Coder, Edits/Denials Lundbeck LLCCoder, Edits/DenialsILA HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations. This role is responsible for performing advanced coding and appeal activities; investigating payer issues, completing charge corrections, and for timely filing of appeals to insurance companies.
Coder, SDS Lundbeck LLCCoder, SDSILRemoteThe SDS coder is responsible for reviewing medical records for outpatient, or same day, surgical procedures, and assigning appropriate diagnostic and procedural codes (CPT and ICD-10) to ensure accurate billing and reimbursement. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.
Coder, Edit/Denials Lundbeck LLCCoder, Edit/DenialsILA HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations. This role is responsible for performing advanced coding and appeal activities; investigating payer issues, completing charge corrections, and for timely filing of appeals to insurance companies.
Coder, ED Lundbeck LLCCoder, EDILDemonstrates courtesy and professionalism through interaction, appearance, attitude, and written and oral communications with visitors, co-workers, physicians, and other hospital personnel as to represent the Medical Records Services as a high-quality service area of the Hospitals. A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.
Biller/Collector/Coder Humboldt Park Health CareersBiller/Collector/CoderChicago, IllinoisFollows up on outstanding balances to determine why claims have not been paid, handles denial follow-ups and appeals. Contacts carriers and patients to resolve outstanding balances.
New Accounts - Coder (PTCB) SpecialtyRxNew Accounts - Coder (PTCB)Morton Grove, IllinoisSpecialtyRx is not your average Long-Term Care pharmacy—we're a fast-growing team dedicated to delivering personalized, top-tier pharmaceutical care to long-term care facilities and assisted living communities. This is an exciting opportunity for an experienced Pharmacy Technician who thrives in a fast-paced, detail-oriented environment and enjoys working collaboratively to support new facility onboarding.
Biller/Collector/Coder Humboldt Park HealthBiller/Collector/CoderChicago, ILPart timeFollows up on outstanding balances to determine why claims have not been paid, handles denial follow-ups and appeals. Contacts carriers and patients to resolve outstanding balances.
NewEMS Biller and Coder Superior Air-Ground AmbulanceEMS Biller and CoderElmhurst, Illinois$19–$23 / hourFull timeR eviews Patient Care Report thoroughly, utilizing all available documentation to establish medical necessity, selection of levels of service, origin/destination modifiers and the patient’s condition at time of transport. Keeps an open line of communication with internal and external departments in a professional, tactful manner to obtain missing documentation or to clarify existing documentation.
Part-time Biller/Coder - Claims Analyst Alera GroupPart-time Biller/Coder - Claims AnalystChicago, IllinoisRemoteThe Part-time Biller/Coder - Claims & Alert/Trigger Criteria supports Vital Oversight's continuous monitoring of medical and pharmacy claims by reviewing claims for coding accuracy and reimbursement appropriateness and by developing and maintaining alert and trigger logic that identifies high-risk or outlier claims. This role works collaboratively with claims, clinical, and oversight stakeholders to surface actionable findings that support proactive cost and payment integrity oversight.
NewMedical Records Administration Specialist U.S. Department of DefenseMedical Records Administration SpecialistIL$101,206–$131,571 / yearFor each relevant work experience, make sure you include the employers name, job title, start and end dates (include month and year), for qualifications purposes, the number of hours worked per week, and a brief description that show you can perform the tasks at the required level listed in the job announcement. Applicants selected from the contiguous United States (contiguous United States consists of the 48 adjoining U.S. states plus Washington, D.C., on the continent of North America) will be afforded pay retention in circumstances in which the basic rate of pay would otherwise be reduced if selected for the position.
Medical Billing Representative Aishling Obstetrics & Gynecology SC/Fox Valley Vein CentersMedical Billing RepresentativeSandwich, ILFull timeAishling Obstetrics and Gynecology is seeking a detail-oriented and organized individual to work in our Sandwich, Il Billing department, to assist with billing, and accounts receivable. In this position, you will play a key role in posting insurance payments, reviewing and analyzing office and hospital charges, and following up on submitted claims.
Inpatient Medical Coding Specialist - Per Diem Huron Consulting ServicesInpatient Medical Coding Specialist - Per DiemChicago, IllinoisRemotePHYSICAL DEMANDS : This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments.
NewMedical Coders-Remote NITELINES USA, INCMedical Coders-RemoteChicago, ILRemoteMust have knowledge of relevant VA software, including Oracle Cerner applications, 3M/Solventum application, and International Classification of Diseases, 10 th Revision, Clinical Modification (ICD-10-CM) for both Diagnosis coding and Facility Procedure Coding System (PCS), Current Procedural Terminology (CPT), Evaluation and Management (E/M) Level Coding, Healthcare Common Procedure Coding System (HCPCS). A certified Coder shall have at least one of the following credentials from the American Health Information Management Association (AHIMA): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS or CCS-P), or Registered Health Information Administrator (RHIA) or American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC).
Inpatient Medical Coding Specialist - Per Diem Huron Consulting GroupInpatient Medical Coding Specialist - Per DiemChicago, ILRemote$26.44–$37.50 / hourPHYSICAL DEMANDS: This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. KEY RESPONSIBILITES: Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments.
Medical Records Administrator U.S. Department of DefenseMedical Records AdministratorIL$91,320–$118,718 / yearSpecialized Experience: One year of specialized experience which includes 1.) managing outpatient & inpatient medical records programs, 2.) leading other medical records technicians, including assigning and distributing workload, 3.) performing medical records audits for accuracy, and 4.) providing education and training on medical record documentation and coding guidelines. For each relevant work experience, make sure you include the employers name, job title, start and end dates (include month and year), for qualifications purposes, the number of hours worked per week, and a brief description that show you can perform the tasks at the required level listed in the job announcement.
Nurse Auditor - Medical Bill Review (Remote) Rising Medical SolutionsNurse Auditor - Medical Bill Review (Remote)Chicago, ILRemoteIn this role, you'll be a part of our mission by giving clients the information they need to determine case value based on evaluation of medical records and medical billing statements, and will: Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary. Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges.
Medical Coding/Health Information Instructor Lake Land CollegeMedical Coding/Health Information InstructorMattoon, IL$46,724–$49,704 / yearLake Land College offers tuition waivers for credit courses to current full-time employees, employee's spouse or civil union partner, and their unmarried dependents under age 23. Full-time employees are entitled to a tuition reimbursement of $200 per credit hour with a maximum of $1200 a fiscal year to advance their education with a baccalaureate, masters, or doctoral degree.
Medical Coding Specialist Affiliated OncologistsMedical Coding SpecialistOrland Park, IllinoisRemote$26–$39 / hourThe Coding Specialist is responsible for accurately assigning ICD‑10‑CM, CPT, and HCPCS codes for services rendered across a multispecialty oncology practice, including Medical Oncology, Gynecologic Oncology, Radiation Oncology, and Imaging. We extend an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401-K with a matching component, Life Insurance, Short-term and Long-term disability, and Wellness & Perks Programs.
Adjunct Medical Coding Instructor Lake Land CollegeAdjunct Medical Coding InstructorMattoon, ILEngage in activities aimed at promoting the Health Information - Medical Coding Programs in Business and Technology Division and Lake Land College to potential and current students. Essential Job Functions: In cooperation with other instructors concerned prepare or revise guides for courses offered in their division and submit to the Division Chair or appropriate Administrator for review.
Medical Coding Specialist US Oncology IncMedical Coding SpecialistOrland Park, ILCookies are used on this site to assist in continually improving the candidate experience and all the interaction data we store of our visitors is anonymous. We're sorry, but it looks like this job may be no longer available or does not exist.
Coding Manager - Epic Professional Billing Huron Consulting GroupCoding Manager - Epic Professional BillingChicago, IL$90,000–$130,000 / yearE/M, Emergency Medicine, Family practice, Hospitalists, OB, critical care, ancillary, IV infusion, outpatient departments, Urgent Care, Primary Care, Inpatient E/M, Pediatrics, Observation, Ancillary services, and claim edit work queues. The US Professional Coding Manager is responsible for the day-to-day operations and oversight of multi-shore professional coding services processes to ensure timely, accurate, consistent and compliant assignment of diagnosis and CPT/HCPCS codes.
Data Entry Clerk - Billing II Quest Diagnostics IncData Entry Clerk - Billing IISchaumburg, IL$17.20–$22 / hourStudents & early career | Quest Diagnostics Whether you are transitioning from high school, college or to civilian life after serving in the military, we have programs that can help you reach your goals - and share in the incredible work we do. Through our 11 Employee Business Networks (EBNs) employees can grow, connect, and contribute with professional development, mentorship, EBN program offerings, and community engagement.
Billing Representative II Quest Diagnostics IncBilling Representative IISchaumburg, IL$17.20–$24 / hourStudents & early career | Quest Diagnostics Whether you are transitioning from high school, college or to civilian life after serving in the military, we have programs that can help you reach your goals - and share in the incredible work we do. Through our 11 Employee Business Networks (EBNs) employees can grow, connect, and contribute with professional development, mentorship, EBN program offerings, and community engagement.
Senior Coding Compliance Auditor - Outpatient Ensemble Health PartnersSenior Coding Compliance Auditor - OutpatientIllinoisRemoteThey will lead & complete detailed Coding compliance audits including complex audits, implement Management Action Plans, prepare high quality audit reports, establish and maintains an Audit the Auditor Quality program, coaches and mentors new and existing Coding auditors, and participate in other compliance program related activities. The senior auditor is expected to work independently with minimal supervision, will manage projects/initiatives as assigned, use analytical and problem-solving skills to assist the auditors with their complex account reviews.
Senior Coding Compliance Auditor - Inpatient Ensemble Health PartnersSenior Coding Compliance Auditor - InpatientILRemote$76,300–$131,550 / yearThey will lead & complete detailed Coding compliance audits including complex audits, implement Management Action Plans, prepare high quality audit reports, establish and maintains an Audit the Auditor Quality program, coaches and mentors new and existing Coding auditors, and participate in other compliance program related activities. The senior auditor is expected to work independently with minimal supervision, will manage projects/initiatives as assigned, use analytical and problem-solving skills to assist the auditors with their complex account reviews.
Coding Manager - Epic Professional Billing Huron Consulting ServicesCoding Manager - Epic Professional BillingChicago, IllinoisE/M, Emergency Medicine, Family practice, Hospitalists, OB, critical care, ancillary, IV infusion, outpatient departments, Urgent Care, Primary Care, Inpatient E/M, Pediatrics, Observation, Ancillary services, and claim edit work queues. The US Professional Coding Manager is responsible for the day-to-day operations and oversight of multi-shore professional coding services processes to ensure timely, accurate, consistent and compliant assignment of diagnosis and CPT/HCPCS codes.
Clinical Systems Analyst SMART TECH SKILLS LLCClinical Systems Analystchicago, ILFull timeThis role is highly suited for a credentialed Registered Nurse (RN) and Certified Medical Coder who thrives in complex, change-oriented project environments. Acting as a Subject Matter Expert (SME), the successful candidate will facilitate process improvements and system enhancements, bridging the gap between clinical requirements and IT implementation.
Coding Auditor - Ambulatory/Professional Coding/Profee Huron Consulting GroupCoding Auditor - Ambulatory/Professional Coding/ProfeeChicago, IL$26.44–$37.50 / hourPHYSICAL DEMANDS: This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
Ambulatory Clin Doc Integrity Spec - Must have Pro Fee Coding, diagnosis and CPT coding w/ multiple specialties Carle HealthAmbulatory Clin Doc Integrity Spec - Must have Pro Fee Coding, diagnosis and CPT coding w/ multiple specialtiesChampaign, Illinois$26.03–$43.47 / hourQualifications: Certifications: Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Certified Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Coding Specialist - Physician-Based (CCS-P) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA), Education:, Work Experience: Carle Health Company Overview: Find it here. Overview: Performs ambulatory chart review to determine appropriate code assignment based on documentation in the chart to support clinical care provided, including preventives, Medicare Annual Wellness Visits, lowest and highest CPT E/M level, New Patient visits versus Consultation, and medical necessity.
Clinical Application Support Specialist Jardogs.aiClinical Application Support SpecialistHillsboro, IllinoisExceptional verbal and written communication skills, with a proven ability to explain complex information clearly and concisely to diverse audiences (including busy healthcare providers). You will be the primary point support contact for users with concerns with medical billing, focusing on explaining the logic behind our AI-driven medical coding suggestions and ensuring a smooth user experience.
Coding Auditor – Ambulatory/Professional Coding/Profee Huron Consulting ServicesCoding Auditor – Ambulatory/Professional Coding/ProfeeChicago, IllinoisPHYSICAL DEMANDS : This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
Ambulatory Clin Doc Integrity Spec - Must have Pro Fee Coding, diagnosis and CPT coding w/ multiple specialties Carle Foundation HospitalAmbulatory Clin Doc Integrity Spec - Must have Pro Fee Coding, diagnosis and CPT coding w/ multiple specialtiesChampaign, IL$26.03–$43.47 / hourCertifications: Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Certified Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC)American Academy of Professional Coders (AAPC); Certified Coding Specialist - Physician-Based (CCS-P) - American Health Information Management Association (AHIMA)American Health Information Management Association (AHIMA), Education:, Work Experience: Responsibilities. Assists in the provision of an efficient and effective clinical coding service within Carle by providing accurate and timely auditing and coding education to providers and coding team members to include CPT E/M coding, CPT Procedural Coding, and ICD10CM coding, as applicable.
Inpatient Coding Auditor Huron Consulting GroupInpatient Coding AuditorChicago, ILRemote$38.46–$52.40 / hourPHYSICAL DEMANDS: This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.
Coding Educator Endeavor HealthCoding EducatorSkokie, Illinois$24.86–$37.29 / hourOur more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) Elevance Health IncDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)IL$86,560–$155,808 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
NewRevenue Integrity Chargemaster Analyst Ann & Robert H Lurie Children's Hospital of ChicagoRevenue Integrity Chargemaster AnalystChicago, IL$65,520–$107,120 / yearUpdates the CDM annually based on changes published by the AMA (American Medical Association) via CPT guidelines; updates quarterly based on CMS (Centers for Medicare and Medicaid) guidelines for HCPCS codes (Healthcare Common Procedure Coding System). Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
NewCharge Master Analyst Sutter HealthCharge Master AnalystSpringfield, IL$106,745.60–$160,118.40 / yearPosition Overview: Serves as a subject matter expert for Charge Description Master (CDM) regulatory requirements and guidelines and payer contractual obligations in order to ensure CDM line items are aligned with current billing, coding regulations, guidelines, and contractual obligations. Maintains the CDM data elements (billing description, Current Procedural Terminology/Healthcare Procedure Coding System codes, revenue codes for Inpatient/Outpatient and appropriate modifiers) in the CDM software.
Inpatient Coding Auditor Huron Consulting ServicesInpatient Coding AuditorChicago, IllinoisRemotePHYSICAL DEMANDS: This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.
Diagnosis Related Group Clinical Validation Auditor-Rn (Cdi, Ms-Drg, Ap-Drg And Apr-Drg) Elevance HealthDiagnosis Related Group Clinical Validation Auditor-Rn (Cdi, Ms-Drg, Ap-Drg And Apr-Drg)Chicago, IL$86,560–$155,808 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
NewRevenue Integrity Chargemaster Analyst Ann & Robert H. Lurie Children's Hospital of ChicagoRevenue Integrity Chargemaster AnalystChicago, IllinoisUpdates the CDM annually based on changes published by the AMA (American Medical Association) via CPT guidelines; updates quarterly based on CMS (Centers for Medicare and Medicaid) guidelines for HCPCS codes (Healthcare Common Procedure Coding System). Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
DRG Clinical Validation Lead Elevance Health IncDRG Clinical Validation LeadChicago, IL$89,520–$161,136 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Research Financial Specialist Trinity Health CorporationResearch Financial SpecialistMaywood, IL$31.06–$48.15 / hourBenefits: Click or copy URL to your browser: www.trinity-health.org/sites/default/files/my-benefits/Health-and-Wellbeing/Compliance/Illinois-Transparency-Law/Trinity-Health-Summary-of-Benefits-Illinois-Job-Req-Discloser-Law.pdf. This role is critical to ensuring accurate charge segregation, maintaining research billing compliance, managing Medicare Coverage Analyses (MCA), and resolving billing disputes.
DRG Clinical Validation Lead Elevance HealthDRG Clinical Validation LeadChicago, IL$89,520–$161,136 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Senior Manager, Corporate Compliance - Risk Adjustment CVS Health CorpSenior Manager, Corporate Compliance - Risk AdjustmentNorthbrook, IL$75,400–$165,954 / yearThis position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements. As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements.
NewPROFESSIONAL CODING COMPLIANCE SPECIALIST (ON-SITE) Riverside HealthcarePROFESSIONAL CODING COMPLIANCE SPECIALIST (ON-SITE)KANKAKEE, Illinois$28.83–$37.13 / hourFull timeOverview: The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team. Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistIL$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystChicago, ILRemoteFull timeIndependent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Conducts retrospective medical claims review for coding and pricing determinations and/or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment.
Senior Healthcare Coding Analyst (Hybrid) American Medical AssociationSenior Healthcare Coding Analyst (Hybrid)Chicago, IL$99,410–$131,637 / yearThis role is responsible for supporting and enhancing the activities of the CPT Editorial Panel and/or the CPT Editorial Assistant Board in maintaining the CPT code set by working with national medical specialty societies, non-physician professional organizations, public and private payers, pharmaceutical and device manufactures, and other high profile stakeholders. Author and develop educational content to support the policies of the CPT Editorial Panel and/or the CPT Editorial Assistant Board, in the form of books, newsletters, electronic products and advice, to assist AMA members, physicians, non-physician health care professionals and other CPT stakeholders in appropriately applying the CPT code set.
SINAI CHICAGO REVENUE INTEGRITY ANALYST Sinai Health System IncSINAI CHICAGO REVENUE INTEGRITY ANALYSTChicago, ILREQUIRED LICENSES, CERTIFICATES, REGISTRATIONS: CERTIFIED PROFESSIONAL CODER (CPC), CERTIFIED OUTPATIENT CODER (COC), CERTIFIED CODING SPECIALIST (CCS) OR CERTIFIED CODING ASSOCIATE (CCA). Under the direction of the Revenue Integrity Manager, the Revenue Integrity Analyst will assist with chargemaster (CDM) integrity, code assignment, claim editing, the development, training and education of process flows that reflect best practices and supports our vision.
NewSenior Software Engineer (Python) - Senior Associate PricewaterhouseCoopers LLPSenior Software Engineer (Python) - Senior AssociateDes Moines, IA$77,000–$202,000 / yearWithin our Cloud Engineering, Data & Analytics practice, you will leverage your technical skills and creative thinking to design, code, and test applications that redefine industries and deliver exceptional user experiences. 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 .