Medical Coder jobs at Progressive

**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

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.

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 AAPCwithin 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\.** As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945\. More than that, we're your neighbors and friends - fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow\. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members\. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability\. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously\. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST\. BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\. BCBST hires employees for remote positions from across the U\.S\. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York\. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance\.

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

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

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 requires 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

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. Temporary contract position to review medical charts. Medical records will be reviewed to find documentation and compliance for HEDIS performance measures. Data elements being sought are laboratory results, blood pressures, body mass index, colon cancer screening, and other aspects of care. Essential Responsibilities: The auditor will review medical records obtained by a vendor and available electronically at the PacificSource office. The medical record review on the members in the population will be performed according to NCQA HEDIS specifications. Data will be entered using certified HEDIS software on laptop computer after training has been completed. The medical record will be reviewed for confirmation of member identification, data elements, numerator events and exclusions per HEDIS specifications outlined on MRR tools in the certified software system. Numerator events and exclusions will be documented in the software program and by photocopying, printing, or capturing a digital image of the page of the medical record where the event or contraindication is found. Ability to audit with 95% accuracy. Protect PHI by never leaving laptop in car. Always lock computer when leaving its location. Do not reveal passwords. Do not discuss PHI with anyone who does not have a legal need to know. All photocopied medical records will be handled according to the health plan confidentiality and safe guarding PHI policy and procedure. Supporting Responsibilities: 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. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Acute care experience or experience in a primary care clinic or experience with disease management. Experience using or viewing electronic medical records. Experience performing chart audits preferred. Education, Certificates, Licenses: Valid nursing license (RN or LPN). Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work remotely and occasional inside a general office setting with ergonomically configured equipment. 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.

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Salary Range: $65,000.00 - $74,655.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview The Medical Payments and Fee Schedules Analyst will lead the analysis, development, and implementation of payment rates and fee schedules. Collaborate with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates for medical services. Conduct financial modeling, impact analyses, and audits to assess variations in reimbursements. Perform research to aid in the development of a base fee schedule. Serve as subject matter expert in all areas of fee schedules, rate reimbursements, and payment methodologies. Facilitate the integration of contract payment terms into the claims processing system and comprehensively understand the downstream impact of loaded rates within the Plan's entire claims reimbursement cycle. Identify, correct, and perform root cause analyses of fee schedule loaded and reimbursement issues. The ideal candidate will have strong analytical skills, a deep understanding of healthcare reimbursement models, and experience in data reporting and analysis. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Lead analysis of medical payment rates and fee schedules. * Oversee and verify accurate loading of fee schedules per provider contracts. * Identify, correct, and perform root cause analysis of fee schedules and reimbursement issues. * Collaborate with departments including Compliance, Claims Operation, Core Configuration, Products, Contracting, Provider Network Relations, and other related areas to ensure fee schedules and claims adjustments are timely and accurately loaded. * Ensure appropriate implementation of fee schedules and reimbursement methodologies as MetroPlusHealth transitions to value-based reimbursement. * Analyze negotiated contracts to confirm that reimbursements align with negotiated intent. * Work with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates as necessary. * Serves as subject matter expert with all contract implementation for fee schedule, rate reimbursement matters, and payment methodologies. * Lead and oversee rate testing with all impacted teams within the Plan. * Analyze large data sets to identify trends and present findings with actionable recommendations to senior leaderships and other stakeholders. * Collaborate with departments across the MetroPlusHealth organization to continually understand and optimize performance. * Establish and maintain continuing collaboration with multiple departments. Triage and resolve reimbursement issues. * Organize, log and create categorization of issues for long-term resolution and trend analysis. * Create and execute plans for reimbursement projects, including identifying high-volume providers, setting resolution goals and working with internal departments to achieve Key Performance Indicator (KPI). * Access various systems and analytical tools, including SQL, Tableau, Epace, Microsoft Offices to provide solutions to reimbursement issues. * Use various data elements (including the dates of service, provider type, lines of business and servicing locations etc) to validate accuracy of reimbursements. Minimum Qualifications * Bachelor of Science in Business, Finance, Economics, Information Systems, Healthcare Administrations or equivalent. * Minimum 5 years of relevant experience, preferably in a health care environment. * Strong knowledge of CMS, New York State Medicaid, and third-party fee schedules, as well as industry wide payment methodologies, and claims edit policies required. * Proficiency with Microsoft Excel including LOOKUPs, Pivot Table and Macros. * Excellent understanding of contracts, especially in a provider and payer relationship. * Excellent analytical, problem-solving, and communication skills, with the ability to present complex data in an understandable manner. * Ability to translate business process requirements into a production environment. * Strong familiarity with health plan claims/provider billing systems and interdependent applications. * Experience in data and auditing functions. * Experience in developing and improving business processes. * Knowledge of SQL/SAS/Tableau. Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication * Excellent communication and documentation skills * Ability to multi-task * Strong analytical skills and attention to detail * Analytics, problem solving, technical skills and attention to detail are required Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

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. Temporary contract position to review medical charts. Medical records will be reviewed to find documentation and compliance for HEDIS performance measures. Data elements being sought are laboratory results, blood pressures, body mass index, colon cancer screening, and other aspects of care. Essential Responsibilities: The auditor will review medical records obtained by a vendor and available electronically at the PacificSource office. The medical record review on the members in the population will be performed according to NCQA HEDIS specifications. Data will be entered using certified HEDIS software on laptop computer after training has been completed. The medical record will be reviewed for confirmation of member identification, data elements, numerator events and exclusions per HEDIS specifications outlined on MRR tools in the certified software system. Numerator events and exclusions will be documented in the software program and by photocopying, printing, or capturing a digital image of the page of the medical record where the event or contraindication is found. Ability to audit with 95% accuracy. Protect PHI by never leaving laptop in car. Always lock computer when leaving its location. Do not reveal passwords. Do not discuss PHI with anyone who does not have a legal need to know. All photocopied medical records will be handled according to the health plan confidentiality and safe guarding PHI policy and procedure. Supporting Responsibilities: 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. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Acute care experience or experience in a primary care clinic or experience with disease management. Experience using or viewing electronic medical records. Experience performing chart audits preferred. Education, Certificates, Licenses: Valid nursing license (RN or LPN). Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work remotely and occasional inside a general office setting with ergonomically configured equipment. 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.

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.