Medical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley Hospital SCA HealthMedical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley HospitalBoise, IdahoAs part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.
Medical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley Hospital Surgical Care Affiliates LLCMedical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley HospitalBoise, IDAs part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Here, you'll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.
NewSupervisory Inpatient/Outpatient Medical Coder Loyal Source Government Services LLCSupervisory Inpatient/Outpatient Medical CoderBoise, IDLoyal Source Government Services is looking for 1 full-time Supervisory Inpatient/Outpatient Medical Records Technician (MRT) Coder to provide remote services to the VA Northeast Ohio Healthcare System located in Cleveland, OH. Supervisory MRT Coders are expected to maintain a high degree of accurate productivity and performance while working with our VA community at the VA Northeast Ohio Healthcare System in Cleveland, OH.
NewOutpatient Medical Record Technician Coder Loyal Source Government Services LLCOutpatient Medical Record Technician CoderBoise, IDLoyal Source Government Services is looking for 10 full-time Outpatient Medical Records Technician (MRT) Coders to provide remote services to the VA Northeast Ohio Healthcare System located in Cleveland, OH. MRT Coders are expected to maintain a high degree of accurate productivity and performance while working with our VA community at the VA Northeast Ohio Healthcare System in Cleveland, OH.
NewSurgical Medical Record Technician Coder Loyal Source Government Services LLCSurgical Medical Record Technician CoderBoise, IDAccurately perform the full scope of assigned coding, including ambulatory surgical cases, diagnostic studies and procedures, inpatient facility coding, including inpatient discharges, surgical cases, diagnostic studies and procedures, and inpatient professional services. Loyal Source Government Services is looking for 1 full-time Surgical Medical Records Technician (MRT) Coders to provide remote services to the VA Northeast Ohio Healthcare System located in Cleveland, OH.
NewInpatient Medical Record Technician Coder Loyal Source Government Services LLCInpatient Medical Record Technician CoderBoise, IDAccurately perform the full scope of assigned coding, diagnostic studies and procedures, inpatient facility coding, including inpatient discharges, surgical cases, diagnostic studies and procedures, and inpatient professional services. Loyal Source Government Services is looking for 3 full-time Inpatient Facility Medical Records Technician (MRT) Coders to provide remote services to the VA Northeast Ohio Healthcare System located in Cleveland, OH.
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)ID$43,888–$102,081 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
NewMedical Coding Quality Team Lead PacificSourceMedical Coding Quality Team LeadBoise, Idaho$65,296.83–$111,004.62 / yearOversee and support the Claims Refunds team with adjusting claims for refunds, sending refund letters and follow-up, sending to PRS for collection, posting refunds, balancing daily deposit and month end report. Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization Compensation Disclaimer .
NewMedical Coding Quality Team Lead PacificSource Health PlansMedical Coding Quality Team LeadBoise, ID$65,296.83–$111,004.62 / yearOversee and support the Claims Refunds team with adjusting claims for refunds, sending refund letters and follow-up, sending to PRS for collection, posting refunds, balancing daily deposit and month end report. Skills: Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization.
Program Manager-Risk Adjustment Blue Cross and Blue Shield AssociationProgram Manager-Risk AdjustmentMeridian, IDRemote$86,650–$129,974 / yearCollaborate with cross-functional teams, including, Provider Engagement, Risk Adjustment Coders, Data Analysts, vendors, Quality/HEDIS, Healthcare Operations, Compliance, Legal, Marketing, Corporate Communications, IT and Procurement to streamline processes, ensure compliant timely execution and to support data integrity. The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data.
Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystBoise, IDRemoteFull 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.
Charge Master Analyst Sutter HealthCharge Master AnalystBoise, ID$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.
NewProFee Audit Specialist- PRN DatavantProFee Audit Specialist- PRNBoise, IDRemote$35–$45 / hourAs 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.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Boise, IDRemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
Program Integrity Investigator TriWest Healthcare AllianceProgram Integrity InvestigatorBoise, IDRemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
Specialist, Appeals & Grievances (Must live in TX and Medicaid experience) Molina Healthcare IncSpecialist, Appeals & Grievances (Must live in TX and Medicaid experience)Nampa, IDRequests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met.
VP Claims & Payment Integrity Operations Blue Cross of IdahoVP Claims & Payment Integrity OperationsMeridian, IdahoRequired Education: Bachelor’s Degree in Business Administration, Healthcare Administration, Health Information Management or related field; or equivalent work experience (Two years’ relevant experience is equivalent to one-year college); Master's degree (MBA, MHA, MPH) strongly preferred. Proven track record of driving measurable savings and payment accuracy improvements through payment integrity initiatives and operational efficiency programs, with accountability for first-pass yield, financial accuracy, and payment accuracy benchmarks.
Special Investigations Unit Investigator CareOregon IncSpecial Investigations Unit InvestigatorID$74,250–$90,750 / yearStrong research, investigative and problem-solving skills Strong communication skills, including written, verbal and listening skills Effective computer skills, including MS Office Suite Strong interpersonal and motivational skills Ability to think logically and creatively without undue influence from personal biases Ability to operate with a high degree of professionalism and confidentially Ability to plan, organize, manage, and monitor work projects Ability to facilitate learning opportunities in a variety of informal and formal settings Ability to make presentations to small and large groups. Ability to bend and speak clearly for at least 3 hours/day Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read and hear and for at least 6 hours/day Ability to perform repetitive finger and wrist movement for at least 3-6 hours/day Ability to work effectively with diverse individuals and groups.
Vice President Claims & Payment Integrity Operations Blue Cross and Blue Shield AssociationVice President Claims & Payment Integrity OperationsMeridian, IDRequired Education: Bachelor's Degree in Business Administration, Healthcare Administration, Health Information Management or related field; or equivalent work experience (Two years' relevant experience is equivalent to one-year college); Master's degree (MBA, MHA, MPH) strongly preferred. Proven track record of driving measurable savings and payment accuracy improvements through payment integrity initiatives and operational efficiency programs, with accountability for first-pass yield, financial accuracy, and payment accuracy benchmarks.