NewCompliance Audit / Investigator / Coder - CCS / CPC / or CCA MedStar HealthCompliance Audit / Investigator / Coder - CCS / CPC / or CCAWashington, DC$65,062–$117,291Performs concurrent and retrospective coding and documentation or clinical review audits of respective plan service areas including Behavioral Health services and other duties as assigned to detect potential compliance and/or fraud waste and abuse. Conducts provider coding and documentation audits for specific provider types including behavioral health for MFC DC depending upon the health plan that this role supports (MFC MD or MFC DC).
DRG Coder, Registered Nurse Pivotal Placement ServicesDRG Coder, Registered NurseWashington, DC$90,000–$104,841 / yearHeadquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in healthcare talent—from frontline staff to executive leadership—in both clinical and non-clinical roles. We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records.
Senior Medical Coder UnitedHealth Group IncSenior Medical CoderWashington, DC$24–$43 / hourThe 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. The Senior Medical Coder performs concurrent review of FFS coding rules within Epic, ensuring all CPT and E/M codes are accurately coded and billed for maximum reimbursement and minimal denials.
NewMedical Pro Fee Coder III Cardiac Cath/EP (Cardiology experience require) SavistaMedical Pro Fee Coder III Cardiac Cath/EP (Cardiology experience require)District of ColumbiaWe partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results.
Medical Records Technician (Coder) US Department of Health and Human ServicesMedical Records Technician (Coder)Washington, DC$50,460–$65,599 / yearRefer to BIA-4432 link: Verification of Indian Preference for Employment in the BIA and IHS When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference. Required as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements: Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only."
OP Coder Cooper ThomasOP CoderRemote Home Office, DCRemoteKnowledge in anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS). · Must be able to perform the full scope of multi-specialty OP clinic, ED, minor procedures, radiology, rehabilitation, and lab encounters utilizing ICD-10, CPT, and HCPCS codes.
Inpatient PTF Coders Cooper ThomasInpatient PTF CodersRemote Home Office, DCRemoteExperience including, but not limited to data validation; analyzing and generating reports; reviewing and abstracting health record information, adhering to coding compliance, and ensuring that CPT/AMA and ICD codes and modifiers support clinical and physician documentation for proper and consistent data collection and reimbursement. Cooper Thomas, LLC, a leading provider of medical coding, auditing, and training services to the Department of Veterans Affairs (VA), has up to immediate openings for VA experienced Inpatient PTF Coders with at least 2 years of experience for (W-2) full-time (40 hours a week) positions.
Profee Coder III (Radiology (IR), Vascular and Neurosurgery Coding) SavistaProfee Coder III (Radiology (IR), Vascular and Neurosurgery Coding)District of ColumbiaWe partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results.
Professional Fee Coder Seattle Children's HospitalProfessional Fee CoderWashingtonRemoteTogether, we deliver superior patient care, advance new discoveries and treatments through pediatric research, and serve as the pediatric and adolescent, academic medical center for Washington, Alaska, Montana and Idaho – the largest region of any children’s hospital in the country. Seattle Children’s welcomes people of all experiences, backgrounds, and thoughts as this is what drives our spirit of inquiry and allows us to better connect with our patients and families.
Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder Ankura Consulting Group LLCHealth Care | Life Sciences, Senior Associate - Registered Nurse / Certified CoderDCRegistered Nurse with active license, unrestricted license • Bachelor of Science in Nursing from an accredited college/university • Substantial clinical experience with demonstrated ability to interpret clinical documentation and medical necessity • Certified Professional Coder (CPC) with coding experience across inpatient, outpatient, and professional services • Familiar with the revenue cycle process and facility and professional claims • Demonstrates excellent communication skills, both written and oral • Experience managing small projects and teams • Familiar with accessing and identifying clinical documentation in electronic medical record systems • Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings • Ability to problem solve, multi-task, and prioritize assignments • Understands the importance of privileged and confidential communication • Willingness to travel when needed • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers.
Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder Ankura Consulting GroupHealth Care | Life Sciences, Senior Associate - Registered Nurse / Certified CoderWashington DC, District of ColumbiaRemoteOur clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations.
PT Instructor Pool - Medical Coding Specialist Program Madison Area Technical College DistrictPT Instructor Pool - Medical Coding Specialist ProgramDCMadison College offers degrees, diplomas, apprenticeships and certificates in Architecture & Engineering; Arts, Design & Humanities; Business; Construction, Manufacturing & Maintenance; Culinary, Hospitality & Fitness; Education & Social Services; Health Sciences; Information Technology; Law, Protective & Human Services; Science, Math & Natural Resources; and Transportation. This includes developing a relevant and progressive curriculum, designing and implementing effective learning strategies and environments, delivering instruction of high quality, assessing student learning, advising students, and participating in college service activities at the department, division and college levels.
MEDICAL RECORDS ADMINISTRATION SPECIALIST (TRAINER/AUDITOR) U.S. Department of DefenseMEDICAL RECORDS ADMINISTRATION SPECIALIST (TRAINER/AUDITOR)Washington, DC$63,795–$82,938 / yearOne-year specialized experience equivalent to the GS-09 grade level in the Federal Service in planning, coordinating, administering, advising, monitoring, and auditing the use of International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM), Diagnosis Related Group (DRG), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) code assignment to assure all diagnoses and procedures are properly documented through review of medical records. FOREIGN EDUCATION: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show the education credentials have been evaluated by a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university.
Senior Medical Coding Specialist (Remote) Blue Cross and Blue Shield AssociationSenior Medical Coding Specialist (Remote)DCRemote$67,464–$133,991 / yearThis role utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge, to build effective guidelines and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Consults with various teams, including the Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.
Payment and Medical Policy Coordinator (Remote) Blue Cross and Blue Shield AssociationPayment and Medical Policy Coordinator (Remote)DCRemote$51,264–$101,816 / yearThis role ensures business readiness across impacted functions, including claims, configuration, provider communications and operations, and provides support during testing, implementation, and post-implementation validation. QUALIFICATIONS: Education Level: Bachelor''s Degree in Health Administration, Business, Finance or related discipline OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Medical Coding Specialist-New Jersey Avenue, Washington, D.C Unity Health Care IncMedical Coding Specialist-New Jersey Avenue, Washington, D.CDCAdvanced knowledge of medical codes involving selections of most accurate and description code using the extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes. Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
Coding Compliance Audit & Education Specialist Privia Health Group, IncCoding Compliance Audit & Education SpecialistDC$70,000–$80,000 / yearThe Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers. Technical Requirements (for remote workers only, not applicable for onsite/in office work): In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed.
Program Director - Federal Health (CMS) DOMA TechnologiesProgram Director - Federal Health (CMS)Washington, DCRemoteThis is a high-visibility, high-accountability role that demands deep expertise in Medicare Fee-for-Service (FFS) program operations, federal contracting environments, and large-scale healthcare program management. Lead and manage a multi-disciplinary team including clinical reviewers, medical coders, customer service representatives, and IT staff; oversee hiring, training, performance management, and workforce planning.
Manager, Coding Compliance - Pediatrics Central Administration Washington University in St LouisManager, Coding Compliance - Pediatrics Central AdministrationWashingtonAccounting, Code Compliance, Coding Compliance, Compliance Management, Healthcare Auditing, Health Care Regulation, Health Insurance Portability & Accountability Act (HIPAA), ICD Coding, Medical Billing and Coding, Organizing, Supervisory Management, Trend Analysis, Trend Reporting Grade . This leader is responsible for overseeing a team reviewing complex clinical documentation and diagnostic results timely to accurately assign codes for diagnoses (ICD-10), procedures (CPT), and applicable modifiers for services provided to assure maximum reimbursement and regulatory compliance.
Field Reimbursement Manager - Mid-Atlantic HeartFlowField Reimbursement Manager - Mid-AtlanticWashington, DCRemote$90,000–$120,000 / yearHeartflow is the first AI-driven non-invasive integrated heart care solution across the CCTA pathway that helps clinicians identify stenoses in the coronary arteries (RoadMapAnalysis), assess coronary blood flow (FFRCT Analysis), and characterize and quantify coronary atherosclerosis (Plaque Analysis). The flagship product-an AI-driven, non-invasive cardiac test supported by the ACC/AHA Chest Pain Guidelines called the Heartflow FFRCT Analysis-provides a color-coded, 3D model of a patient's coronary arteries indicating the impact blockages have on blood flow to the heart.
Pre-Certification Coordinator II - Pediatric Endocrinology Washington University in St LouisPre-Certification Coordinator II - Pediatric EndocrinologyWashingtonCommunication, Detail-Oriented, Epic EHR, Fast-Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), Insurance Claim Processing Software, Insurance Precertification, Insurance Terminology, Interpersonal Communication, Medical Coding Software, Multitasking, Organizational Savvy, Prioritization Grade . Contacts appropriate insurance companies for benefit verification and pre-certification of surgical and non-surgical procedures, outpatient testing, and medications; notifies financial counselor for pre-payment of un-coded services.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistDC$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.
Pre-Certification Coordinator I - Pediatric Allergy & Pulmonary Medicine Washington University in St LouisPre-Certification Coordinator I - Pediatric Allergy & Pulmonary MedicineWashingtonThe screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. Contacts appropriate insurance companies for benefit verification and pre-certification of surgical and nonsurgical procedures; notifies financial counselor for pre-payment of un-coded services.
Compliance Audit/Investigator - CCS / CPC / or CCA MedStar Health Research InstituteCompliance Audit/Investigator - CCS / CPC / or CCADC$65,062–$117,291 / yearPerforms concurrent and retrospective coding and documentation or clinical review audits of respective plan service areas including Behavioral Health services and other duties as assigned to detect potential compliance and/or fraud waste and abuse. Conducts provider coding and documentation audits for specific provider types including behavioral health for MFC DC depending upon the health plan that this role supports (MFC MD or MFC DC).
Compliance Audit/Investigator - CCS / CPC / or CCA MedStar HealthCompliance Audit/Investigator - CCS / CPC / or CCADC$65,062–$117,291 / yearPerforms concurrent and retrospective coding and documentation or clinical review audits of respective plan service areas including Behavioral Health services and other duties as assigned to detect potential compliance and/or fraud waste and abuse. Conducts provider coding and documentation audits for specific provider types including behavioral health for MFC DC depending upon the health plan that this role supports (MFC MD or MFC DC).
Dental Billing Specialist Howard UniversityDental Billing SpecialistDC$43,641–$48,006 / yearResearches and resolves submission issues and claim denials, acts as a liaison with third-party carrier professionals regarding reimbursement/ claim denial issues, requests and submits additional documentation/ radiographs as needed, and identifies the root cause of submission issues/denials and implements process and system or policy enhancements to limit issues and denials. MINIMUM REQUIREMENTS: Prefer an Associate's Degree or equivalent from a 2-year college or completion of a certified coding program and 2-3 years related experience - will consider applicants with relevant experience and minimum 2-3 years CPT or CDT coding experience.
Payment Policy Analyst (Remote) Blue Cross and Blue Shield AssociationPayment Policy Analyst (Remote)DCRemote$58,320–$115,830 / yearQUALIFICATIONS: Education Level: Bachelor''s Degree in Health Administration, Business, Finance, Nursing or related discipline OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Nurse Practitioner firsthand HealthNurse PractitionerWashingtonThe Centralized Health Guide is responsible for virtual whole person assessments and management of our vulnerable population, collaborating closely with community primary care and behavioral health providers, as well as an internal team of triage registered nurses and psychiatric nurse practitioners. Supporting individuals in developing and exercising self management skills and skills skills person-centered care around their individual goals and preferences via motivational interviewing and holistic care planning.
Sr. Manager, Department of Medicine Howard UniversitySr. Manager, Department of MedicineDC$90,909–$100,000 / yearManager for the Department of Medicine supports patient care, throughput and clinical operations for Medicine and Medicine subspecialties (Cardiology, Rheumatology, Infectious Disease, Pulmonology, GI, Nephrology, Endocrinology & Sleep Medicine). OR Certified Health Access Associate/Manager (CHAA or CHAM), Certified Professional Coder (CPC) or equivalent certification required w/ 5 years+ outpatient management experience.
Nurse Practitioner FirstHand Health IncNurse PractitionerWashington, DCThe experience you bring to this role includes: • 3+ years clinical care as a Nurse Practitioner, ideally in a primary care setting or emergency department • Working with and managing a population with challenges such as behavioral health and/or SUD conditions • Care management and coordination • Psych RN cert (optional, willingness to become certified). The Centralized Health Guide is responsible for virtual whole person assessments and management of our vulnerable population, collaborating closely with community primary care and behavioral health providers, as well as an internal team of triage registered nurses and psychiatric nurse practitioners.
Sr. Director, Risk Adjustment (0778) CINQCARESr. Director, Risk Adjustment (0778)Washington, DC$146,744–$183,435 / yearThis data science-forward role leverages advanced analytics, machine learning, and predictive modeling to maximize risk score accuracy, optimize reimbursement, and drive population health outcomes across Medicare Advantage, Medicaid Managed Care, and ACO REACH programs. • Develop and own the enterprise risk adjustment analytics strategy, roadmap, and governance framework across all lines of business including Medicare Advantage, Medicaid Managed Care, and ACO REACH.