Medical Coder - Revenue Integrity Audit Job at Clarus RCM (Pasig, Manila)

Coding Services Manager

We are looking for a Coding Services Manager (Professional Services) for a full-...

Location

United States , Las Vegas

Salary:

77000.00 - 124000.00 USD / Year

Dynamic Computing Services

Expiration Date

Until further notice

Requirements

Equivalent to a Bachelor’s Degree in Health Information Management or related field
five (5) years of coding/auditing experience in an acute care setting
three (3) years of supervisory/management role experience
Certified Professional Coder (CPC) or multiple specialty-specific coding certifications from AAPC or Certified Coding Specialist, Physician-based (CCS-P) or Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) from AHIMA
Knowledge of Federal, state and county laws and regulations governing coding
modern theories, principles and practices of effective supervision
coding principles and guidelines including ICD-10-CM/PCS, CPT/E&M, and HCPCS
coding documentation and billing regulations related to Medicare, Medicaid, and commercial insurance
revenue cycle workflows including charges/charge master, code edits, auditing, denials management, and documentation improvement
budget principles and practices

Job Responsibility

Manages the daily operations and delivery of physician office and professional fee coding services with adherence to established coding guidelines
responsible for managing the coordination of accurate and compliant Professional Services coding of pertinent medical information
ensures accurate assignment of codes and compliance with regulatory requirements
Assists in determining strategic priorities and planning for unit operations and participates in the audit projects and provides education to the Professional Services coding team based on the audit findings

What we offer

Employer Paid Pension Plan through Nevada Public Employees’ Retirement System “PERS”
Vesting in the pension plan after 5 years of qualifying employment
Health/Dental/Vision Insurance – Less than $20 per paycheck for employee-only coverage
Consolidated Annual Leave (CAL) – CAL is used for personal leave, holidays (twelve scheduled holidays per year), doctor appointments, vacation, and sick days up to 16 consecutive scheduled work hours (short-term sick leave), etc.
Extended Illness Bank (a/k/a Sick Bank)
457 Deferred Compensation Plan
Comprehensive Group Health Insurance Plan
Nevada has no State Income Tax
No Social Security (FICA) Deduction

Fulltime

Coder IV facility hospital based

Location

United States

Salary:

30.15 - 45.25 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Minimum of five years' of coding experience in an academic medical center or an equivalent combination of coding experience and education with demonstrated competency of knowledge base
Coding QA background or similar experience preferred
Satisfactory completion of college level courses in anatomy, physiology and medical terminology preferred
EPIC health information system experience preferred
Coding certification CCA, CIC, CPC-H, CPC, CCS, RHIT, or RHIA required
Ability to concentrate for extended periods
Knowledge of medical terminology and basic anatomy, physiology, pathophysiology, and pharmacology with ability to apply knowledge to the coding process
Demonstrates skill in coding classification systems, diagnosis, procedure selection, and sequencing guidelines
Knowledge of APC prospective payment system
Demonstrates competence in coding and correct extrapolation of official coding and select billing guidelines to specific coding situations

Job Responsibility

Ensures the timely and accurate coding and completion of patient accounts within established departmental accuracy and productivity standards
Applies correct ICD CM/PCS (Inpatient) and ICD CM/CPT codes (Outpatient) guidelines meeting departmental policy regarding compliant methods, timeframes, use of applications and productivity
Assists in demonstrating medical necessity for procedures performed by ensuring that all documented disease processes are coded
Demonstrates proficiency in utilizing official coding books as well as the electronic medical record, computer assisted coding/encoding software, and clinical documentation information systems to facilitate code assignment
Reviews facility charges as provided and edits where necessary to ensure charges are compliant and substantiated by provider documentation
May require frequent and close collaboration with multiple areas of the organization including providers, Professional Coding, and Finance for audit and problem-solving activities
Demonstrates full understanding and is compliant with correct coding initiative guidelines, regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS) and other payers, and the Joint Commission
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines
Queries physician when existing documentation is unclear or ambiguous following AHIMA guidelines and established policy
Brings identified concerns to Manager Coding for resolution

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Professional Coding Lead-Oncology

Acts as a resource and role model to team members. Codes routine to complex proc...

Location

United States , Milwaukee

Salary:

30.70 - 46.05 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)
Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience.
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.
Advanced proficiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
Excellent communication (oral and written) and interpersonal skills.
Excellent organization, prioritization, and reading comprehension skills.
Excellent analytical skills, with a high attention to detail.
Ability to work independently and exercise independent judgment and decision making.

Job Responsibility

Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance. Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues.
Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers. Meets or exceeds department quality and production standards.
Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy. May assist with provider education/orientation regarding policy requirements of federal and state government agencies.
Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols. Detects, reports and acts as a resource to assist in resolving billing compliance issues. Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders.
Responsible for processing denial management claims and addressing patient concerns. Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit. Coordinates payer audit reviews and acts as a resource for coding-related audits.
Participates in various department projects including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, presenting demonstrations, etc. Acts as the system/application administrator
ensures the integrity of the system and recognizes performance issues. Performs calibration and troubleshooting procedures and escalates unresolved issues as needed.
Suggests modifications to current policies and procedures that are needed to coincide with requirements of insurance payers. Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver.
Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance

Fulltime

Professional Coding Lead-Oncology

Location

United States , Milwaukee

Salary:

30.70 - 46.05 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)
Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience.
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.
Advanced profiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
Excellent computer skills including the use of Microsoft officeproducts, electronic mail, including exposure or experience with electronic coding systems or applications.
Excellent communication (oral and written) and interpersonal skills.
Excellent organization, prioritization, and reading comprehension skills.
Excellent analytical skills, with a high attention to detail.
Ability to work independently and exercise independent judgment and decision making.

Job Responsibility

Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance. Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues.
Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers. Meets or exceeds department quality and production standards.
Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy. May assist with provider education/orientation regarding policy requirements of federal and state government agencies.
Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols. Detects, reports and acts as a resource to assist in resolving billing compliance issues. Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders.
Responsible for processing denial management claims and addressing patient concerns. Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit. Coordinates payer audit reviews and acts as a resource for coding-related audits.
Participates in various department projects including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, presenting demonstrations, etc. Acts as the system/application administrator
ensures the integrity of the system and recognizes performance issues. Performs calibration and troubleshooting procedures and escalates unresolved issues as needed.
Suggests modifications to current policies and procedures that are needed to coincide with requirements of insurance payers. Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver.
Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Professional Coding Lead-Oncology

Location

United States , Milwaukee

Salary:

30.70 - 46.05 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)
Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues
Advanced profiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology
Excellent computer skills including the use of Microsoft officeproducts, electronic mail, including exposure or experience with electronic coding systems or applications
Excellent communication (oral and written) and interpersonal skills
Excellent organization, prioritization, and reading comprehension skills
Excellent analytical skills, with a high attention to detail
Ability to work independently and exercise independent judgment and decision making

Job Responsibility

Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance. Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues
Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers. Meets or exceeds department quality and production standards
Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy. May assist with provider education/orientation regarding policy requirements of federal and state government agencies
Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols. Detects, reports and acts as a resource to assist in resolving billing compliance issues. Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders
Responsible for processing denial management claims and addressing patient concerns. Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit. Coordinates payer audit reviews and acts as a resource for coding-related audits
Participates in various department projects including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, presenting demonstrations, etc. Acts as the system/application administrator
ensures the integrity of the system and recognizes performance issues. Performs calibration and troubleshooting procedures and escalates unresolved issues as needed
Suggests modifications to current policies and procedures that are needed to coincide with requirements of insurance payers. Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver
Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate
Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Coder Lead Facility - Day Surgery/Observation

Acts as a resource and role model to team members. Codes routine to complex proc...

Location

United States

Salary:

30.70 - 46.05 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)
Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics
Knowledgeable in researching coding related topics and issues
Advanced proficiency of ICD, CPT and HCPCS coding guidelines
Advanced knowledge of medical terminology, anatomy and physiology
Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications
Excellent communication (oral and written) and interpersonal skills
Excellent organization, prioritization, and reading comprehension skills

Job Responsibility

Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance
Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues
Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers
Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy
May assist with provider education/orientation regarding policy requirements of federal and state government agencies
Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols
Detects, reports and acts as a resource to assist in resolving billing compliance issues
Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders
Responsible for processing denial management claims and addressing patient concerns
Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance

Fulltime

Hcc coding auditor senior - hp network documentation integration

Coding Auditor Senior will perform code audits and abstraction using the Officia...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High School Diploma required or equivalent
Excellent written and verbal communication skills
Ability to drive within assigned areas or overnight travel for internal or external meetings
Capacity to attend remote provider meetings day/evening/weekends as needed within assigned regions as defined by manager/leadership
At least three (3) years of hospital inpatient/outpatient or medical office coding experience, preferably three (3) years risk adjustment coding experience
Prior experience teaching/training others on correct coding guidelines and have the ability to present to large groups of Physicians/Providers
Coding certification required through AHIMA or AAPC (at least two of the below): Certified Professional Coder (CPC) required
Certified Risk Adjustment Coder (CRC) preferred
Certified Coding Specialist for Providers (CCS-P) preferred
Registered Health Information Management Technician (RHIT) preferred

Job Responsibility

Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk adjustment
Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS (HCC) Risk Adjustment guidelines
Perform coding quality audits within multiple EMRs, databases, and/or vendor platforms to support both employed and independent clinic risk adjustment strategies
Identifies revenue, reimbursement, and provider educational opportunities while remaining compliant with state and federal regulations
Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines
Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices to ensure chronic conditions are recaptured annually
Ensures that rendered physician services for claim submission and any subsequent payments are as accurate as possible while complying with regulatory guidelines including CMS, DHS, and OIG
Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes

Fulltime

Site Reliability Engineer

An Elite FinTech Firm is looking for a highly talented DevOps Engineer/Systems S...

Location

Hong Kong , Hong Kong

Salary:

1200000.00 HKD / Year

Hunter Bond

Expiration Date

Until further notice

Requirements

Genuine passion in Linux & Open-source
Excellent knowledge of Python
Use of CI/CD, Docker, Ansible, Chef, Puppet
Knowledge of large-scale storage systems (on-prem)

Job Responsibility

Help architect a resilient, multi-petabyte storage solutions & build new data centres
Automate anything and everything with Python & config tools
Innovate whilst bringing in new ideas

What we offer

Flexible hours/work options
Working in one of the world’s most elite teams
Invest heavily in cutting-edge and next-gen tech
Technologists only report to other technologists
Brand new skyline Manhattan office
Start-up style environment

Fulltime

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Medical Coder - Revenue Integrity Audit

Job Description

Job Responsibility

Requirements

Nice to have

What we offer

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