Medical Coder jobs at Progressive

Description Western Growers Health─a part of Western Growers Family of Companies─provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry. Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today! Compensation: $46,669.19 - $65,668.50 with a rich benefits package that includes profit-sharing. This is a remote position and can reside anywhere in the U.S. JOB DESCRIPTION SUMMARYPosition reports to the Supervisor Benefit Distribution & Installation and performs in-depth pharmacy and medical plan coding of new and existing business accounts. This position will ensure that all new and existing health (medical/dental/pharmacy) insurance plans underwritten by Western Growers Assurance Trust (WGAT) and those of Pinnacle Claims Management, Inc. (PCMI) are in compliance with the respective employers' summary plan descriptions.Qualifications· BS/BA degree in computer science, business or related field and a minimum of two years of experience as a pharmacy, medical, dental claims auditor and/or plan testing experience, preferred.· Exceptional ability to interpret summary plan descriptions of employee medical, dental, pharmacy benefits.· Strong ability to work efficiently and effectively in a multiple task, multi-project, and multi-demanding environment to meet expected goals, dates, and milestones.· Excellent writing, editing, and proofreading skills to compose and edit correspondence, reports, emails, and other written materials.· Superior ability to analyze and interpret group health benefits provisions, administrative policies, and provider contracts.· Advanced skills in Microsoft Office applications, specifically word processing and spreadsheets.· Demonstrated ability to analyze and comprehend complex issues, and personalities using independent judgment, leadership, tact, diplomacy, and initiative· Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds. · Home router with wired Ethernet (wireless connections and hotspots are not permitted). · A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.) · A functioning smoke detector, fire extinguisher, and first aid kit on site. DUTIES AND RESPONSIBILITIES Plan Coding· Plan code new business and plan changes.· Verify new and existing plans loaded on the company's claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.· Respond to work orders received from examiners to investigate plan issues and irregularities. · Evaluate testing requests for all new plans prior to loading them into the production system.Administrative · Keep a detailed log of open and completed work. · Document resolutions to closed work orders.· Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses. · Create and document a minimum of one new Standard Operating Procedure (SOP) annually. · Identify, initiate and implement at least one process improvement and/or innovation annually.· Maintain detailed log of plans that are currently being coded and in the process of being loaded.· Send confirmations to internal stakeholders when applicable plans have been loaded. Work with programmers to test claims and related system programs to verify impact within the Health Care Processing System (HCPS).Other· Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.· Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet. · Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data. · Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).· All other duties as assigned. Physical Demands/Work EnvironmentThe physical demands and work environment described here represent those that an employee must meet to perform this job's essential functions successfully. 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 communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate. #LI-Remote

**Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities. **ESSENTIAL FUNCTIONS:** + Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors, providers and hospital staff to coordinate record access. + Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions. Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards. + Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** Associate's Degree in Health Information Technology, Business or related field OR in lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience. **Experience:** 3 years risk adjustment/hierarchical condition category (HCC) coding experience. **Knowledge, Skills and Abilities (KSAs)** + Adobe Acrobat Professional. + Microsoft Word, Excel, Outlook, Claims Processing Facets. + Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms. + Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Licenses/Certifications** : CCS-Certified Coding Specialist or CPS, CCS-P, CRC Upon Hire Required or RHIT - Registered Health Information Technician or RHIA Upon Hire Preferred. Salary Range: $50,976 - $93,456 **Travel Requirements** : 5% medical sites to supervise medical record retrieval, conferences **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Risk Adjustment **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-NH2 REQNUMBER: 21273

Explore opportunities with Lafayette Home Office, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.** As a Coding Specialist, you will review medical record documentation submitted by clinicians and subsequently assign the proper International Classification of Disease numerical codes. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Review medical records and assign codes + Follow official coding guidelines per CMS and ICD rules + Ensure documentation supports codes + Consult clinicians for clarification + Educate and maintain positive communication with clinicians + Follow workflow processes to maintain productivity standards You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Clinician or a Registered Health Information Administrator (RHIA) or be certified as a Home Care Specialist - Diagnosis (HCS-D) + Successfully pass the HCS-D certification exam within 90 days of employment and maintain HCS-D certification annually **Preferred Qualifications:** + 1+ years of professional work experience + Effective Verbal and Communication *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Risk Adjustment Coding Specialist is responsible for comprehensive clinical documentation and coding chart review assigned for PacificSource Medicare Advantage Plans. This individual will collaborate with the Risk Adjustment Coding Manager to ensure the chart review process is maintained in accordance with coding expectations and meets the Medicare program regulations and coding guidelines set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the application of a standardized HCC chart review process as a foundation of coding guidance supporting Medicare Advantage FFS lines of business, engage and develop strong relationships with all stakeholders at PacificSource Health Plans. This individual will also identify opportunities to improve provider documentation and deliver customized provider-specific documentation improvement recommendations to the Risk Adjustment Coding Manager for escalation purposes. Essential Responsibilities: Provide support and coding expertise to all programs that support risk adjustment and data validation efforts for assigned PacificSource Health Plans, along with other ad hoc and long-term projects assigned by the Risk Adjustment Coding Manager. Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Assist in obtaining patient records from provider Electronic Health Record (EHR) systems. Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams. Supporting Responsibilities: Reliability and a commitment to meeting tight deadlines. Personal discipline to work remotely without direct supervision. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Complete other projects and duties as needed and assigned. SUCCESS PROFILE Work Experience: A minimum of 3 years of experience as a certified coder in professional setting. A minimum 2 years of risk adjustment HCC Coding experience. Ability to code using an ICD-10-CM code book. Computer proficiency (including MS Windows, MS Office, and High-speed Internet access. Education, Certificates, Licenses: Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC. Certified Professional Coder certification through AHIMA or AAPC. A CRC certification is required for this role. Knowledge: Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation. Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred). Reliability and a commitment to meeting tight deadlines. Exemplary attention to detail and completeness. Strong organization, interpersonal, and customer service, written and oral communication, and analytical skills. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Risk Adjustment Coding Specialist is responsible for comprehensive clinical documentation and coding chart review assigned for PacificSource Medicare Advantage Plans. This individual will collaborate with the Risk Adjustment Coding Manager to ensure the chart review process is maintained in accordance with coding expectations and meets the Medicare program regulations and coding guidelines set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the application of a standardized HCC chart review process as a foundation of coding guidance supporting Medicare Advantage FFS lines of business, engage and develop strong relationships with all stakeholders at PacificSource Health Plans. This individual will also identify opportunities to improve provider documentation and deliver customized provider-specific documentation improvement recommendations to the Risk Adjustment Coding Manager for escalation purposes. Essential Responsibilities: Provide support and coding expertise to all programs that support risk adjustment and data validation efforts for assigned PacificSource Health Plans, along with other ad hoc and long-term projects assigned by the Risk Adjustment Coding Manager. Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Assist in obtaining patient records from provider Electronic Health Record (EHR) systems. Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams. Supporting Responsibilities: Reliability and a commitment to meeting tight deadlines. Personal discipline to work remotely without direct supervision. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Complete other projects and duties as needed and assigned. SUCCESS PROFILE Work Experience: A minimum of 3 years of experience as a certified coder in professional setting. A minimum 2 years of risk adjustment HCC Coding experience. Ability to code using an ICD-10-CM code book. Computer proficiency (including MS Windows, MS Office, and High-speed Internet access. Education, Certificates, Licenses: Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC. Certified Professional Coder certification through AHIMA or AAPC. A CRC certification is required for this role. Knowledge: Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation. Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred). Reliability and a commitment to meeting tight deadlines. Exemplary attention to detail and completeness. Strong organization, interpersonal, and customer service, written and oral communication, and analytical skills. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Risk Adjustment Coding Specialist is responsible for comprehensive clinical documentation and coding chart review assigned for PacificSource Medicare Advantage Plans. This individual will collaborate with the Risk Adjustment Coding Manager to ensure the chart review process is maintained in accordance with coding expectations and meets the Medicare program regulations and coding guidelines set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the application of a standardized HCC chart review process as a foundation of coding guidance supporting Medicare Advantage FFS lines of business, engage and develop strong relationships with all stakeholders at PacificSource Health Plans. This individual will also identify opportunities to improve provider documentation and deliver customized provider-specific documentation improvement recommendations to the Risk Adjustment Coding Manager for escalation purposes. Essential Responsibilities: Provide support and coding expertise to all programs that support risk adjustment and data validation efforts for assigned PacificSource Health Plans, along with other ad hoc and long-term projects assigned by the Risk Adjustment Coding Manager. Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Assist in obtaining patient records from provider Electronic Health Record (EHR) systems. Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams. Supporting Responsibilities: Reliability and a commitment to meeting tight deadlines. Personal discipline to work remotely without direct supervision. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Complete other projects and duties as needed and assigned. SUCCESS PROFILE Work Experience: A minimum of 3 years of experience as a certified coder in professional setting. A minimum 2 years of risk adjustment HCC Coding experience. Ability to code using an ICD-10-CM code book. Computer proficiency (including MS Windows, MS Office, and High-speed Internet access. Education, Certificates, Licenses: Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC. Certified Professional Coder certification through AHIMA or AAPC. A CRC certification is required for this role. Knowledge: Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation. Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred). Reliability and a commitment to meeting tight deadlines. Exemplary attention to detail and completeness. Strong organization, interpersonal, and customer service, written and oral communication, and analytical skills. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Risk Adjustment Coding Specialist is responsible for comprehensive clinical documentation and coding chart review assigned for PacificSource Medicare Advantage Plans. This individual will collaborate with the Risk Adjustment Coding Manager to ensure the chart review process is maintained in accordance with coding expectations and meets the Medicare program regulations and coding guidelines set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the application of a standardized HCC chart review process as a foundation of coding guidance supporting Medicare Advantage FFS lines of business, engage and develop strong relationships with all stakeholders at PacificSource Health Plans. This individual will also identify opportunities to improve provider documentation and deliver customized provider-specific documentation improvement recommendations to the Risk Adjustment Coding Manager for escalation purposes. Essential Responsibilities: Provide support and coding expertise to all programs that support risk adjustment and data validation efforts for assigned PacificSource Health Plans, along with other ad hoc and long-term projects assigned by the Risk Adjustment Coding Manager. Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines. Assist in obtaining patient records from provider Electronic Health Record (EHR) systems. Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams. Supporting Responsibilities: Reliability and a commitment to meeting tight deadlines. Personal discipline to work remotely without direct supervision. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Complete other projects and duties as needed and assigned. SUCCESS PROFILE Work Experience: A minimum of 3 years of experience as a certified coder in professional setting. A minimum 2 years of risk adjustment HCC Coding experience. Ability to code using an ICD-10-CM code book. Computer proficiency (including MS Windows, MS Office, and High-speed Internet access. Education, Certificates, Licenses: Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC. Certified Professional Coder certification through AHIMA or AAPC. A CRC certification is required for this role. Knowledge: Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation. Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred). Reliability and a commitment to meeting tight deadlines. Exemplary attention to detail and completeness. Strong organization, interpersonal, and customer service, written and oral communication, and analytical skills. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem Develop and maintain the audit schedule Audit staff as outlined in the system auditing policies Train audit staff at the health plan in the use of audit process and tools Facilitate compliance with the auditing process Act as a consultant related to system auditing to others in the unit, department and health plan Work with staff to identify and resolve authorization load error report system problems Coordinate auditing outcomes with the Trainer to identify, develop and publish corrective actions/educational material related to audit errors Coordinate auditing outcomes and system maintenance with the Sr. Clinical Systems Specialist to resolve or enhance clinical systems Performs other duties as assigned Complies with all policies and standards ***POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI***Ideal candidate will be a Licensed Practical Nurse (LPN) with auditing experience. Education/Experience: Bachelor's degree in related field or equivalent experience. 3+ years of related experience. For Home State Health Plan only: State unrestricted license as Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Registered Nurse (RN), or Licensed Practical Nurse (LPN) Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The Risk Adjustment & Quality Division at BCBST is seeking a skilled Risk Adjustment Medical Record Coder to support our mission of delivering accurate and compliant coding practices. What You'll Do: In this role, you will perform first-pass reviews of member medical records to identify and capture active conditions that map to risk values. This is a remote, day-shift position with flexibility to work up to 8 additional hours per week in accordance with BCBST policy. Preferred Qualifications: CRC (Certified Risk Adjustment Coder) certification is a plus. If not currently certified, you must obtain it within one year of hire. Strong expertise in HCC (Hierarchical Condition Category) coding, with experience in MA (Medicare Advantage) and Affordable Care Act (ACA) programs highly preferred. What Sets You Apart: Self-motivated and proactive, thriving in a remote work environment A true team player, ready to engage in team chats and support colleagues A learner, eager to grow and adapt in a constantly evolving industry Job Responsibilities Maintain compliance with CMS risk adjustment diagnosis coding guidelines. Perform comprehensive 1st pass reviews of medical records and physician assessment forms (HCC coding). Assist with the intake and quality assurance of medical records as necessary. Perform or participate in special projects as directed by management. ICD-10 Coding assessment is required. Job Qualifications Education Associates degree or equivalent work experience required. Equivalent experience is defined as 2 years of professional work experience. Experience 1 year - Progressive medical coding and health care experience required. Skills\Certifications Professional coding certification from AHIMA or AAPC (CPC, CCS, RHIT, RHIA). Must acquire the Certified Risk Adjustment Coder (CRC) certificate from AAPC within one year, after completed training. Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint). Proven analytical and problem-solving skills and ability to perform non-routine analytical tasks. Must be a team player, be organized and have the ability to handle multiple projects. Excellent oral and written communication skills. Strong interpersonal and organizational skills. Understanding of ICD-10 coding standards required. Number of Openings Available 0 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $76,000.00 - $86,661.00 The Inpatient-Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines. Scope of Role & Responsibilities * Identifies trends and inconsistencies in provider documentation and coding practices. * Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy. * Develops curriculum to improve provider coding practices. * Educates providers and their practice staff in coding guidelines. * Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers. * Participates in the review and analysis of summary data. Assist with data collection and report generation. * Maintains the confidentiality and security of sensitive information and files. Required Education, Training & Professional Experience * Associate degree required. * 2-5 years of health care experience in a physician group practice or other ambulatory care setting preferred. * 1+ years of medical coding experience with demonstrated sustained coding quality. * In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, APR-DRG/MS-DRG and APC/APG prospective payment systems * Demonstrates advanced knowledge of CPT/HCPS/Revenue Code procedure coding, ICD-9/ICD-10 coding principles and practices. * Ability to research authoritative citations related to coding, compliance, and additional reporting requirements. * Demonstrates overall knowledge of claims processing for various insurances both private and government Licensure and/or Certification Required * Certification as a professional coder (CPC); or * Certification as an inpatient coder (CIC) Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication * Excellent verbal and written communication skills * Excellent computer skills. Able to learn, use and toggle between multiple systems. * Analytical skills and ability to create reports, charts, and graphs (e.g. Microsoft Excel) * Ability to work independently or in a team setting, while handling multiple projects and adjusting to changes quickly while meeting all deadlines #LI-Hybrid #MHP50

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Under direction of the Coding Manager, the primary responsibility of the Medical Coder is to ensure that codes representing current International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) accurately reflect documented services by applying a demonstrated knowledge of anatomy, physiology and medical terminology as well as compliant coding rules and regulations, including medical necessity and modifiers. Additionally, the Medical Coder serves as the key resource to the Chief and Administrative Director and/or Manager regarding coding changes affecting assigned clinical areas, ongoing coding reviews of providers, and trends associated with coding utilization and optimization, denial management, reimbursement, and customer services issues. The Medical Coder is ultimately responsible for efficient charge capture and reconciliation processes (electronic or paper), knowing and meeting expected targets at sufficient accuracy rates as measured by Transaction Editing System (TES) edits, claim action report volumes, and denials. The Medical Coder will identify potential compliance concerns and/or barriers toward timely completion of all tasks to the Coding Manager and will endeavor to work in collaboration with colleagues in Coding, Clinical Departments, Health Information Management, Information Technology, and Finance toward viable solutions. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: The following section contains representative examples of work that will be performed in positions allocated to this classification. Bassett Healthcare is a dynamic organization, and the environment can be fluid. Roles and responsibilities can often be expanded to accommodate changing patient or organizational needs and conditions as well as to tap into skills and talents of employees. Accordingly, employees may be asked to perform duties that are outside the specific functions that are listed. * Charge Capture * Review charge capture documents, paper or electronic, for completeness and accuracy * Reconcile collection of charges to daily census report or schedules depending on place of service * Accurately indicate and link all ICD-10 diagnosis codes, procedure codes and modifiers on the charge document * Prepare daily charge capture documents according to Bassett policies and procedures * Process all pre-billing edits daily and complete each edit within 2 business days * Ensure charges are posted within the following timelines: 4 days from date of service for Outpatient services and 7 days from date of service for Inpatient services by monitoring Lag Time Reports and working with practitioners and associated staff responsible for charge capture to meet those goals * Denial Management * Process denials daily ensuring all requested timelines are met * Ensure procedure and ICD-10 codes reflect documentation * Customer Service * Respond to customer service questions and report recurring issues to management * Work and communicate in a positive, cooperative manner with patients and their families when resolving customer service issues based on management observation and/or patient feedback * Competency * Attend all staff meetings * Maintain current Coding Certification and active membership in the local AAPC chapter, including participation in local events and meetings * Have a good working knowledge of all hospital computer systems and coding tools available to assist with correct coding. This includes Epic's Electronic Health Record application, MedAssets CodeCorrect application, and other department specific clinical/coding applications, e.g. CodeRyte * Keep abreast of coding changes and reimbursement reporting requirements and raise concerns to Coding Manager for resolution * Review and implement changes to departmental/site clinic sheets and charge documents to reflect current ICD-9 or ICD-10 in October, HCPCS and CPT's in January * Abide by Standards of Ethical Coding as set forth by the AAPC or AHIMA (depending on certification) and adhere to Official Coding Guidelines as set forth by CMS and the OIG * Coding Review and Reimbursement Resource * Conduct annual and focused reviews * Use interpersonal skills effectively to build and maintain cooperative working relationships with all levels and departments within the organization * Based on management requests, assists with the orientation, skill development and mentoring of employees new to the coding function * Provide education to all providers within a given specialty based on coding trends and will conduct new provider orientation * Performs similar or related duties as requested or directed * Performs other duties as requested and observed by supervisor or manager You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * High School Diploma/GED (or higher) * Professional coder certification with credentialing from AHIMA and/or AAPC (RHIA, RHIT, CCS, CCS-P CPC, OR CPC-H) to be maintained annually * 3+ years of experience in Professional Services Surgery Coding (Plastics & Dermatology) * 3+ years of experience working with CPT, HCPCS, ICD-10 codes, anatomy and physiology and medical terminology * 3+ years of experience working with coding rules and regulations for issues regarding medical record documentation, compliance and reimbursement, including medical necessity, claims denials, bundling issues and charge capture Telecommuting Requirements: * Required to have a dedicated work area established that is separated from other living areas and provides information privacy * Ability to keep all company sensitive documents secure (if applicable) * Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Physical Requirements: * The position involves extensive work at the computer station * All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN

We are seeking a detail-oriented and experienced Senior Certified Medical Coder to join our client's Claims team. This dual-role position is responsible for ensuring accurate medical coding and efficient claims processing to support timely reimbursement and regulatory compliance. The ideal candidate will have a strong background in medical coding, claims adjudication, and healthcare administration. Compensation: $50,000 - $60,000/year (based on experience) 4 weeks of PTO + 9 company holidays 401(k) with generous company match Full medical benefits Requirements: Education: Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or related field. Certifications: CPC, CCS, or equivalent medical coding certification required. Experience: Minimum 5 years of experience in medical coding and claims processing, preferably in a senior or lead role. Strong knowledge of medical terminology, anatomy, and healthcare reimbursement systems. Proficiency with EHR systems and claims management software (e.g., Epic, Cerner, Availity). Excellent analytical, organizational, and communication skills. Key Responsibilities: Review and analyze medical records to assign accurate ICD-10, CPT, and HCPCS codes. Submit, track, and follow up on insurance claims to ensure timely and accurate reimbursement. Investigate and resolve claim denials, discrepancies, and appeals. Collaborate with providers, billing staff, and insurance companies to clarify documentation and coding issues. Maintain up-to-date knowledge of payer policies, coding guidelines, and regulatory changes. Generate reports on claims status, coding accuracy, and reimbursement trends. Mentor junior staff and assist with training on coding and claims procedures. #LI-MW1 #LI-CD5 INDTJG-CTT

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Certified Sr. (IP) Acute Edits Medical Coder you will determine and record the correct medical codes for all treatments and health services. Ensuring proper records is just one way your work will impact on the health and wellness of our members on a huge scale. Who are we? We're Optum360. We're a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage our compassion, our talent, our resources, and experience to bring financial clarity and a full suite of revenue management services to health care providers nationwide. As a Certified Sr. (IP) Acute Edits Medical Coder you will work remotely to correct CCI, MUE, and Medical Necessity Edits on accounts of all patient types in addition to periodic coding. You will ensure that all coding assignments are accurate according to coding policies and based on the documentation provided in the medical record. Using a thorough knowledge of coding policies and procedures as well as medical terminology and technology, you will be responsible for providing documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel. Schedule: This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given business need, to work occasionally overtime or weekends. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Identify appropriate assignment of ICD-10-CM and ICD-10-PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility * Identify appropriate assignments of CPT and ICD-10 Codes for outpatient surgery, observation, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility * Understand the Medicare Ambulatory Payment Classification (APC) codes * Abstract additional data elements during the Chart Review process when coding, as needed * Adhere to the ethical standards of coding as established by AAPC and/or AHIMA * Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360 * Provide documentation feedback to providers and query physicians when appropriate * Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the QM Manager, Coding Operations Managers, and Director of Coding/Quality Management, etc. * Participate in coding department meetings and educational events * Review and maintain a record of charts coded, held, and/or missing * Additional responsibilities as identified by manager You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * High School Diploma/GED (or higher) * Professional coder certification with credentialing from AHIMA and/or AAPC (CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, CPC-P) to be maintained annually * 3+ years of recent inpatient medical coding experience with ICD-10-CM/PCS & DRG (hospital, facility, etc.) * 2+ years of recent working experience with OCE, MUE and NCCI classification and reimbursement structures * Intermediate level of proficiency with a PC in a Windows environment, including MS Excel and EMR systems * Intermediate level of experience working in a level I trauma center and/or teaching hospital with a mastery of complex procedures, major trauma ER encounters, cardiac catheterization, interventional radiology, orthopedic and neurology cases, and observation coding Preferred Qualifications: * Experience with OSHPD reporting * Experience with various encoder systems (eCAC,3M, EPIC) * Intermediate level of proficiency with Microsoft Excel * All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN

Full-time Description We are GROWING and looking to hire Certified Medical Coders to join our team in Williamsville, NY. The positions are hybrid and require only one day in the office each week! Roswell Park Care Network is a recognized leader in oncology and specialty care, serving community physician practices across New York State. We are committed to delivering exceptional patient care and advancing innovative treatment options. Excellent Benefits: Medical Coder is SIGN ON BONUS eligible! Schedule is Monday through Friday - Hybrid Role with Only One Day In Office! 11 Holidays Medical Insurance via Highmark Blue Cross Blue Shield HRA - employer funded Dental Insurance and Vision Insurance 401(k) with company match Company paid life insurance, options for LTD, Critical Illness, Accident Generous Vacation and Sick time The Medical Coder is responsible for reviewing medical records to assure proper billing of the medical service, comparison of physician chosen CPT and ICD-10 codes to the physicians' documentation to substantiate the level of coding, physician services to include identification of professional services and complete review of medical record. Claim denials received for coding errors, refund requests, etc., the coder is responsible to send written appeals to the insurance payer for adjudication and follow-up for payment status within the 90 day timely filing limit of the insurance payer. Responsibilities: Meet coding accuracy standards within 90% to 95% as well as coding productivity standards. Coders will review, re-code and appeal denials for all specialties including Inpatient, outpatient, physician, pathology, and infusion charts, as necessary. Review the discharge summary, history and physical, physician progress notes, consultation reports, operative records, inpatient hospital record to accurately assign a diagnosis and / or procedure. Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-10-CM and CPT codes. Utilize computer applications and resources essential to completing the coding process efficiently. Responsible for correcting any data found to be in error after reviewing the medical record and comparing with system entries. Including, investigating payer coding rules to complete insurance claim appeals, submitting supporting documentation, tracking, and following up accordingly to ensure claim is processed. Assign Risk Adjustment diagnoses by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology, and pathology. Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM and CPT codes. Reviews state and federal Medicare reimbursement claims for completeness and accuracy before submission to minimize claim denial. Educates and advises staff on proper code selection, documentation, procedures, and requirements. Identifies training needs, prepares training materials, and support staff to improve skills in the collection and coding of quality health data. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing education by reviewing updated CPT guidelines and updated coding clinics. Performs other duties as assigned Requirements Experience / Certification: CPC (Certified Professional Coder) or CMC (Certified Medical Coder) required 1-3 years experience with specialty coding (e.g., Urology, ENT, Dermatology, Pulmonology, Breast health & Oncology). Experience with EMR and billing systems, such as Medent & ONCO preferred. Working knowledge of medical terminology, CPT, and ICD-10 coding Familiarity with medical office procedures Salary Description $23.00-$30.00/hour

Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities: * Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. * Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. * Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. * Responsible for assisting the Fraud Investigative Unit Manager with potential fraud, waste or abuse investigations requiring medical coding expertise, participating in external audit requests, and special projects as needed. * Coordinates, conducts, and documents audits as needed for investigative purposes. * Prepares written reports or trending data related to findings and facilitates timely turnaround of audit results. * Prepares written summaries of audit results for purposes of reporting potential fraud, waste, abuse and/or overpayment. * Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner. * Identifies potential provider fraud through review of claims data, complaint referrals, and application of rules, healthcare coding practices, and fraud detection software. * Reviews provider billing practices to investigate claims data and compliance with State and Federal laws. * Analyzes provider data and identifies erroneous or questionable billing practices. * Interprets state and federal policies, Florida Medicaid, Children's Health Insurance Program, and contract requirements. * Determines and calculates overpayment/underpayment, appropriately documents and participates in steps to remediate. * Determines priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner. * Performs all other duties as assigned. This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Qualifications: * Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) must have. * Candidates with relevant work experience may be eligible for company-sponsored certification or licensure. * Prior experience in Medicaid claims role and/or post payment medical coding auditor role preferred. * Knowledge of Medicaid rules, claims processing, medical terminology and coding principles and practices. * Knowledge of auditing, investigation, and research. * Knowledge of word processing software, spreadsheet software, and internet software. * Manage time efficiently and follow through on duties to completion. Skills and Abilities: * Written and verbal communication skills. * Ability to organize and prioritize work with minimum supervision. * Detail oriented. * Ability to perform math calculations. * Analytical and critical thinking skills. * Ability to operate personal computer and general office equipment as necessary to complete essential functions, including using spreadsheets, word processing, database, email, internet, and other computer programs. * Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. * Ability to write reports, business correspondence, and procedure manuals. * Ability to effectively present information and respond to questions. Work Schedule: Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.

Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities: * Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. * Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. * Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. * Responsible for assisting the Fraud Investigative Unit Manager with potential fraud, waste or abuse investigations requiring medical coding expertise, participating in external audit requests, and special projects as needed. * Coordinates, conducts, and documents audits as needed for investigative purposes. * Prepares written reports or trending data related to findings and facilitates timely turnaround of audit results. * Prepares written summaries of audit results for purposes of reporting potential fraud, waste, abuse and/or overpayment. * Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner. * Identifies potential provider fraud through review of claims data, complaint referrals, and application of rules, healthcare coding practices, and fraud detection software. * Reviews provider billing practices to investigate claims data and compliance with State and Federal laws. * Analyzes provider data and identifies erroneous or questionable billing practices. * Interprets state and federal policies, Florida Medicaid, Children's Health Insurance Program, and contract requirements. * Determines and calculates overpayment/underpayment, appropriately documents and participates in steps to remediate. * Determines priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner. * Performs all other duties as assigned. This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Qualifications: * Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) must have. * 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.

Coordinates all admissions activities Ensures compliance with applicable standards Triage and accepts referrals from the hospitals, Assisted Livings, and communities Verify insurance information pending admission Confirms Medical Insurance coverage of patients and assign beds Meet with patients admitted to complete paperwork for admissions Responds to medical records requests from sources such as patient, regulatory bodies and insurance companies. Coordinates with Medical, Nursing and accounting staff to ensure appropriate patient placement. Coordinates transfer of medical records to and from the facility Conduct business development activity to generate leads for referrals Requirements High school will be considered with at least 3 years of experiences; Associates degree with 2 years of experience preferred.

Job DescriptionBenefits: Bonus based on performance Flexible schedule Opportunity for advancement We are seeking a Medical Biller to join our team! As a Medical Biller, you will be working closely with clients to answer questions related to billing, processing all forms needed for insurance billing purposes, and collecting necessary documentation from clients. You will also assist other Medical Billers with follow-up inquiries to clients, communicate with physicians' offices and hospitals to obtain records, and accurately record patient information. The ideal candidate has excellent attention to detail, strong customer service skills, and is comfortable spending much of the day on the phone. Responsibilities Assist clients with processing insurance claims through both private insurance and Medicaid/Medicare Note and process all necessary forms from the insurance Assist patients in navigating the billing and insurance landscape, including collecting all necessary forms and signatures Work with doctors offices and hospitals to obtain charge information and billing details Enter all billing and payment information into the system properly and without errors Follow up with clients and payments, as needed Answer phones, assist clients with questions, take messages, and screen calls Maintains the highest level of confidentiality Qualifications Strong customer service skills Previous experience with medical coding or billing desired Strong organization skills Excellent attention to detail Electronic Medical Records a MUST eclinical Works

Medical Records Coordinator Opportunity at University RN/LPN The Medical Records Coordinator is responsible for the successful utilization of the electronic medical record (EMR). The Medical Records Coordinator will work with physicians, office staff, nursing management and staff to utilize the EMR through auditing, analysis, and training. Skills Needed: * Attention to detail/Accuracy: Ensures the medical record is complete and accurate. * Training: The ability to teach and motivate staff, vendors, and other key stakeholders to ensure the database and records comply with company, Federal, and State guidelines. * Collaboration: Work with hospitals, physicians, nursing staff, and leadership to ensure that all records are obtained and maintained in the EMR. * Supportive Presence: Create a comforting and engaging atmosphere for our residents and staff. Requirements: * Graduate of an accredited school of nursing. * Minimum of one year in nursing management in the long-term industry. * Two years of professional nursing experience in long-term care, acute care, restorative care or geriatric nursing setting. * Demonstrates C.A.R.E. values to our residents, family members, customers and staff. Compassion, Accountability, Relationships and Excellence Benefits and perks include: * Competitive Compensation: Access your earnings before payday. Take advantage of lucrative employee referral bonus programs, 401(k), FSA program, free life insurance, PTO exchange for pay programs and more. * Health & Wellness: Medical coverage as low as $25, vision and dental insurance. Employee Assistance Program to help manage personal or work-related issues, as well as Workforce Chaplains to provide support in the workplace and Personalized Wellness Coaching. * Life in Balance: Holiday pay and PTO with opportunities to earn additional PTO. Employee Discount Programs that allow you to save on travel, retail, entertainment, food and much more. * Career Growth: Access to preceptors and mentorship programs, clinical and leadership development pathways, education partnerships with colleges and universities across the state like Ivy Tech and Purdue Global, financial assistance for continuing education, company sponsored scholarship programs, and tuition reimbursement. * Team Culture: A.R.E. Values: Compassion, Accountability, Relationships and Excellence carrying a legacy for improving the lives of Seniors across Indiana. Celebrate the hard work you and your team put in each day through employee recognition events and monthly and annual awards. * Full-Time and Part-Time Benefits may vary, terms and conditions apply About American Senior Communities Compassion, Accountability, Relationships and Excellence are the core values for American Senior Communities. These words not only form an acronym for C.A.R.E., but they are also our guiding principles and create the framework for all our relationships with customers, team members and community at large. American Senior Communities has proudly served our customers since the year 2000, with a long history of excellent outcomes. Team members within each of our 100+ American Senior Communities take great pride in our Hoosier hospitality roots, and it is ingrained in everything we do. As leaders in senior care, we are not just doing a job but following a calling.