HIM Coding Supervisor -- Coding & Data Registry -- Document Center Building Charleston Area Medical Center Health System IncHIM Coding Supervisor -- Coding & Data Registry -- Document Center BuildingCharleston, WVAssociate's Degree (Required) Experience: 5 yrs coding experience with at least 3 of the years with progressive coding; dependent on coding specialty - outpatient coding experience with strong grasp of coding guidelines and rules or inpatient experience with strong grasp of coding and rules; experience in Clinical Documentation Improvement Substitution: May substitute 5 yrs progressive coding experience in addition to required experience for the Associates Degree in Health Information Technology. The position will also act as a liaison with Clinical Documentation Specialists and Coders to settle differences in coding and DRG assignment; with Coders and Patient Accounts to resolve coding and billing issues; and provide clinical and documentation clarification facility-wide.
NewInpatient Coding Manager Huron Consulting Group IncInpatient Coding ManagerCharleston, WV$90,000–$130,000 / yearREQURIED SKILLS: Effective and efficient organization and planning skills with the proven ability to manage complex multi-workstream performance improvement projects or multiple concurrent client engagements, while delegating and overseeing the work of junior team members. is directly responsible for the daily oversight of coding operational processes and workflow, including but not limited to delivering timely and accurately coded cases for facility billing and for reporting hospital and provider quality metrics.
Medical Records Coder 1 Charleston Area Medical Center Health System IncMedical Records Coder 1Charleston, WVEffectively utilize the APCpro features of 3M with the 3M encoder and grouper software to identify appropriate assign modifiers, make appropriate changes to charges, notify departments to make changes, identify missing documentation, and prepare the account as a clean claim for billing to the third party payer. Participate in the Coding Hotline by responding to callers+ needs for coding advice, identify callers needs that must be referred to a higher level of coding skill, and overall act as a liaison between coding and other departments that need coding services.
Senior Product Manager (PM/RCM) - Full Time - Remote Experity IncSenior Product Manager (PM/RCM) - Full Time - RemoteWVRemote$107,750–$151,400 / yearResponsibilities: Own day-to-day execution of the Revenue Cycle Management product roadmap, ensuring on-time delivery of capabilities across charge capture, coding, claim creation and submission, payer processing, payment posting, denial management, accounts receivable, patient balances, reporting, and related billing workflows. Deep knowledge of healthcare revenue cycle management, including charge capture, coding, claim submission, clearinghouses, payer adjudication, remittance processing, denial management, accounts receivable, and payment posting.
Nurse Investigator The Health PlanNurse InvestigatorCharleston, WVRequired: Registered Nurse; Certified Coder (or eligible within 12 months)or similar certification; Basic knowledge of ICD-9/10, CPT, HCPCS, DRG and/or Rev codes; Proficiency with Office products, including Word and Excel; Critical problem-solving skills and attention to detail. The successful candidate will utilize their unique blend of coding, claims payment, clinical, and payment integrity/investigations expertise to assist the SIU in achieving its mission to prevent, detect, investigate, and resolve healthcare fraud, waste, and abuse.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistWV$17–$28.46 / hourPerforms claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
NewSenior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)WV$46,988–$112,200 / yearThis position will routinely handle high profile or highly sensitive matters involving cases that are national in scope, as well as, complex cases involving multi-lines of business, multiple subjects, or intricate healthcare fraud schemes. Strong communication skills, both written and oral, are necessary for the development and implementation of professional presentations for internal and external stakeholders regarding healthcare fraud matters and Enterprise approach to FWA.
Pre-Certification Specialist Charleston Area Medical Center Health System IncPre-Certification SpecialistCharleston, WVThe employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements.
Pre-Certification Specialist -- Vascular Center of Excellence -- Heart & Vascular Center Charleston Area Medical Center Health System IncPre-Certification Specialist -- Vascular Center of Excellence -- Heart & Vascular CenterCharleston, WVThe employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements.
Patient Accounts Resolution Specialist -- Patient Accounts -- General Hospital Charleston Area Medical Center Health System IncPatient Accounts Resolution Specialist -- Patient Accounts -- General HospitalCharleston, WVReview assigned work items daily to resolve "at risk, past due, and technical denial" claim issues Work with coding to resolve coding related denials Work with Utilization Review to resolve authorization related denials and appeals Use various payer web portals and DDE systems to obtain claim information that will help in resolution Contact payers by phone to resolve claim issues Contact Physician offices to obtain necessary information needed to resolve claims Manually and accurately resolve claims in Suspense (Medicare only) Ensure that medical records and itemized statement are submitted and received when requested by payers (work with contracted agencies as applicable) Follow proper workflow assigned by management Ensure accurate rebilling of claims to avoid denials Communicate billing errors that can be prevented to Department Manager, Supervisor, or Team Lead Communicate identified system related issue to Department Manager, Supervisor, or Team Lead Accurately, Professionally, and thoroughly document necessary information necessary to resolve outstanding balances in encounter timeline Ensure that result driven follow up is be accomplished and documented. Other duties as assigned Skills: Healthcare billing and collection knowledge Ability to interpret a payer explanation of benefit (EOB) Ability to identify and resolve claim issues Excellent communication and customers service skills Computer and keyboarding skills Knowledge of Microsoft software applications (Excel and Word) a plus Cerner knowledge a plus.
Claims Analyst The Health PlanClaims AnalystCharleston, WVUnder the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines.
Production Supervisor WillScot CorporationProduction SupervisorCharleston, WVManages employee/vendor health and safety through creating a safer workplace, conducting daily safety meetings, DuPont STOP, training and observations, and regularly scheduled assessments of the branch. Disclaimer: This posting describes the general nature and level of work performed and does not represent an exhaustive list of responsibilities, duties, skills, or physical abilities required.
Production Supervisor Williams Scotsman IncProduction SupervisorCharleston, WVManages employee/vendor health and safety through creating a safer workplace, conducting daily safety meetings, DuPont STOP, training and observations, and regularly scheduled assessments of the branch. At WillScot, our team of nearly 5000+ people makes our company a Great Place to Work and we believe our people are what give us a competitive advantage in the industry.
Bilingual Customer Service Representative IBEX Holdings LtdBilingual Customer Service RepresentativeCharleston, WVArkansas, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Michigan, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia, Wisconsin, and Wyoming. About the role: Bilingual Customer Service Representatives will be working directly with the customer to answer general inquiries, address concerns, and assist with requests about products and services across multiple lines of business.
Bilingual Customer Service Representative ibexBilingual Customer Service RepresentativeCharleston, West VirginiaArkansas, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Michigan, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia, Wisconsin, and Wyoming. Researching and consistently providing accurate information to resolve all member and provider inquiries through verbal and written communications through all channels including phone, email, web portal, and chat interactions.
NewInsurance Specialist West Virginia University MedicineInsurance SpecialistCharleston, WVCommunicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility. Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection.
Office Manager West Virginia University MedicineOffice ManagerSouth Charleston, WVAs designated delegate, works directly with providers to complete any travel and/or purchase reimbursements in WorkDay; also registers providers for conferences and/or makes travel arrangements (hotel/flight/etc.) using department credit card on behalf of the provider. The Office Manager is the key contact in a community Emergency Department/Hospital Medicine/Intensivist Department, supporting all efforts for the Physicians and Advance Practice Professionals (APPs), as well as the liaison to Community Hospital Departments that interact with the Medical Director and Providers.