DRG Validator Nesco Resource, LLCDRG ValidatorGarden City, NYRemote$95,000–$110,000 / yearThis role is responsible for auditing inpatient medical records to ensure the accuracy of coding, clinical documentation, and DRG assignment while maintaining compliance with applicable coding guidelines and regulatory requirements. Perform concurrent and retrospective clinical, MS-DRG, and APR-DRG validation reviews in accordance with UHDDS, Medicare guidelines, and applicable federal and state regulations.
Senior Outpatient Coder Westchester Medical Center Health NetworkSenior Outpatient CoderValhalla, NY$30.46–$38.29 / hourJob Details: Job Summary: The Senior Outpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records, including all diagnoses and operative and diagnostic procedures in patient medical records, using the current International Classification of Diseases (ICD 10CM), Current Procedural Terminology (CPT) and Health Care Financing Administration Common Procedures Coding System (HCPCS), and entering coded information into an automated grouper system. Job Category Job Category Advanced Clincial Providers Advanced Practice Providers Allied Health Prof/Technical Clerical/Administrative Support Executive/Management Finance/Info Systems Nursing Support Nursing/Nursing Management Physicians Professional/Non-Clinical Service/Trades.
Product Security Engineer Candid HealthProduct Security EngineerNew York, NY$180,000–$258,000 / yearMedical billing is expensive because it's nuanced and hard - maybe ~100x harder than credit card payment processing - and because it's traditionally done by armies of humans who track and manage complex rules and processes specific to individual insurance companies with little or no supporting software. We're rethinking medical billing from the ground up, building software backed by best-in-class data science (and, soon, a dash of machine learning) to automate much of this complexity so healthcare providers can get paid dramatically more easily and inexpensively.
Senior Compliance Auditor Montefiore Medical CenterSenior Compliance AuditorBronx, NY$81,600–$102,000 / yearDevelops and conducts documentation, coding and billing curriculum and education classes for 500 + physicians, allied health professionals, and coding and billing associates annually, including: One-on-one education sessions based on audit findings. Safeguards Montefiore Medical Center revenue and reputation, through the following activities: Participates in external government audits, including: NY Office of Medicaid Inspector General (OMIG).
NewClaims Specialist- Liab Crawford & CoClaims Specialist- LiabBerkeley Heights, NJTo determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim.
Care Manager (Clinical) [CMA] Guideway Care, Inc.Care Manager (Clinical) [CMA]NYUsing computer applications Making and answering phone calls the majority of the shift Welcoming patients Reviewing patient medical records Coding and filling out insurance forms Scheduling appointments Arranging for hospital admissions and laboratory services Handling correspondence, billing, and bookkeeping Escalating patient concerns or needs to appropriate provider. Essential Functions: (may include, but not limited to): Manage and support patients' healthcare needs via telephonic outreach Conduct and document visits by using several technology platforms and EHRs Monitors adherence to care plans, evaluates effectiveness, monitors patient progress in a timely manner, and facilitates changes as needed.
NewOncology Authorization Specialist St. Joseph's Healthcare SystemOncology Authorization SpecialistPaterson, NJThe combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care". Key responsibilities include verifying insurance coverage, obtaining necessary authorizations, and providing clear cost estimates to patients, thereby promoting transparency and reducing financial uncertainty.
Director, Provider Education & Risk Adjustment Metropolitan Jewish Health SystemDirector, Provider Education & Risk AdjustmentNew York, New YorkFull timeThey are responsible for implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. • Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.
Community Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET) AnewHealthCommunity Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET)NJRemoteAbility to communicate effectively and professionally through written, verbal (e.g., face-to-face, telephonically and/or virtual communication platforms), and interpersonal skills as applied when interacting with employees, patients, healthcare professionals, clients, or agency representatives; successfully conveying and exchanging information at an appropriate level and in a positive and timely manner. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly.
NewMgr - Multi-Facility CDI - SMNJ Medical Records FAC#1 Saint Michaels Medical CenterMgr - Multi-Facility CDI - SMNJ Medical Records FAC#1Newark, New JerseyFull timeCombining state-of-the-art technology, the latest diagnostic and therapeutic procedures, leading-edge research, and a network of highly qualified physicians, nurses, and allied health professionals, the hospital provides top-quality health care services delivered with compassionate care. Established by the Franciscan Sisters of the Poor in 1867, Saint Michael's Medical Center is a 358-bed regional tertiary-care, teaching, and research center in the heart of Newark's business and educational district and is accredited by The Joint Commission.
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.
Clinical Documentation Specialist - DRG Appeals Catholic HealthClinical Documentation Specialist - DRG AppealsMelville, New York$130,000–$170,000 / yearContinuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation, clinical validation for inpatient diagnoses that impact the code selection, resulting DRG, and payment. Provides feedback to HIM management staff and CDI leadership regarding opportunities for documentation improvement, and participates with the planning and development of educational programs directed towards improving documentation.
CDI Specialist Episcopal Health Services IncCDI SpecialistNYAdditionally, St. Johns is proud to be redesignated as a Baby-Friendly Hospital by Baby-Friendly USA - the accrediting body and national authority for the Baby-Friendly Hospital Initiative (BFHI) in the United States. The hospital is a recipient of the Gold-Plus Get with the Guidelines-Stroke Quality Achievement Award and the Gold-Plus Get with the Guidelines-Heart Failure Quality Achievement Award from the American Heart Association.
Clinical Documentation Specialist - DRG Appeals St. Catherine of Siena Medical CenterClinical Documentation Specialist - DRG AppealsMelville, NY$130,000–$170,000 / yearContinuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation, clinical validation for inpatient diagnoses that impact the code selection, resulting DRG, and payment. Provides feedback to HIM management staff and CDI leadership regarding opportunities for documentation improvement, and participates with the planning and development of educational programs directed towards improving documentation.
Full-Time NSQIP Clinical Data Abstractor (Hourly) Non-Exempt Carta HealthcareFull-Time NSQIP Clinical Data Abstractor (Hourly) Non-ExemptNew York City, NYRemotePaid Holidays: "Full-time hourly employees receive six paid holidays per year: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas Day, paid at their regular hourly rate. Carta Healthcare is dedicated to building a diverse and inclusive company because we serve health systems across the country; we've seen how our product and impact are strengthened the more we reflect that diversity.
Senior Coding and Revenue Integrity Analyst Boston Medical CenterSenior Coding and Revenue Integrity AnalystNYRemote$78,000–$113,000 / yearREQUIRED EDUCATION AND EXPERIENCE: Associate's degree in Business, Healthcare, or a related field; and at least five (5) years of healthcare experience, including at least two years in an active role involving coding, auditing, finance, revenue cycle management, and/or physician billing (preferably within an Academic Medical Center setting); or equivalent combination of education and experience. ESSENTIAL RESPONSIBILITIES / DUTIES: Revenue Cycle Initiative Leadership: Leads complex revenue cycle initiatives and large-scale optimization projects across high-revenue-generating or at-risk clinical departments to improve overall revenue integrity, operational efficiency, and regulatory compliance.
Certified Coding Auditor St. Joseph's Healthcare SystemCertified Coding AuditorPaterson, NJWork requires the level of knowledge normally acquired through the completion of two to three years of occupationally specific education beyond high school OR an Associates degree in Medical Record Technology or closely related field and two to three years of previous work related experience. Responsible for audits which are internal record reviews for compliance with coding regulations and guidelines in order to provide rebuttals to CMS or other payer denials and to assist and improve on physician correct coding/documentation education.
Medical Coding Specialist Therapymatch, Inc.Medical Coding SpecialistNY$60,520–$89,000 / yearA notice to Headway applicants: To protect yourself against phishing and recruitment fraud, please note that Headway only accepts applications through our official careers page at https://headway.co/careers . Determine whether a flagged finding is accurate - confirming genuine documentation and coding errors, and identifying findings that were flagged incorrectly so they can be corrected and escalated.
Medical Billing & Coding Instructor American InstituteMedical Billing & Coding InstructorClifton, New Jersey$24–$27 / hourOther skills and abilities - ability to inspire students to meet career goals by tying course curriculum to potential career outcomes, Learning Management Systems, Student Information Systems, synchronous instructional tools. You collaborate closely with program leaders and other departments to enhance student success, foster retention, support certification, celebrate graduation milestones, and facilitate successful career placements.
NewCoding Analyst II Medica Health Plans IncCoding Analyst IINY$45,900–$68,775 / yearAnnual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the positions scope and responsibility, internal pay equity and external market salary data. The analyst also supports cross-functional partners by offering coding expertise that strengthens data integrity, payment accuracy, and operational consistency.