employee satisfaction. Happy employees; means happy customers! At Centerprise we offer our clients a wide variety of services, therefore, we require a large range of skill sets within our company. We would love to hear from dynamic individuals who are seeking an opportunity to grow their skills in an upbeat, fast paced, and team-based environment. Centerprise has a small company feel, with larger company resources. Please refer to our website for more information, *************** ESSENTIAL DUTIES AND RESPONSIBILITIES: Follow-up: Regularly monitor patient account insurance balances to ensure timely payment and resolve any outstanding issues. Payer Communication: Contact payers regarding payment status, resolve incorrect payment issues, and ensure proper reimbursement. Denial Management: Work closely with leadership to address and resolve any denied claims promptly. Understanding Guidelines: Stay informed about both government and non-government contractual billing and follow-up guidelines, ensuring compliance with individual payer requirements. Payment Resolution: Address issues related to lack of payment or improper payment by government, non-government, and self-payers, ensuring that all incorrect payment issues are resolved promptly. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty completely. The requirements listed below are representative of the knowledge skill and/or ability required. Minimum Qualifications: High School Diploma or Equivalent (GED), associate degree preferred. Medical billing experience required. FQHC billing experience is a plus. Proficiency with Microsoft Office Suite. Must be able to use Excel spreadsheets. Knowledge of Medical Terminology, CPT and ICD-10 Coding, Electronic Billing, and HIPPA EHR Experience in required. Preferred experience with NextGen or eClinicalWorks Excellent written and oral communication skills Pay: $18-$20/hour based on experience Benefits: Competitive benefits package, including options to enroll in the following programs: Health, Dental, Vision, Life, Short Term Disability, Long Term Disability, Flex Savings Accounts 401 (k) Program with competitive company match Courtesy Plan, full time staff and their immediate family members are eligible for courtesy treatment at any HealthSource of Ohio office up to $500.00 per family PTO and Long-Term Sick Bank, full time employees earn up to 25 days per year in first calendar year: 15 days of Paid Time Off (PTO), and 10 days of Long-Term Sick Bank (LTSB) Credit Union Privileges, Sharefax Credit Union Quarterly Bonus Incentive Program Schedule: Monday to Friday; no evenings, or weekends After training may be eligible to work a hybrid-remote schedule which will include 2-3 in office days per week. Work Location: Loveland, OH 45140. Must be able to commute or planning to relocate before starting work. Centerprise Inc. is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran$18-20 hourly 29d agoMedical Coder 3 - Region 5
A-Line Staffing Solutions
Columbus, OH
Assist in monitoring and analyzing policies and procedures for the ICD policy and system support program. Serve as a medical policy resource, analyst, and technical expert advisor for coding systems. Analyze ICD reports for appropriate usage and assignment of ICD codes. Collaborate to resolve coding discrepancies related to CPT and HCPCS coding. Maintain high standards of accuracy and efficiency in coding practices. Draft and edit administrative policies and procedures as necessary. Critical Information Work hours are from 08:00 to 17:00. This position is on-site. Submissions must include resume, cover letter, and RTR. Education/Licenses Needed RHIA or RHIT degree and/or CCS/CCS-P/CPC certification required. Active membership in professional coding organizations (AAPC, AHIMA). Benefits: Benefits are available to full-time employees after 90 days of employment. A 401(k) with company match is available after 1 year of service. This is an AI-formatted job description; recruiter confirmation required.$32k-41k yearly est. 14d agoN5A541 - Specialist Record Review
Versiti
Dayton, OH
Versiti is a fusion of donors, scientific curiosity, and precision medicine that recognize the gifts of blood and life are precious. We are home to the world-renowned Blood Research Institute, we enable life saving gifts from our donors, and provide the science behind the medicine through our diagnostic laboratories. Versiti brings together outstanding minds with unparalleled experience in transfusion medicine, transplantation, stem cells and cellular therapies, oncology and genomics, diagnostic lab services, and medical and scientific expertise. This combination of skill and knowledge results in improved patient outcomes, higher quality services and reduced cost of care for hospitals, blood centers, hospital systems, research and educational institutions, and other health care providers. At Versiti, we are passionate about improving the lives of patients and helping our healthcare partners thrive. Position Summary Under the direction of the Manager of Record Review and/or the Record Review Team Lead, the Record Review Specialist is responsible for reviewing records and/or reports associated with donor qualification, blood donation, and lot release to ensure all processes are performed in accordance with standard operating procedures (SOPs) and are within regulatory guidelines. The Record Review Specialist verifies that associated quality control and maintenance are performed and within parameters for all processes. The Record Review Specialist ensures that review and lot release occurs within established turn-around times. Total Rewards Package Benefits Versiti provides a comprehensive benefits package based on your job classification. Full-time regular employes are eligible for Medical, Dental, and Vision Plans, Paid Time Off (PTO) and Holidays, Short- and Long-term disability, life insurance, 7% match dollar for dollar 401(k), voluntary programs, discount programs, others. Responsibilities Reviews records and/or reports to ensure compliance with SOPs and within regulatory guidelines before lot release (release of blood components for labeling). Reviews daily, weekly, and monthly quality control and maintenance records of equipment, supply, and storage for the applicable collection date before lot release. Perform data entry of blood donation record into system if applicable. Initiates the appropriate deviation reporting forms and communicates with the appropriate management of unacceptable conditions for lot release. Organizes and correlates in an established manner all paperwork associated in the record review process for record retention purposes. Responsible for independent and/or collaborative decision making regarding critical steps in donor qualification, determining viability of product, and product release. Serves as the internal and external point-of-contact for complex questions/concerns related to Record Review/Lot Release. Contacts donors via phone, letter, or email to verify donation information. Participates in meetings and communicates effectively to foster a team environment. Assists in the development and achievement of departmental goals and objectives in support of the vision and mission of Versiti. Assists in the implementation of federal requirements, blood center directives, and SOPs. Seeks to participate in process improvement projects. Completes projects/tasks according to established project plans. Other duties as assigned. Performs other duties as assigned Complies with all policies and standards Qualifications Education High School Diploma required equivalent required In lieu of academic degree, equivalent combination of education and/or commensurate experience (2+ years) in healthcare or blood banking required Experience 1-3 years Minimum 1-year health care, laboratory, or blood banking experience required 1-3 years Minimum 1-year donor qualification or record review experience preferred Knowledge, Skills and Abilities Demonstrate service excellence skills with ability to use tact and care in all situations according to people's individual differences. required Ability to apply judgment to detailed but very structured written or oral instructions. required Able to organize work to provide productive work flow. required Be able and available to work a flexible schedule as required based on volume, timing of blood collections and other departmental variables. required Ability to write complex reports and correspondences. required Ability to speak effectively with donors, volunteers and employees of the organization utilizing instructive or persuasive skills. required Ability to work independently with minimum supervision, multi-task, and work with confidential information. required Demonstrated knowledge of current Good Manufacturing Practices, Food and Drug Administration (FDA) regulations, and AABB standards related to blood center operations and collection requirements. required Possess the following: * Professional demeanor * Projection of appropriate professional image * Analytical skills * High level of organizational and detail-oriented skills * Excellent communication and customer service skills. required Tools and Technology Personal Computer (desk top, lap top, tablet) required General office equipment (computer, printer, fax, copy machine) required Microsoft Suite (Word, Excel, PowerPoint) required Telephone required Not ready to apply? Connect with us for general consideration.$25k-33k yearly est. Auto-Apply 60d+ agoMedical Claims Specialist
The Hiring Method, LLC
Brecksville, OH
Job Description Job Type: Full-Time Compensation: $22.00 - $27.00 per hour (based on experience) Schedule: 40 hours/week, standard business hours About the Role We are seeking a detail-oriented Medical Claims Specialist to join a growing healthcare organization with a mission-driven focus on quality patient care and service excellence. In this role, you'll manage the full lifecycle of medical claims-ensuring accuracy, compliance, and timely reimbursement from Medicare, Medicaid, and commercial insurance payers. This position requires strong technical billing expertise, a passion for problem-solving, and a commitment to delivering a positive experience for patients and healthcare partners alike. What You'll Do Prepare and submit medical claims to Medicare, Medicaid, and private payers Follow up on unpaid, underpaid, or denied claims; initiate appeals or resubmissions Research payer rejections, denials, and discrepancies to resolve issues and maximize reimbursement Verify and maintain patient insurance and demographic data Process CPT, ICD-10, and HCPCS coding specific to ambulance and medical transport services Handle incoming billing-related phone calls with professionalism and compassion Coordinate with internal dispatch and operations teams for billing documentation Review and process EOBs and ERAs to reconcile patient accounts Generate billing reports, assist with month-end closing, and support payment plans when needed What You Bring Required: 2+ years of experience in medical billing or revenue cycle (ambulance/EMS billing preferred) Strong knowledge of CPT, ICD-10, and HCPCS codes Proficiency in clearinghouse portals and electronic claims processing Excellent verbal and written communication skills High school diploma or GED Strong organizational and customer service skills Familiarity with HIPAA and payer-specific compliance requirements Preferred: Associate's degree in Healthcare Administration or related field Certified Professional Biller (CPB) or Certified Professional Coder (CPC) Medicare Part B billing experience Experience with ambulance-specific billing practices Bilingual (English/Spanish) a plus What You Get Competitive hourly pay ($22.00-$27.00/hour) Full health, dental, and vision insurance 401(k) with company match Paid time off, holidays, and life insurance HSA, EAP, and professional development support Opportunities to grow your healthcare administration career$22-27 hourly 9d agoBMS CODER
Wooster Community Hospital
Wooster, OH
Job Description The Coder is responsible to review, abstract and assign appropriate CPT/HCPC and ICD 10 codes to all BMS clinic visits as well as services provided by BMS providers in the hospital setting. The Coder is also responsible to assist the Revenue Cycle team. Under the direction of the System Director of Revenue Cycle, the Coder collaborates with the Providers, BMS Practice Managers, and COO to ensure timely and compliant billing for services provided. Job Requirements Minimum Education Requirement Training/certification from an accredited coding/billing program. Must be certified upon hire, or successfully complete certification exam within 3 months of hire. Minimum Experience Requirement Three years' experience in medical office billing preferred. Working knowledge of computers, billing and basic office software, especially Excel. Ability to communicate with all levels of staff. Analytical ability to detect trends in reimbursement/collections and to recommend or take corrective action. Prior experience using encoder software. Demands are typical of a position in a medical billing office, with extensive periods of sitting at a desk working on a computer. External applicants, as well as position incumbents who become disabled, must be able to perform the essential functions, either unaided or with the assistance of a reasonable accommodation, to be determined on a case-by-case basis. Required Skills Because medical billing duties are so varied, a flexible skill set is needed to perform them well. The following skills and personality traits are necessary to succeed in the field of medical billing/collections. Ability to multi-task Ability to understand insurance denials and payer remittances Ability to understand different insurance policies/coverages Ability to employ people skills to handle different personalities and situations Essential Functions Coder responsibilities below are subject to change as the job demands change: Using encoder software to compliantly apply appropriate CPT/HCPC and ICD codes to claims. Use claims submission software to review and resolve any rejected/denied or otherwise unpaid claims. Promptly reports any trends or issues impacting timely coding and billing of claims to management team. Collaborates with team, including providers, practice managers and revenue cycle to resolve. Act as a consultant for billing/coding questions from BMS practice staff. Maintain coding credential and staying up to date on changing guidelines by obtaining an appropriate number of CEUs Researching unpaid claims. Submitting appeals as necessary. Researching and resolving credit balances. Employee Statement of Understanding I understand that this document is intended to describe the general nature and level of work being performed. The statements in this document are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Monday thru Friday 8am to 430pm Full Time FTE 40 hour per week$57k-74k yearly est. 1d agoN5A541 - Specialist Record Review
Versiti
Dayton, OH
Versiti is a fusion of donors, scientific curiosity, and precision medicine that recognize the gifts of blood and life are precious. We are home to the world-renowned Blood Research Institute, we enable life saving gifts from our donors, and provide the science behind the medicine through our diagnostic laboratories. Versiti brings together outstanding minds with unparalleled experience in transfusion medicine, transplantation, stem cells and cellular therapies, oncology and genomics, diagnostic lab services, and medical and scientific expertise. This combination of skill and knowledge results in improved patient outcomes, higher quality services and reduced cost of care for hospitals, blood centers, hospital systems, research and educational institutions, and other health care providers. At Versiti, we are passionate about improving the lives of patients and helping our healthcare partners thrive. Position Summary Under the direction of the Manager of Record Review and/or the Record Review Team Lead, the Record Review Specialist is responsible for reviewing records and/or reports associated with donor qualification, blood donation, and lot release to ensure all processes are performed in accordance with standard operating procedures (SOPs) and are within regulatory guidelines. The Record Review Specialist verifies that associated quality control and maintenance are performed and within parameters for all processes. The Record Review Specialist ensures that review and lot release occurs within established turn-around times. Total Rewards Package Benefits Versiti provides a comprehensive benefits package based on your job classification. Full-time regular employes are eligible for Medical, Dental, and Vision Plans, Paid Time Off (PTO) and Holidays, Short- and Long-term disability, life insurance, 7% match dollar for dollar 401(k), voluntary programs, discount programs, others. Responsibilities Reviews records and/or reports to ensure compliance with SOPs and within regulatory guidelines before lot release (release of blood components for labeling). Reviews daily, weekly, and monthly quality control and maintenance records of equipment, supply, and storage for the applicable collection date before lot release. Perform data entry of blood donation record into system if applicable. Initiates the appropriate deviation reporting forms and communicates with the appropriate management of unacceptable conditions for lot release. Organizes and correlates in an established manner all paperwork associated in the record review process for record retention purposes. Responsible for independent and/or collaborative decision making regarding critical steps in donor qualification, determining viability of product, and product release. Serves as the internal and external point-of-contact for complex questions/concerns related to Record Review/Lot Release. Contacts donors via phone, letter, or email to verify donation information. Participates in meetings and communicates effectively to foster a team environment. Assists in the development and achievement of departmental goals and objectives in support of the vision and mission of Versiti. Assists in the implementation of federal requirements, blood center directives, and SOPs. Seeks to participate in process improvement projects. Completes projects/tasks according to established project plans. Other duties as assigned. Performs other duties as assigned Complies with all policies and standards Qualifications Education High School Diploma required equivalent required In lieu of academic degree, equivalent combination of education and/or commensurate experience (2+ years) in healthcare or blood banking required Experience 1-3 years Minimum 1-year health care, laboratory, or blood banking experience required 1-3 years Minimum 1-year donor qualification or record review experience preferred Knowledge, Skills and Abilities Demonstrate service excellence skills with ability to use tact and care in all situations according to people's individual differences. required Ability to apply judgment to detailed but very structured written or oral instructions. required Able to organize work to provide productive work flow. required Be able and available to work a flexible schedule as required based on volume, timing of blood collections and other departmental variables. required Ability to write complex reports and correspondences. required Ability to speak effectively with donors, volunteers and employees of the organization utilizing instructive or persuasive skills. required Ability to work independently with minimum supervision, multi-task, and work with confidential information. required Demonstrated knowledge of current Good Manufacturing Practices, Food and Drug Administration (FDA) regulations, and AABB standards related to blood center operations and collection requirements. required Possess the following: * Professional demeanor * Projection of appropriate professional image * Analytical skills * High level of organizational and detail-oriented skills * Excellent communication and customer service skills. required Tools and Technology Personal Computer (desk top, lap top, tablet) required General office equipment (computer, printer, fax, copy machine) required Microsoft Suite (Word, Excel, PowerPoint) required Telephone required$25k-33k yearly est. Auto-Apply 60d+ agoCertified Coder - Fraud, Waste & Abuse (FWA)
Summa Health
Akron, OH
Certified Coder, Special Investigations Unit Investigator SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days Hybrid / Remote Code with Integrity. Detect with Precision. Join Us as a Certified FWA Coder! Are you a certified coding professional with a sharp eye for detail and a passion for protecting healthcare integrity with experience reviewing medical records? Step into a high-impact role where your expertise helps uncover fraud, prevent waste, and ensure compliance across the healthcare system. We're looking for a Fraud, Waste, and Abuse (FWA) Certified Coder to join our Special Investigations Unit and play a critical role in safeguarding resources and promoting ethical billing practices. This position collaborates with investigators, clinical and compliance staff, and regulatory agencies. Summary: Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met. Makes recommendations to Medical Directors, Compliance, Internal Audit and the Fraud, Waste and Abuse (FWA) Committee for investigations and provider communication. Maintains knowledge of current schemes and ensures the SIU processes and procedures reflect industry norms. Formal Education Required: a. Bachelor's Degree, or equivalent combination of education and experience. Experience & Training Required: a. Three (3) years of health insurance or provider office experience to include: clinical review of medical records, and appropriate claims coding b. Three (3) years' experience of ensuring coding is accurate and compliant with federal regulations, payer policies, and organizational guidelines. c. Active AAPC Coding certification - Certified Professional Coder (CPC). d. Accredited Healthcare Fraud Investigator (AHFI) certification preferred. e. LSS Yellow Belt Certified preferred. Essential Functions: 1) Conducts comprehensive medical record reviews to ensure billing is consistent with the information contained in the medical record. 2) Maintains a working knowledge of coding rules and industry coding guidelines. 3) Provides detailed written summary of medical record review findings. 4) Articulates findings to investigators, plan leadership, law enforcement, legal counsel, providers, state regulators, etc. 5) Reviews and discuss cases with Medical Directors to validate decisions. 6) Assist with investigative research related to coding questions, and state and federal policies. Makes recommendations for additional claim edits. 7) Identifies potential billing errors and provides suggestions for provider education and/or plan payment policies. 8) Identifies opportunities for savings related to potential cases resulting in a prepayment review. 9) Maintains appropriate records, files, documentation, etc. 10) Able to travel for meetings and to testify in legal hearings. 3. Other Skills, Competencies and Qualifications: a. Demonstrate intermediate proficiency in MS Office, Project, and database management. b. Maintain excellent working knowledge of process improvement techniques, methodologies and principles applying these in the normal course of operations. c. Demonstrate excellent analytical and problem-solving skills. d. Effectively conduct statistical analyses and accurately work with large amounts of data. e. Ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions. f. Ability to organize and manage time to accurately complete tasks within designated time frames in fast paced environment. g. Maintain current knowledge of and comply with regulatory and company policy and procedures. 4. Level of Physical Demands: a. Sit for prolonged periods of time. b. Bend, stoop, and stretch. c. Lift up to 20 pounds. d. Manual dexterity to operate computer, phone, and standard office machines. As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare.Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Equal Opportunity Employer/Veterans/Disabled $28.10/hr - $42.15/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. * Basic Life and Accidental Death & Dismemberment (AD&D) * Supplemental Life and AD&D * Dependent Life Insurance * Short-Term and Long-Term Disability * Accident Insurance, Hospital Indemnity, and Critical Illness * Retirement Savings Plan * Flexible Spending Accounts - Healthcare and Dependent Care * Employee Assistance Program (EAP) * Identity Theft Protection * Pet Insurance * Education Assistance * Daily Pay$28.1-42.2 hourly 46d agoOutpatient Coder
Dayton Childrens Hospital
Ohio
Facility:Work From Home - OhioDepartment:HIM - Hospital CodingSchedule:Full time Hours:40Job Details:Under general supervision of the Coding Manager, the Coding Analyst supports Dayton Children's goals for reimbursement through accurate and timely diagnosis and procedural coding of emergency department, specialty clinic, inpatient, observation, outpatient surgery, and outpatient ancillary. This includes the examination and interpretation of the electronic medical documentation to assign and report the appropriate diagnostic and procedural codes for the services provided for clean claim submission. Department Specific Job Details: Shift Monday-Friday 8am-5pm (flexible) No weekends or holidays Education High School Diploma or GED (required) A.A.S. in Health Information Technology or B.S. In Health Information Management is preferred Experience 2+ years coding experience ( preferred ) Certifications One of the following certifications are required: RHIA RHIT CCS CCS-P Education Requirements: High School (Required) Certification/License Requirements: [Cert] CCS: Certified Coding Specialist - American Health Information Management Association, [Cert] CCS-P: Certified Coding Speciralist Physician-based - American Health Information Management Association - American Health Information Management Association, RHIA - Registered health Information Administrator - American Health Information Management Association, RHIT - Registered health Information Technician - American Health Information Management Association$38k-45k yearly est. Auto-Apply 13d agoCoder - Coding Specialist
Direct Staffing
Zanesville, OH
40 hours/week, Monday - Friday, 8a-4:30p CCS, CPC-H, RHIT or RHIA required or must be obtained within 18 months of hire Qualifications Associates Degree in HIM required OR must have at least two years of hospital-based coding experience Sorry, no NEW GRADS Associates and 1 year of hospital-based experience would be acceptable Additional InformationAll your information will be kept confidential according to EEO guidelines. Direct Staffing Inc$40k-60k yearly est. 60d+ agoTrauma Coder
Ohiohealth
Pickerington, OH
**We are more than a health system. We are a belief system.** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. ** Summary:** This position performs coding and abstracting functions for Trauma Patients including Emergency Department, Observation, Observation in a bed and the inpatient setting. **Responsibilities And Duties:** 60% - Assigns appropriate admit, & principal and secondary diagnoses and/or procedure codes by reading documentation present in medical record and applying knowledge of correct coding guidelines as appropriate for hospital service and/or patient type while maintaining 95% quality and meeting and maintaining the minimum Coder productivity requirements. - Assign Present on Admission POA indicator to all inpatient account diagnoses as required by official coding guidelines. - Accurately Assign ICD10 diagnosis/procedure codes, AIS scoring at the minimum standards of 95% quality and meeting and maintaining the minimum Coder productivity requirements. Review Diagnosis and CC/MCC for maximum SOI/ROM Clinical understand of laboratory and radiology values Knowledge of quality outcomes indicators Work with CDS to improve physician documentation and case mix index Assign Principal Diagnosis accurately at least 95% or better - Monitor and appropriately assign codes when appropriate - Responsible for recognizing when it is necessary to obtain further clarification from physician when documentation is inadequate, ambiguous, or unclear for coding purposes. - Assists providers and supervisors with reviewing accounts denied by NTDB and other governing bodies for appropriate documentation to support original coding. 35% - Abstracts all data elements necessary to complete NTDB and TQIP requirements and meet hospital-reporting requirements. - In the event of insufficient, missing, or conflicting documentation, follows department policy for follow up and physician query. - Identifies problem cases in EPIC and forwards to appropriate staff for follow up. 5% - Verifies demographics, account number, service and identify missing or incorrect forms in each record. The major duties, responsibilities and listed above are not intended to be all-inclusive of the duties, responsibilities and to be performed by employees in this job. Employee is expected to all perform other duties as requested by supervisor. **Minimum Qualifications:** **Additional Job Description:** **SPECIALIZED KNOWLEDGE** Associate's degree or 1-3 years of coding experience in an acute care/hospital setting. Specialized Knowledge: AIS Scoring, ICD-10CM and PCS classification systems, Advanced Anatomy & Physiology, Pathophysiology, Pharmacology, Medical Terminology, inpatient documentation schemes. Knowledge of Hospital Acquired Conditions (HAC), Present on Admission (POA), Severity of Illness (SOI), Risk of Mortality (ROM), and Quality outcome indicators. Knowledge of operative reports, clinical lab, and radiology results for physician queries. Knowledge of Clinical Documentation improvement programs. Knowledge of NTDB and TQIP abstracting elements. **Work Shift:** Day **Scheduled Weekly Hours :** 40 **Department** Trauma Services Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment$45k-54k yearly est. 4d ago
