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

    Today
    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

    Hospital Coding Specialist II (Observation) WVU Medicine

    Hospital Coding Specialist II (Observation)
    South Carolina

    Reviews and accurately interprets medical record documentation from all hospital accounts in order to identify all diagnosis and procedures that affect the current outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

    22 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

    Outpatient Coding Specialist * This

    Outpatient Coding Specialist
    South Carolina
    Remote

    This is a remote/work from home position * Overview Codes all requested medical records using the most accurate and appropriate ICD-10-CM/PCS and CPT codes in accordance with regulatory coding guidelines, best practices in the industry and HIA policy and procedures. Responsibilities: Codes all requested outpatient acute care facility records using the most accurate and appropriate ICD-10-CM/PCS and CPT codes in accordance with coding guidelines.

    8 days ago

    Provider Coding Specialist Health Information Associates

    Provider Coding Specialist
    South Carolina
    Remote

    Codes outpatient medical records using the most accurate and appropriate ICD-10-CM and CPT codes in accordance with regulatory coding guidelines, best practices in the industry and HIA policy and procedures. Responsibilities Codes all requested medical records using the most accurate and appropriate ICD-10-CM/PCS and CPT code assignment in accordance with coding guidelines.

    8 days ago

    Inpatient Coding Specialist * This

    Inpatient Coding Specialist
    South Carolina
    Remote

    This is a remote/work from home position * Overview Codes all requested Inpatient medical records using the most accurate and appropriate ICD-10-CM/PCS and DRG assignment in accordance with regulatory coding guidelines, best practices in the industry and HIA policy and procedures. Responsibilities Codes all requested Inpatient records using the most accurate and appropriate ICD-10-CM/PCS and DRG assignment in accordance with coding guidelines.

    8 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.

    29 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.

    5 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.

    10 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, 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.

    27 days ago

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

    Patient Services Representative, Senior Primary Care, 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.

    16 days ago

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

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

    Patient Services Representative, Surgery, 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, 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.

    15 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

    Periop Revenue Charge Coordinator, Richland, FT Days Prisma Health

    Periop Revenue Charge Coordinator, Richland, FT Days
    Columbia, SC

    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

    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.

    14 days ago

    Supervisor, Revenue Cycle Clinical Coder Denials | Enterprise Denials | Remote (FL, GA, MO, PA, NC, SC, TN, TX) University of Florida Health Science Center

    Supervisor, Revenue Cycle Clinical Coder Denials | Enterprise Denials | Remote (FL, GA, MO, PA, NC, SC, TN, TX)
    SC
    Remote

    Demonstrated knowledge of hospital billing and reimbursement processes, including denials and appeals, third-party contracts, insurance protocols, delay tactics, systems, and workflows, as well as federal and state healthcare regulations. Monitors patient accounts for compliance with financial policies, trains staff on handling inquiries and payment plans, and implements process improvements to optimize revenue cycle management.

    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.

    2 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.

    16 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.

    8 days ago

    Revenue Cycle Manager Little River Medical Center

    Revenue Cycle Manager
    South Carolina

    SUPERVISORY RESPONSIBILITIES Revenue Support Supervisor, Patient Services Specialist, Billing Administration Support, Billing Specialist, Payments Specialist, Patient Financial Specialist, Certified Coding Specialist. Revenue Cycle Manager POSITION SUMMARY The Revenue Cycle Manager (RCM) is responsible for managing the day-to-day activities of the billing department, which includes oversight of collections, cash posting and reconciliations.

    8 days ago

    Review Consultant * This

    Review Consultant
    South Carolina
    Remote

    Reviews additional chart documentation to validate admission order, admission and discharge dates, point of origin, patient status, present on admission indicator, and coder queries to ensure accuracy. Uses various software applications, groupers, 3M and other coding tools to analyze and ensure appropriate codes, sequencing and edits.

    8 days ago

    Medical Coder Humana Inc

    Medical Coder
    SC
    Remote
    • $59,300–$80,900 / year

    To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques.

    30+ 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.

    9 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.

    10 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

    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.

    29 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.

    27 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

    PFS Billing Rep Prisma Health

    PFS Billing Rep
    Columbia, SC

    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.

    22 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
    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.

    27 days ago

    Coder II-3 MUSC

    Coder II-3
    South Carolina

    Classification systems include ICD-10 and CPT edition, and all coding is in accordance with official coding guidelines from the American Medical Association, the American Hospital Association, and the American Health Information Management Association. The coder/abstracter is responsible for accurate code assignment of all inpatient, outpatient, and emergency service diagnoses, procedures and conditions as indicated in the patient medical record.

    30+ days ago

    Coder II MUSC

    Coder II
    South Carolina

    Classification systems include ICD-10 and CPT edition, and all coding is in accordance with official coding guidelines from the American Medical Association, the American Hospital Association, and the American Health Information Management Association. The coder/abstracter is responsible for accurate code assignment of all inpatient, outpatient, and emergency service diagnoses, procedures and conditions as indicated in the patient medical record.

    28 days ago

    Coder II Medical University of South Carolina

    Coder II
    South Carolina

    Classification systems include ICD-10 and CPT edition, and all coding is in accordance with official coding guidelines from the American Medical Association, the American Hospital Association, and the American Health Information Management Association. The coder/abstracter is responsible for accurate code assignment of all inpatient, outpatient, and emergency service diagnoses, procedures and conditions as indicated in the patient medical record.

    29 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

    Clinical Documentation Improvement Specialist Health Information Associates

    Clinical Documentation Improvement Specialist
    South Carolina

    Required Skills and Experience • Recognized CDI credential from ACDIS (CCDS) • Current RN license • Current AHIMA or AAPC coding credential preferred • Three or more years of experience working as a clinical documentation specialist • Three years or more of clinical experience in an acute care setting Job Requirements Essential Duties and Responsibilities: • Adhere to all coding and clinical documentation improvement guidelines endorsed by ACDIS and AHIMA • Analyze records for potential query opportunities, appropriate DRG assignment, severity of illness, risk of mortality, and case mix data, as well as clinical indicators (HACs, PSI, mortality, etc.) • Research, analyze, and respond to inquiries regarding queries issued and their compliance, potential coding errors, diagnoses at risk for denials, and reconciliation of CDI reviewed charts. Performance and Professionalism • Maintains strict confidentiality and adheres to HIPAA guidelines • Exhibits professional demeanor at all times • Maintains communication by responding promptly to corporate office staff • Demonstrates flexibility, open mindedness, and versatility in adjusting to changing environments • Handles constructive feedback with a positive attitude • Receptive to suggestions for changing or improving the way work is accomplished.

    8 days ago
    12

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