NewCoder Quality Auditor Ensemble Health PartnersCoder Quality AuditorPortsmouth, RIRemote$57,400–$99,000Reporting - Provides reports of audit findings to coding management, individual coders and leadership as needed/requested along with providers that are contracted/employed and outlined in the client SOW. Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts.
NewPhysician Coding Auditor Ensemble Health PartnersPhysician Coding AuditorPortsmouth, RIRemote$57,400–$99,000The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Educating - Assesses the educational needs of coding staff and providers that are contracted/employed and outlined in the client SOW (included Provider Education verbiage) and develops programs or researches educational resources to meet those needs.
Coder, Physician Medical Boston Children's HospitalCoder, Physician MedicalMA$26.62–$42.59 / hourEstablishes and maintains working relationships with Physicians in order to resolve specific case issues, as well as general questions and or principles. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team.
Certified Professional Coder, Full Time Days, 40 Hours, Central Business Office Day Kimball Healthcare IncCertified Professional Coder, Full Time Days, 40 Hours, Central Business OfficeCTCertified Professional Coder Job Summary Under the general supervision of the Director of Professional Revenue Cycle, the Certified Professional Coder performs all phases of abstracting, diagnosis coding, charge capture and posting through record analysis. Conduct quarterly chart audits; in collaboration with the Director of Professional Fee Revenue Cycle, provide one-on-one or small group education to clinical staff on audit results while maintaining professionalism.
NewInpatient Certified Coder Care New England Health SystemInpatient Certified CoderWarwick, Rhode IslandPart timeAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Job Summary: The role of a Certified Inpatient Coder at Care New England is to ensure accurate coding and abstracting of all inpatient services, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record.
Certified Inpatient Coder Care New England Health SystemCertified Inpatient CoderWarwick, Rhode IslandFull timeAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Job Summary: The role of a Certified Inpatient Coder at Care New England is to ensure accurate coding and abstracting of all inpatient services, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record.
HIM Certified Coder Per Diem Care New England Health SystemHIM Certified Coder Per DiemPawtucket, Rhode IslandPer diemAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. All work carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic), ICD9 (ICD10 when applicable), AMA CPT and CMS coding guidelines.
HIM Coder 40D Care New England Health SystemHIM Coder 40DProvidence, Rhode IslandFull timeAbout Us: Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. All work carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic), ICD9 (ICD10 when applicable), AMA CPT and CMS coding guidelines.
Coding Specialist Outpatient Telecommute-Surgical Coder Brown University HealthCoding Specialist Outpatient Telecommute-Surgical CoderRI$24.29–$40.07 / hourMonitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity and various other coding and billing issues. Reviews the outpatient clinical documentation of extract data and assign appropriate ICD-10-CM and CPT codes in accordance with the outpatient ICD-10-CM Official Guidelines for Coding and Reporting and the AHA HCPCS Coding Clinics.
Special Investigation Unit (SIU) Manager CVS Health CorpSpecial Investigation Unit (SIU) ManagerRI$54,300–$159,120 / yearThe Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers. Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.
Coding & Compliance Auditor South Shore Health Systems IncCoding & Compliance AuditorWeymouth, MA$73,000–$104,400 / yearResponsibilities if Required: Education if Required: License/Registration/Certification Requirements: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician Based - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator - American Health Information Management Association (AHIMA). The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders.
Coding and Compliance Auditor South Shore HealthCoding and Compliance AuditorWeymouth, MAThe Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. Support all departments of the Health System with coding guidance: Pertaining to compliance training / education as requested from providers and/or staff related to coding, billing and documentation in the inpatient, outpatient, professional, surgical and Home Health divisions of the Health System to ensure accuracy and support program objectives.
RN Clinical Auditor (43914) Neighborhood Health Plan of Rhode IslandRN Clinical Auditor (43914)Smithfield, RIQualifications: Required: • Registered Nurse with an active, current, unrestricted license in RI in good standing • Minimum of three (3) years experience in healthcare coding directly related to determining appropriate diagnosis, procedure and other codes used in billing for services, utilization management, medical record auditing, or health care quality improvement • Knowledge of clinical medical record documentation requirements • A high-level knowledge of medical terminology • Proficient with various technology software tools, including Microsoft Office • Excellent written and verbal communication skills, and strong attention to detail • Ability to maintain confidentiality • Ability to take direction and support a multitude of individuals • Ability to work independently and prioritize activities. Preferred: • Working knowledge of fraud, waste and abuse policies and practices • Evaluation and management coding and auditing expertise • Knowledge of Behavioral Health billing & coding guidelines and/or regulatory guidelines • Electronic medical record review experience • Electronic investigative case management and/or healthcare claims data mining tool experience.
Payment Integrity Program Development Manager Devoted Health ServicesPayment Integrity Program Development ManagerMassachusettsRemoteThat’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. (Note: We provide modern AI tools to generate and edit SQL scripts; you do not need to be a software expert, but you must possess the ability to read, interpret, and understand data scripts to validate results and analyze proof-of-concept datasets).
Revenue Integrity Specialist Top Prospect Group LLCRevenue Integrity SpecialistGreater Boston, MARevenue Integrity Specialist (Professional Billing) Position Overview Serves as a Charge Generation Tracker (CGT) and regulatory resource to ensure compliance with coding and billing guidelines. Acts as a primary resource for providers and staff, supporting revenue integrity, charge capture, and coding accuracy.
Grievance and Appeals Specialist (44017) Neighborhood Health Plan of Rhode IslandGrievance and Appeals Specialist (44017)Smithfield, RIBuild effective and successful inter-departmental relationships with all areas of the company and utilize good communication and customer service skills in responding to internal and external inquiries about the grievance, appeal and complaint processes while being able to respond quickly regarding the status. Duties and Responsibilities: Responsibilities include but are not limited to: Responsible for accurate identification of all Medicaid, Medicare and Commercial grievances, appeals, and complaints, including potential Quality of Care complaints or grievances and provider claims disputes.
Investigator II Point32Health, Inc.Investigator IICanton, MA$80,741.22–$121,111.82 / yearKey Responsibilities/Duties - what you will be doing (top five): Lead moderately complex to complex investigations in established and emerging areas of Fraud Waste and Abuse (FWA) involving internal and external research, detailed data analyses, review of medical records, and interviews of members, providers, and other third parties. The Investigator II is an essential team member of the Special Investigation Unit (SIU) responsible for leading complex provider investigations related to fraud, waste, and abuse, and developing action plans to address the investigative findings and prevent future loss.
Claim Auditor Payment Integrity (44544) Neighborhood Health Plan of Rhode IslandClaim Auditor Payment Integrity (44544)Smithfield, RIClaim payment accuracy will be recognized through sound audit review methods and practices, including but not limited to; claim payment evaluation, medical chart review, claim payment data analysis and assessment of established organizational contractual parameters. The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)RI$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Ambulance Billing & Revenue Cycle Specialist EPOCH HEALTHCARE LLCAmbulance Billing & Revenue Cycle SpecialistNorwood, MAhandle claims submission, payment posting, denials management, and collections for Medicare. • Enter BLS/ALS level-of-service codes, mileage, diagnosis codes (ICD-10), and procedure codes.
Investigator, Special Investigations Unit (Meritain Health) CVS Health CorpInvestigator, Special Investigations Unit (Meritain Health)RI$46,988–$122,400 / yearDemonstrated proficiency in Microsoft Office Suite (including Excel, specifically with pivot tables), database search tools, and use of the Intranet/Internet to research information. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpInvestigator, Special Investigations Unit (Aetna SIU)MA$43,888–$93,574 / yearExperience with Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research. Bachelor's Degree in Criminal Justice, Healthcare Management, Public Health, Biological Sciences, Data Analytics, or other related field preferred or equivalent experience.