NewClaims Specialist- Liab Crawford & CoClaims Specialist- LiabBerkeley Heights, NJTo determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim.
Care Manager (Clinical) [CMA] Guideway Care, Inc.Care Manager (Clinical) [CMA]NYUsing computer applications Making and answering phone calls the majority of the shift Welcoming patients Reviewing patient medical records Coding and filling out insurance forms Scheduling appointments Arranging for hospital admissions and laboratory services Handling correspondence, billing, and bookkeeping Escalating patient concerns or needs to appropriate provider. Essential Functions: (may include, but not limited to): Manage and support patients' healthcare needs via telephonic outreach Conduct and document visits by using several technology platforms and EHRs Monitors adherence to care plans, evaluates effectiveness, monitors patient progress in a timely manner, and facilitates changes as needed.
IBR Senior Analyst Zelis Healthcare, Inc.IBR Senior AnalystNJ$79,000–$99,750 / yearThis 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. The Itemized Bill Review Senior Analyst will be responsible for analyzing hospital claims for adherence to proper billing guidelines and will work closely with Expert Claims Review staff to efficiently adhere to policies and procedures for claims processing.
NewPre Service Rep - Patient Access Central - Full Time Day Shift (23944) Bergen New Bridge Medical CenterPre Service Rep - Patient Access Central - Full Time Day Shift (23944)Paramus, New JerseyThe preservice representative assures that all patients have all information they need so that they will arrive on time and prepared for their appointment and the hospital has all the information required to properly bill or services. Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.
NewOncology Authorization Specialist St. Joseph's Healthcare SystemOncology Authorization SpecialistPaterson, NJThe combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care". Key responsibilities include verifying insurance coverage, obtaining necessary authorizations, and providing clear cost estimates to patients, thereby promoting transparency and reducing financial uncertainty.
Director, Provider Education & Risk Adjustment Metropolitan Jewish Health SystemDirector, Provider Education & Risk AdjustmentNew York, New YorkFull timeThey are responsible for implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. • Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.
NewMgr - Multi-Facility CDI - SMNJ Medical Records FAC#1 Saint Michaels Medical CenterMgr - Multi-Facility CDI - SMNJ Medical Records FAC#1Newark, New JerseyFull timeCombining state-of-the-art technology, the latest diagnostic and therapeutic procedures, leading-edge research, and a network of highly qualified physicians, nurses, and allied health professionals, the hospital provides top-quality health care services delivered with compassionate care. Established by the Franciscan Sisters of the Poor in 1867, Saint Michael's Medical Center is a 358-bed regional tertiary-care, teaching, and research center in the heart of Newark's business and educational district and is accredited by The Joint Commission.
Community Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET) AnewHealthCommunity Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET)NJRemoteAbility to communicate effectively and professionally through written, verbal (e.g., face-to-face, telephonically and/or virtual communication platforms), and interpersonal skills as applied when interacting with employees, patients, healthcare professionals, clients, or agency representatives; successfully conveying and exchanging information at an appropriate level and in a positive and timely manner. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly.
Risk Adjustment Expert - Fully Remote MercorRisk Adjustment Expert - Fully RemoteNew York, New YorkRemote5+ years of experience in risk adjustment coding , HCC coding , or Medicare Advantage coding operations , with at least 2 years in a leadership role. Lead risk adjustment and HCC coding operations across Medicare Advantage , Medicaid , and ACA risk adjustment programs.
Outpatient Audit Specialist PRN - Remote Datavant LLCOutpatient Audit Specialist PRN - RemoteNYRemote$35–$45 / hourWhat We're Looking For: As an Outpatient Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.
ProFee Audit Specialist- PRN Datavant LLCProFee Audit Specialist- PRNNYRemote$35–$45 / hourWhat We're Looking For: As a Profee Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.
Remote Pediatric Medical Coder - PICU / Neonatology (ProFee) UCSF Medical CenterRemote Pediatric Medical Coder - PICU / Neonatology (ProFee)NYRemote$50.61–$63.01 / hourThe University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. Resolve Claims Manager and Epic edits to ensure correct coding of services provided, including review of documentation for correct coding, evaluation and management (E/M) leveling, diagnosis coding, bundling issues, and modifier usage.
Clinical Research Billing Analyst VitaliefClinical Research Billing AnalystNew Brunswick, NJ$75,000–$110,000 / yearBy combining deep subject matter expertise with the experience of senior research practitioners, we help organizations accelerate study activation, optimize operations, improve financial performance, and build scalable workforce solutions that reduce costs, increase efficiency, and advance clinical breakthroughs for patients. The Analyst collaborates with Clinical Trial Finance, Revenue Cycle, Research Operations, study teams, investigators, IRB, and other stakeholders to resolve billing issues, improve processes, and ensure accurate, compliant research revenue cycle operations.
DRG Clinical Validation Nurse MedReviewDRG Clinical Validation NurseManhattan, NY$85,000–$95,000 / yearSolid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments. Here is what we are searching for: Responsibilities: Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record.
Facility-Fee Emergency Department Medical Coder Sutherland GlobalFacility-Fee Emergency Department Medical CoderClifton, NJThe Facility-Fee Emergency Department Medical Coder is responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters. The coder will review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits.
DRG Reviewer MachinifyDRG ReviewerNY$90,000–$115,000 / yearAs part of the Complex Payment Solutions Team, you will, as a DRG Reviewer, be a key contributor responsible for conducting thorough DRG payment validation reviews, including clinical and coding assessments, of medical records and related documentation in accordance with contract-specific review criteria. Qualifications: Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required.
DRG QA and Trainer MachinifyDRG QA and TrainerNY$85,000–$95,000 / yearThis position plays a key role in auditing the work of both new hires and current staff while conducting training to ensure team members are equipped with the knowledge and skills needed to succeed. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise.
Facility-Fee Emergency Department Medical Coder Sutherland Global Services IncFacility-Fee Emergency Department Medical CoderClifton, NJThe Facility-Fee Emergency Department Medical Coder is responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters. The coder will review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits.
Medical Biller Specialist I Urban Health Plan IncMedical Biller Specialist IBronx, NYRemoteAbout Urban Health Plan: At Urban Health Plan (UHP) our mission is to continuously improve the health of communities and the quality of life of the people we serve by providing affordable, comprehensive, quality, primary and specialty health care and by assuring the performance and advancement of innovative best practices. The Billing Specialist will review medical documentation to property bill services and treatment provided and submit claims to the payers following ICD-10, CPT coding and insurance guidelines.
Senior Certified Coder Abstractor St. Joseph HealthSenior Certified Coder AbstractorPaterson, NJThis role works closely with providers, clinical staff, and revenue cycle teams to review medical records, validate documentation completeness, apply correct CPT, ICD-10-CM, and HCPCS codes, and educate providers on documentation best practices. The Coding Liaison supports documentation integrity, monitors vendor performance, and acts as a subject matter expert for coding-related inquiries.