Certified Coding Auditor St. Joseph HealthCertified Coding AuditorPaterson, NJResponsible for audits which are internal record reviews for compliance with coding regulations and guidelines in order to provide rebuttals to CMS or other payer denials and to assist and improve on physician correct coding/documentation education. Provides assistance with the creation of EMR templates in order to to improve capture of correct documentation to support E&M (Evaluation and Management Coding) levels.
Risk Adjustment Coding Specialist I Millennium Physician GroupRisk Adjustment Coding Specialist IFlorida, PRUnder the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care. Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
Senior Building Code Inspector Willdan Group IncSenior Building Code InspectorNYOur experience includes a range of technical expertise to service your facilities, such as permit issuance, building plan review, building inspection, grading and accessibility plan review and inspection, flood zone experience, fire-life safety plan review, building official services, code enforcement, emergency safety assessment, and disaster recovery. Willdan has provided Building and Safety services for 60 years, working with municipalities, university systems, healthcare facilities, and tribal entities.
Medical Biller ANNA K IMPERATO MD PLLCMedical BillerMANHASSET, NYFull timeAs 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.
NewBilling Manager – NYC Ophthalmology Practice Vitreous-Retina-Macula Consultants of New York PCBilling Manager – NYC Ophthalmology PracticeNew York, NY$85,000–$95,000 / yearThe ideal candidate has deep experience in ophthalmology/retina billing, strong knowledge of Medicare billing rules and reimbursement, advanced analytical and reporting skills, and the ability to synthesize complex data into actionable insights for leadership. Vitreous Retina Macula Consultants of New York (VRMNY) is one of the nation’s leading retina practices, known for world‑class physicians, cutting‑edge treatments, and a commitment to exceptional patient care.
Medical Biller Javier Zelaya MD PCMedical BillerBrooklyn, New York$18–$22 / hourThe team provides medical dermatology treatment options and full body screenings for a number of skin conditions including melanoma and other skin cancers, acne, rosacea, eczema, psoriasis, cysts, skin rashes and allergies, hyperpigmentation, aging skin, photodamage, vitiligo, warts, sweat, hair loss and more. Board certified Dermatologist and Internist, Dr. Javier Zelaya, with over 25 years of dermatology, cosmetic, laser and surgical experience works alongside a skilled team Physician Assistants, Nurse Practitioners and licensed Medical Esthetician.
CPC Investigator Blue Cross and Blue Shield AssociationCPC InvestigatorNewark, NJ$70,500–$94,395 / yearThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. The incumbent will also be responsible for handling low level investigative activities (external) related to claims, enrollment, accounting, receive and review suspected fraud and to complete cases with all information and analysis for resolution, as the manager and prior approved guidelines may direct.
Service Account Specialist - Billing Quest Diagnostics IncService Account Specialist - BillingClifton, NJAccount visits will be prioritized based on evaluation of trends that show education needs in: Medicare Limited Coverage Policy/ABNMedicaid requirements/policiesRegional specific third-party requirements/policiesOrdering provider registration (PECOS)Missing demographic/insurance information for ordering physician and patientSupport Commercial Sales team with client training and education as required for large new customers and/or new billing initiatives. Responsibilities: Improve billing data quality through the education and account management of customers, with efforts and emphasis to reduce missing information, bad debt, non-supported diagnosis/non-covered test write-offs, self-pay write-offs, and third-party denials.
Analyst, Compliance Columbia UniversityAnalyst, ComplianceNew York, NY$80,000–$90,000 / yearProvide oversight and perform, as needed, ongoing, risk-based, and ad hoc coding auditing of complex services, across multiple specialties, rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare/Medicaid, medical necessity, and NCD/LCD requirements; including but not limited to retrospective audits for established providers and prospective audits for newly onboarded providers to ensure appropriate documentation, coding accuracy, and billing compliance. Support departmental compliance teams by providing advisory guidance and expert knowledge of CPT/HCPCS and ICD-10 guidelines across multiple specialties, as well as teaching facility guidance, professional fee billing, including global surgical package rules, modifier usage, incident-to services, split/shared services, and emerging regulatory changes.
Inpatient Program Strategy & Execution Manager Cohere Health Technologies LLCInpatient Program Strategy & Execution ManagerNYRemote$110,000–$127,000 / yearBy unifying pre-service authorization data with post-service claims validation, we''re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. With an enterprise approach that streamlines payer-provider decision-making across the care continuum-including policy, prior authorization, payment accuracy, and more-the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.
Revenue Integrity Coordinator Westchester Medical Center Health NetworkRevenue Integrity CoordinatorValhalla, NY$32.95–$41.42 / hourJob Category Job Category Advanced Clincial Providers Advanced Practice Providers Allied Health Prof/Technical Clerical/Administrative Support Executive/Management Finance/Info Systems Nursing Support Nursing/Nursing Management Physicians Professional/Non-Clinical Service/Trades. Company Company Bon Secours Charity Medical Group Bon Secours Community Hospital Good Samaritan Hospital HealthAlliance Hospital Margaretville Hospital MidHudson Regional Hospital Mountainside Residential Care Center NorthEast Provider Solutions Inc.
Inpatient DRG Reviewer Zelis Healthcare, Inc.Inpatient DRG ReviewerNJ$79,000–$99,750 / yearWhere the regrouped 'new DRG' differs from what was originally claimed by the provider, write a customer facing 'rationale' or 'findings' statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Medical Claims Processor GlobalchannelmanagementMedical Claims ProcessorParamus, New JerseyPartner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system. Medical Claims Processor duties: Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house.
Medical Assistant - Urology UnitedHealth Group IncMedical Assistant - UrologyLake Success, NYClinical › Corporate and business operations › Customer and support services › Early careers› Sales and account management › Technology and data› Physicians› Advanced practice clinicians› Pharmacy› Behavioral health› Nursing› Medical coding› Clinical support› U.S. › Ireland & UK › India › Philippines › Culture of Belonging› Employee Benefits› Blog. Technology and data Artificial intelligence Architecture Business systems analysis Data analytics Data engineering Data science Network infrastructure Product management & development Security and risk Software engineering.
Professional Coder I eTeam Inc.Professional Coder INewark, NJRemote$35–$42.38 / hourThis position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business. Qualifications: Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist, P from the American Health Information Management (AHIMA).
Medical Records Associate The Cardiovascular Care GroupMedical Records AssociateNJConsistently recognized by their peers and patients as the top group in the region, The Cardiovascular Care Group provides the highest quality care using the newest technologies in the setting of years of experience with outstanding results. Effective communication skills facilitate collaboration with healthcare providers and administrative personnel to resolve documentation issues and support quality patient care.
Home-Based Primary Care NP/PA | Orange County, NY UnitedHealth Group IncHome-Based Primary Care NP/PA | Orange County, NYMiddletown, NY$109,500–$164,000 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation.
Lead, Medical Network Claims Pricer Capital Rx, Inc.Lead, Medical Network Claims PricerNew York, NY$128,000–$160,000 / yearApply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules; resource-based relative value methodologies; diagnosis-related groups; ambulatory payment classifications; per-diem, case-rate, percent-of-charge, and other medical reimbursement arrangements.
NewField Ancillary Support Specialist Tristate HRHField Ancillary Support SpecialistJersey City, NJ$15.92–$30Tristate HRH Outreach Management is a growing healthcare services organization that provides on-site staffing and operational support for one of Hudson County’s leading health systems. Our employees play a vital part in the patient experience by supporting day-to-day operations, coordinating workflows, and ensuring that clinical teams can focus on delivering care.
Patient Navigator HealogicsPatient NavigatorNorth Bergen, New JerseyLearn more about this role here: Healogics is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. All Healogics employees must perform their job responsibilities according to all Healogics policies, Hospital policies, as well as to accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services (CMS) guidelines, as applicable.