RCM Coordinator - Claims Resolution Metrocare ServicesRCM Coordinator - Claims ResolutionHillside, New YorkThe RCM Coordinator – Claims Resolution serves as a key financial liaison within the Revenue Cycle Management team, responsible for ensuring the integrity of claim submission, payment accuracy, and denial prevention across multiple service lines including primary care, behavioral health, intellectual and developmental disability (IDD) services, early childhood intervention (ECI), applied behavior analysis (ABA) therapy, and LIDDA programs. In addition to behavioral health care, Metrocare provides primary care centers for adults and children, services for veterans and their families, accessible pharmacies, housing, and supportive social services.
Coding Specialist Job DetailsCoding SpecialistFort Lee, New Jersey$62,400–$78,600 / yearReview clinical documentation in 3M and Epic to assign accurate ICD-10-CM, CPT, HCPCS Level II codes, and applicable modifiers for Radiology and Interventional Radiology procedures in accordance with official coding guidelines. Independently code Interventional Radiology procedures, including complex multi-component cases, and apply appropriate evaluation and management (E/M) consultation codes as needed.
SIU Investigator Centene Corporation GroupSIU InvestigatorNJ$56,200–$101,000 / yearCollaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.
Special Investigation Unit Investigator Centene Corporation GroupSpecial Investigation Unit InvestigatorNJ$56,200–$101,000 / yearEducation/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience (or) An Associates or Bachelor's degree in criminal justice or a related field; (or) employment as an investigator in the MMCO's SIU on or before the effective date of this SubPart required. Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters.
Billing Coordinator(Level III) - (FGP), Manhattan, Plastic Surgery New York University School of MedicineBilling Coordinator(Level III) - (FGP), Manhattan, Plastic SurgeryNew York, NY$70,481.60–$104,622 / yearDemonstrate a significant level of expertise in subject matter to assist and mentor entry-level coding staff, support the operations lead/supervisor in managing day-to-day team activities against scope and timeline, and ensure timely reporting of activities. Collaborate with the corporate Revenue Integrity Analysts to understand CPT and ICD-10 guidelines, payer policy and procedure manuals, updates, and CMS publications to ensure practices are compliant with current policies and procedures.
Billing Coordinator(Level III) - (FGP), Manhattan, Plastic Surgery NYU Langone HealthBilling Coordinator(Level III) - (FGP), Manhattan, Plastic SurgeryNew York, NY$70,481.60–$104,622Full timeDemonstrate a significant level of expertise in subject matter to assist and mentor entry-level coding staff, support the operations lead/supervisor in managing day-to-day team activities against scope and timeline, and ensure timely reporting of activities. • Collaborate with the corporate Revenue Integrity Analysts to understand CPT and ICD-10 guidelines, payer policy and procedure manuals, updates, and CMS publications to ensure practices are compliant with current policies and procedures.
Billing Coordinator II - Urology New York University School of MedicineBilling Coordinator II - UrologyMineola, NY$66,300–$72,345 / yearPreferred Qualifications: Certified Coding Specialist Certification (CCS) or Certified Coding Specialist- Physician-based (CCS-P) or Certified Professional Coder (CPC), Certified Outpatient Coding (COC) preferred. Collaborate with the corporate Revenue Integrity Analysts to understand CPT and ICD-10 guidelines, payer policy and procedure manuals, updates, and CMS publications to ensure practices are compliant with current policies and procedures.
Billing Coordinator II - Urology NYU Langone HealthBilling Coordinator II - UrologyMineola, NY$66,300–$72,345Full timeCertified Coding Specialist Certification (CCS) or Certified Coding Specialist- Physician-based (CCS-P) or Certified Professional Coder (CPC), Certified Outpatient Coding (COC) preferred. Collaborate with the corporate Revenue Integrity Analysts to understand CPT and ICD-10 guidelines, payer policy and procedure manuals, updates, and CMS publications to ensure practices are compliant with current policies and procedures.
DRG Reviewer MedReviewDRG ReviewerNew York, NYRemote$85,000–$90,000 / yearUnder the direction of the DRG Operations leadership team, the DRG Reviewer conducts reviews of inpatient claims to ensure coding accuracy and appropriate DRG assignment while identifying cases requiring clinical review to support coded diagnoses. Responsibilities: Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.
Director, Clinical Data Management PTC TherapeuticsDirector, Clinical Data ManagementWarren, NJ$200,700–$252,600 / yearThe Director, Clinical Data Management provides strategic and operational leadership and oversight of data management activities to ensure the quality, integrity, consistency and inspection readiness of clinical databases for subsequent analysis, reporting and regulatory submissions. Participate in cross functional team meetings, as requested, and communicate with all departments regarding project statuses/issues, provide ongoing feedback on data management workflows to increase efficiency and provide feedback to CRAs.
ProFee Audit Specialist- PRN DatavantProFee Audit Specialist- PRNNew York, NYRemote$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. The estimated base pay range per hour for this role is: $35—$45 USD To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc.
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.
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.
Product Safety Data Coordinator and Coding Associate LancesoftProduct Safety Data Coordinator and Coding AssociateNutley, NJRemote$25Computer proficiency required, including data entry of adverse event information. Description of Responsibilities: Code and enter information into the Product Safety database for Adverse Events.
NewHealthcare Revenue Cycle Coding Director Chartis Group LLCHealthcare Revenue Cycle Coding DirectorNY$100–$120 / hourThe hourly range for this role takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to, skills, experience, training, licensure and certifications, practice area, and other business and organizational needs. We work with more than 1,250 organizations annually to develop and activate transformative strategies, operating models, and organizational enterprises that make US healthcare more affordable, accessible, safe, and human.
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.
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.
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.
Clinical Reimbursement Manager; DRG Manager; Mount Sinai Hospital Mount Sinai Health SystemClinical Reimbursement Manager; DRG Manager; Mount Sinai HospitalNew York, NY$79,720–$128,115.52 / yearMount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology.
Auditor, HCC Risk Adjustment Coding Datavant LLCAuditor, HCC Risk Adjustment CodingNY$29–$32 / hourGuided 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. At Datavant our total rewards strategy powers a high-growth, high-performance, health technology company that rewards our employees for transforming health care through creating industry-defining data logistics products and services.