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JobsJobs in South CarolinaJobs in Cayce, SCHealthcare Jobs in Cayce, SCMedical Billing and Coding JobsCoding Jobs in Cayce, SC
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Coding Jobs in Cayce, SC

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    New

    Coding Denial Management Associate athenahealth, Inc.

    Coding Denial Management Associate
    Columbia, SC
    • $50,000–$86,000 / year

    Job ResponsibilitiesLead detailed claim adjudication analysis to triage rejections, denials, and payer edits; convert adjudication scenarios into consumable, effective processes that identify true root causes and lead to successful outcomes. Preferred: Revenue cycle experience working with denials, rules, payer edits, 835/ERA or EOB review, appeals/resubmissions, and claim reprocessing workflows.

    1 day ago
    InterSources Inc. logo

    IT Healthcare Consultant Business Analyst - Advanced (Clinical Analyst & Coding Specialist InterSources Inc.

    IT Healthcare Consultant Business Analyst - Advanced (Clinical Analyst & Coding Specialist
    Columbia, SC
    Remote

    InterSources Inc , is a Small, Woman, and Minority-Owned Business Enterprise, ISO/IEC 27001, SOC 2 Type 2 certified company with massive 18+ years of diversified experience in providing IT Consulting Services, Artificial Intelligence, Data Analysis, Application Development, Cloud Services, Cybersecurity, Digital Marketing, ERP Management, Custom Software Development, Web Development, UI/ UX Design, System Integration, QA Support etc. Job Title: IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist) ( 11013).

    30+ days ago

    Business Analyst - Clinical Analyst & Coding Specialist Talent Software Services, Inc.

    Business Analyst - Clinical Analyst & Coding Specialist
    Columbia, SC
    • $70 / hour

    The position will also participate as a project team member, as assigned, for related process improvements, Medicaid Management Information System (MMIS) enhancements and provide subject matter expertise for a future MMIS replacement. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.

    30+ days ago
    Datasoft Technologies logo

    IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst & Coding Specialist Datasoft Technologies

    IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst & Coding Specialist
    Columbia, SC
    Remote

    As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist): Specific duties include, but are not limited to: Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes. Client is seeking This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System.

    30+ days ago
    PricewaterhouseCoopers LLP logo

    Managed Services - Revenue Cycle Coding - Senior Manager PricewaterhouseCoopers LLP

    Managed Services - Revenue Cycle Coding - Senior Manager
    SC
    • $124,000–$280,000 / year

    PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy. As a Senior Manager, you will leverage your skills and influence to deliver quality results, motivate and coach teams to solve complex problems, and apply sound judgment to recognize when to take action or escalate issues.

    30 days ago
    New

    Medical Account Manager (#011290) Financial Accounting, Columbia (RICHLAND) State of South Carolina

    Medical Account Manager (#011290) Financial Accounting, Columbia (RICHLAND)
    Columbia, SC
    • $48,000–$49,900 / year

    This position reviews claims prior to payment authorization, monitors billing systems for discrepancies or duplicate charges, coordinates Medicaid rebilling when necessary, conduct internal audits, verify CPT and HCPCS coding issues, ensures billing documentation aligns with clinical records, and serves as the primary point of contact for provider billing inquiries and claim status updates. Agency Specific Application Procedures: This position is recruited through governmentjobs.com only; You must apply online via the South Carolina Department of Corrections Career website www.governmentjobs.com/careers/sc/scdc to be considered as an applicant for this position.

    6 days ago

    Remote role Healthcare Business Analyst Syntricate Technologies Inc

    Remote role Healthcare Business Analyst
    Columbia, SC
    Remote

    The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication outcomes for the benefit of Medicaid members and providers. This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment.

    30+ days ago

    Adjunct Faculty, Medical Assisting South University LLC

    Adjunct Faculty, Medical Assisting
    Columbia, SC

    The South University 125-year story-past, present, and future-is a history formed by the many individuals who have developed the education and spirit of community that have become our pledge to students, faculty, staff, alumni and supporters of South University. JOB REQUIREMENTS: Clinical professionals with terminal degree or Bachelor's degree in a health related field with a minimum of 18 semester credit hours completed in the teaching discipline or in a closely related discipline from an accredited program/college/university or.

    11 days ago

    Medical Records Coder III Outpatient (PRN/ REMOTE) BayCare Health System

    Medical Records Coder III Outpatient (PRN/ REMOTE)
    Columbia, SC
    Remote

    Responsibilities: The Medical Records Outpatient Coder III reviews short stay focused encounters to accurately assign diagnosis and procedural codes-using ICD-10-CM and CPT-4 coding systems. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.

    30+ days ago

    Professional Medical Coder II Lexington Medical Center

    Professional Medical Coder II
    West Columbia, SC
    Remote

    Required Training: Experience working with CPT, ICD diagnosis coding; Experience with CCI edits; Experience with Medicare LCDs and NCDs; Understanding of state and federal regulations as well as payor billing requirements; Must be computer literate and have experience with Microsoft applications (i.e., Word, Excel, Outlook); Experience with electronic health records software; E/M Documentation Guideline (1995/1997/2021) experience. Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina.

    30+ days ago

    Professional Medical Coder I Lexington Medical Center

    Professional Medical Coder I
    West Columbia, SC
    Remote

    Required Certifications/Licensure: Licensure, Registry, or Certification Required (AAPC or AHIMA coding credential required and/or specialty certification, as approved by Director); A CCA or CPC-A will only be eligible for those who have successfully completed the coding fellowship. Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina.

    30+ days ago

    Patient Services Rep, Dentistry, FT, Days Prisma Health

    Patient Services Rep, Dentistry, FT, Days
    Columbia, South Carolina

    As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.

    29 days ago

    Patient Services Representative, Pediatrics (Floater), FT, Days Prisma Health

    Patient Services Representative, Pediatrics (Floater), FT, Days
    Columbia, South Carolina

    As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.

    30+ days ago

    Patient Services Representative, Senior Primary Care, FT, Days Prisma Health

    Patient Services Representative, Senior Primary Care, FT, Days
    Columbia, South Carolina

    As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.

    18 days ago

    Patient Services Representative, Surgery, FT, Days Prisma Health

    Patient Services Representative, Surgery, FT, Days
    Columbia, South Carolina

    As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.

    30+ days ago

    Patient Services Representative, Neurosurgical, FT, Days Prisma Health

    Patient Services Representative, Neurosurgical, FT, Days
    Columbia, SC

    As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.

    30+ days ago

    Patient Services Representative, OBGYN Prisma Health

    Patient Services Representative, OBGYN
    Columbia, SC

    As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.

    30+ days ago

    Receivables and Revenue Operations Manager University of South Carolina

    Receivables and Revenue Operations Manager
    Columbia, SC
    • $69,913–$104,870 / year

    Logo Posting Number STA00466PO26 Job Family Financial and Accounting Operations and Analysis Job Function Accounts Receivable USC Market Title Accounts Receivable Manager Link to USC Market Title https://uscjobs.sc.edu/titles/160889 Job Level M2 - Managerial Business Title (Internal Title) Receivables and Revenue Operations Manager Campus Columbia Work County Richland College/Division Division of Student Affairs and Academic Support Department SAAS Finance State Pay Range G11 USC Market Range MRI - $69,913 $87,391 $104,870 Anticipated Hiring Range $69,913 - $104,870 Location of Vacancy Part/Full Time Full Time Hours per Week 37.5 Work Schedule. The Receivables and Revenue Operations Manager for Student Affairs and Academic Support (SAAS) is responsible for the development, implementation, and oversight of accounts receivable and medical/insurance billing processes across assigned units within the division.

    16 days ago

    Specialty Coder II - Anesthesia (REMOTE) BayCare Health System

    Specialty Coder II - Anesthesia (REMOTE)
    Columbia, SC
    Remote

    The Specialty Coder audits physician documentation to assign appropriate CPT codes, diagnosis codes, and modifiers related to anesthesia coding and billing as well as anesthesia minutes. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.

    30+ days ago

    Specialty Coder II (REMOTE) BayCare Health System

    Specialty Coder II (REMOTE)
    Columbia, SC
    Remote

    The Specialty Coder audits physician documentation to assign appropriate CPT codes, diagnosis codes, and modifiers related to anesthesia coding and billing as well as anesthesia minutes. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.

    30+ days ago

    Medical Reviewer LPN # 26-13483 US Tech Solutions, Inc.

    Medical Reviewer LPN # 26-13483
    Columbia, SC
    Remote
    • $23 / hour

    Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

    30+ days ago

    Provider Audit Specialist BlueCross BlueShield of South Carolina

    Provider Audit Specialist
    Columbia, South Carolina

    Required Licenses and Certificates: Active, unrestricted RN or LPN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN or LPN license as defined by the Nurse Licensure Compact (NLC). We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

    15 days ago

    Periop Revenue Charge Coordinator, Richland, FT Days Prisma Health

    Periop Revenue Charge Coordinator, Richland, FT Days
    Columbia, South Carolina

    Follows established departmental guidelines and consistently, appropriately, and proactively notifies nurses, anesthesia staff and physicians of both documentation and charge capture deficits and issues needing clarification. Assists the Periop Coding Analyst to resolve specific charge capture issues with the Perioperative charge team and other departments to include Revenue Integrity, Patient Accounts and HIM.

    30+ days ago

    Medical Records Coder II (PRN) (REMOTE) BayCare Health System

    Medical Records Coder II (PRN) (REMOTE)
    Columbia, SC
    Remote

    Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. Responsibilities: The Medical Records Coder II assigns diagnosis and procedural codes using ICD-10-CM, ICD-10-PCS, and CPT-4 coding systems and monitors bill hold reports.

    30+ days ago

    Medical Billing Specialist Midlands Neurology and Pain Associates, P.A.

    Medical Billing Specialist
    Columbia, South Carolina

    This role requires a keen attention to detail, knowledge of medical billing best practices, and the ability to work collaboratively across departments to resolve claim issues and improve reimbursement outcomes. The Medical Billing specialist is responsible for working all aspects of the billing cycle, specifically in Accounts receivable, payment posting, denials, appeals, etc.

    30+ days ago
    New

    Receivables and Revenue Operations Manager State of South Carolina

    Receivables and Revenue Operations Manager
    Richland County, SC

    Clickhttps://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsc.edu%2Fabout%2Foffices_and_divisions%2Fhuman_resources%2Fcareers%2Findex.php&data=05%7C01%7CKURTRS%40email.sc.edu%7Ceca45df616784275e15908dab2a706ac%7C4b2a4b19d135420e8bb2b1cd238998cc%7C0%7C0%7C638018727680845870%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=j6sQGvabHDZHDmRBFwMrq8P8QCuDmChuJ%2FH5%2F8hDRUw%3D&reserved=0 to learn more about why you should work at USC. In addition, our Palmetto College campuses in Salkehatchie, Union, Lancaster and Sumter enable students to earn associate or bachelor's degrees through a combination of in-person, online or blended learning.

    3 days ago

    Licensed Practical Nurse # 26-14749 US Tech Solutions, Inc.

    Licensed Practical Nurse # 26-14749
    Columbia, SC
    Remote
    • $23 / hour

    Job Description: Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

    17 days ago
    Physician Services USA logo

    Medical Billing Specialist Physician Services USA

    Medical Billing Specialist
    Columbia, South Carolina

    Responsibilities include the billing and account resolution aspects of revenue cycle management, providing management and clients with reports and account updates with some direct client- and patient-interaction while handling multiple projects and deadlines simultaneously. Family-oriented physician practice management company in NE Columbia is seeking to hire experienced and driven professionals in the medical billing field.

    9 days ago

    Health Information Management Inpatient Coder, FT, Days, - Remote Prisma Health

    Health Information Management Inpatient Coder, FT, Days, - Remote
    Columbia, SC
    Remote

    Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of Diseases-Procedure Coding System (ICD-PCS) codes as well as the Diagnosis Related Groups (DRG) assignment. Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures.

    10 days ago

    Health Information Management Inpatient Coder, FT, Days, Prisma Health

    Health Information Management Inpatient Coder, FT, Days,
    Columbia, South Carolina

    Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of Diseases-Procedure Coding System (ICD-PCS) codes as well as the Diagnosis Related Groups (DRG) assignment. Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures.

    11 days ago

    Quality Medical Auditor TRC Talent Solutions

    Quality Medical Auditor
    Columbia, SC
    • Temporary

    This position plays a critical role in improving documentation quality, reducing risk, and supporting overall revenue integrity. This role is responsible for ensuring the accuracy and integrity of coded medical records, identifying discrepancies, and safeguarding appropriate reimbursement.

    30+ days ago

    Inpatient Medical Coder # 26-14057 US Tech Solutions, Inc.

    Inpatient Medical Coder # 26-14057
    Columbia, SC
    • $36 / hour

    Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates. US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

    25 days ago

    Supervisor Patient Access and Retention Palmetto Infusion Careers

    Supervisor Patient Access and Retention
    Columbia, South Carolina

    For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities. The Supervisor ensures that current patient have updated eligibility and authorization information on file prior to each appointment as well as provide financial assistance options to patients and education regarding financial responsibility.

    30 days ago

    Supervisor Patient Access and Retention Palmetto Infusion Services LLC

    Supervisor Patient Access and Retention
    Columbia, SC

    For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities. The Supervisor ensures that current patient have updated eligibility and authorization information on file prior to each appointment as well as provide financial assistance options to patients and education regarding financial responsibility.

    28 days ago

    PFS Billing Rep Prisma Health

    PFS Billing Rep
    Columbia, South Carolina

    Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient and Prisma Health departments to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered. Works and processes the Billing functions, including resolving the Discharged Not Final Billed/Stop Bill errors that prevented the account from billing, the resolution of Claim Edits in order to submit to our Claims Clearinghouse for electronic submission.

    24 days ago

    IT Healthcare Consultant - Business Analyst - Advanced Lumen Solutions Group, Inc.

    IT Healthcare Consultant - Business Analyst - Advanced
    Columbia, SC
    Remote

    Access to a virtual desktop set up (software) will be provided by Lumen s client, allowing the user access to the required systems and technology.*** . Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.

    30+ days ago
    PricewaterhouseCoopers LLP logo

    Applied AI Health Data System Engineer-Senior Manager PricewaterhouseCoopers LLP

    Applied AI Health Data System Engineer-Senior Manager
    SC
    • $124,000–$280,000 / year

    Managing development teams in building healthcare AI and GenAI solutions, including analytical modeling, prompt engineering, Python-based development, testing, communication of results to clinical and operational stakeholders, front-end and back-end integration, and iterative use case development with health system clients; Documenting and analyzing healthcare business processes - across clinical operations, and population health programs - to identify AI and GenAI opportunities, gather requirements, define initial hypotheses, and develop solution approaches tailored to health system workflows; Collaborating with health system client teams - including clinical informatics, population health, and IT leaders - to understand their business and clinical problems and select the appropriate models, LLMs, and approaches for AI/GenAI use cases; Designing and solutioning AI/GenAI architectures for health system clients, including RAG-based clinical knowledge retrieval systems, agentic AI workflows for care management and revenue cycle automation, and custom LLM application builds with appropriate PHI safeguards; Managing teams to process healthcare unstructured and structured data - including clinical notes, discharge summaries, claims records, EHR data, and ADT feeds - for use as LLM context, including embedding of large clinical text corpora, generative SQL query development, and building connectors to EHR back-end databases; Managing daily operations of a global healthcare data science team on client engagements, reviewing developed models, providing feedback, and assisting in analysis of clinical and operational outcomes; Directing data engineers and other data scientists to deliver efficient, HIPAA-compliant solutions that meet health system client requirements for clinical, financial, and operational AI use cases; Leading and contributing to development of proof of concepts, pilots, and production use cases for health system clients - spanning clinical decision support, prior authorization automation, patient risk scoring, workforce optimization, and throughput modeling - while working in cross-functional teams; Facilitating and conducting executive-level presentations to health system leadership showcasing GenAI and ML solution capabilities, use case development progress, model performance, and recommended next steps; Structuring, writing, communicating, and facilitating client presentations that translate complex AI and ML concepts into clear clinical and business value narratives for health system audiences; and, Managing associates and senior associates through coaching, providing feedback, and guiding work performance, with an emphasis on developing healthcare domain knowledge alongside technical AI and ML capabilities. You will architect and build production-grade RAG pipelines, MCP connections, agentic AI workflows, and MLOps frameworks, managing daily operations across global delivery teams while engaging health system leaders at the executive level to ensure measurable clinical and operational impact.

    30+ days ago
    CVS Health Corp logo

    Medical Director MPO CVS Health Corp

    Medical Director MPO
    SC
    • $174,070–$374,920 / year

    In this role as Medical Director MPO (Medical Policy & Operations) you will be responsible for providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. Additional responsibilities may include: Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services.

    28 days ago
    CVS Health Corp logo

    Fraud Waste and Abuse - Sr. Analyst CVS Health Corp

    Fraud Waste and Abuse - Sr. Analyst
    SC
    • $46,988–$112,200 / year

    Activities include reviewing billing activity for state agency referrals, assisting in the investigation and triage of FWA complaints, coordination with other departments and assist in prevention activities including training of internal staff and internal departments. Analyst, Fraud, Waste, and Abuse (FWA) will assist in detecting, investigating, remediating and referring to state regulatory agencies incidents of FWA arising in connection with medical, behavioral, transportation, and other healthcare services.

    30+ days ago

    Senior SAP Technical Engineer First Quality Enterprises Inc

    Senior SAP Technical Engineer
    SC

    This role is purely technical and platform-focused - responsible for system engineering, integration enablement, performance optimization, archiving execution, connectivity, and S/4HANA migration readiness across a complex SAP ecosystem including EWM, TM, SCM, MDG, GRC, BW, SAP PI, and Solution Manager. Our personal care and household product portfolio includes baby diapers, wipes, feminine pads, paper towels, bath tissue, adult incontinence products, laundry detergents, fabric finishers, and dishwash solutions.

    30+ days ago

    Auditor, Quality Medical Paladin Consulting, Inc.

    Auditor, Quality Medical
    Columbia, SC
    • $36 / hour

    Required Training: Registered Records Administrator or Technician, OR, active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR Certified Codi. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates.

    23 days ago
    Vertex Pharmaceuticals Inc logo

    Field Reimbursement Manager - Kidney (Atlanta, GA, SC) Vertex Pharmaceuticals Inc

    Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
    Columbia, SC
    • $136,000–$204,000 / year

    Key Duties and Responsibilities: Compliantly establish strong connections with key nephrology office personnel, including members of the care team and administrative staff responsible for prior authorizations and patient access to specialty medications, to support patient access to prescribed medications. At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations.

    30+ days ago
    New

    Utilization Management RN Wisconsin Physicians Service Insurance Corp

    Utilization Management RN
    Columbia, SC
    Remote
    • $75,000–$100,000 / year

    We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams.

    2 days ago
    CVS Health Corp logo
    New

    Medical Claim Analyst CVS Health Corp

    Medical Claim Analyst
    SC
    • $18.50–$35.29 / hour

    This function includes, but is not limited to the following: Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician. The Medical Claim Analyst will be part of the Provider Coding and Reimbursement (PCR) team who reviews provider coding and reimbursement denial disputes from providers.

    1 day ago

    Trauma Registry Analyst FT, Day-Remote Prisma Health

    Trauma Registry Analyst FT, Day-Remote
    Columbia, SC
    Remote

    Accurately abstracts clinical data from Emergency Management System (EMS) Patient Care Record (PCR), in-patient medical record, referring hospital records and autopsy reports including patient demographics, injury event, pre-hospital information, injury diagnoses, operative and other procedures, ED data, co-morbidities, complications, patient outcome and financial data as defined by State Trauma Registry, NTDS, and Trauma Quality Improvement Program (TQIP). Data collected by the Trauma Registry Analyst is utilized by administrators, performance improvement coordinators, researchers, and American College of Surgeons (ACS) surveyors to evaluate the quality of care provided to trauma patients, for statistical analysis, performance improvement initiatives, trauma quality improvement and research.

    30+ days ago

    Prior Authorization Medical Office Supervisor Lexington Medical Center

    Prior Authorization Medical Office Supervisor
    Columbia, SC

    Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the regions third largest employer.

    30+ days ago

    Clinical Scheduler (MCP) Medical University of South Carolina

    Clinical Scheduler (MCP)
    Columbia, SC

    Health dental vision and life insurance • Employer Sponsored Retirement Plan • Paid time off and extended sick leave • Paid Parental Leave • Disability insurance plan options • Continuous professional and clinical training • Competitive pay • Annual Merit Increase • Wellbeing resources • Tuition Reimbursement • Employee perks and discounts • Employee referral program • Flexible schedule options • Certification incentive program. MUSC Community Physicians MCP is an entity within the Medical University of South Carolina that provides healthcare to patients within the rural health network throughout the state of South Carolina.

    30+ days ago
    Physician Services USA logo

    Medical Billing Team Lead Physician Services USA

    Medical Billing Team Lead
    Columbia, South Carolina

    The medical billing team lead is responsible for supervising a large billing team in ensuring accurate billing, timely submission of electronic and /or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The employee is occasionally required to stand and walk, vision abilities required include close vision, distance vision, depth perception and ability to adjust focus.

    9 days ago
    CVS Health Corp logo

    Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

    Senior Investigator, Special Investigations Unit (Aetna SIU)
    SC
    • $46,988–$122,400 / year

    Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.

    30+ days ago
    CVS Health Corp logo

    Medical Director - ENT CVS Health Corp

    Medical Director - ENT
    SC
    • $174,070–$374,920 / year

    Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

    30+ days ago
    12

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    • ca
      Canada (English)
    • de
      Deutschland (Deutsch)
    • es
      España (Español)
    • fr
      France (Français)
    • ie
      Ireland (English)
    • it
      Italia (Italiano)
    • nl
      Nederland (Nederlands)
    • se
      Sverige (Svenska)
    • uk
      United Kingdom (English)

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