Physician Coding Review Specialist Job at Advocate Health Care

Risk Adjustment Education Specialist

This Job will report to the Risk Adjustment Manager of Coding Operations. Respon...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate degree or equivalent experience required
5 years of experience in a hospital, a physician setting, or a Managed Care Organization as a medical coder required
2 years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) required
Other experience in teaching, training, or an educator/instructor role is needed
Must have experience in creating effective training materials and presentations (PowerPoint, Adobe, etc.)
Certified Professional Coder (CPC) from AAPC is required
Certified Risk Adjustment Coder (CRC) from AAPC is preferred
An RN or LVN must obtain both CPC and CRC within 12 months of hire
Must be proficient in Prospective, Retrospective, and Concurrent review processes
Must have strong clinical knowledge of disease pathology and ability to identify clinical indicators related to chronic disease

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Subject matter experts for proper risk adjustment coding and CMS data validation
Work in conjunction with other departments, including Provider Relations, Quality, and the Medical Director, to ensure compliance with CMS risk adjustment guidelines
Analyze MRA data to identify patterns and development of provider and market-level interventions to coordinate an educational work plan for providers
Conduct provider education and training regarding risk adjustment to help ensure accurate CMS payment and improve care quality
This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc
Responsible for building positive relationships with assigned Physicians and serving as a contact for any questions or concerns that may arise
Identify those Practices that need initial or ongoing additional training
Perform other duties as necessary

Fulltime

New

Clinician Coding Liaison - Hospital Based Specialties

Location

United States

Salary:

34.90 - 52.35 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification, or Coding Specialist (CCS) certification, or Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA) or Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC). Additional credential preferred.
Completion of advanced training through a recognized or accredited program, equivalent in scope and rigor to post-secondary education or equivalent knowledge. High school diploma or GED required.
Typically requires 4 years of experience in expert-level professional coding.
Advanced Coding Expertise: In-depth knowledge of ICD, CPT, and HCPCS coding guidelines, ensuring accurate and compliant coding practices.
Medical Terminology & Anatomy: Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment.
Epic & Reporting Solutions: Advanced knowledge of Epic and other reporting tools to analyze data, generate reports, and optimize workflow efficiencies.
Critical Thinking & Analytical Skills: Highly proficient in problem-solving and analytical thinking with strong attention to detail.
Interpersonal Communication: Excellent verbal and written communication skills, with the ability to educate and collaborate effectively with physicians, APCs, clinical leadership, and coding teams.
Advanced Computer Skills: Proficiency in Microsoft Office Suite, electronic coding applications, and email communication.
Organizational & Prioritization Skills: Ability to efficiently manage multiple tasks, set priorities, and meet deadlines in a fast-paced environment.

Job Responsibility

Deliver proactive coding education through newsletters, scorecards, and presentations, covering CPT (E&M, modifiers), ICD-10-CM, HCPCS, Risk Adjustment, payer requirements, and rejection resolutions.
Lead onboarding and compliance training for all employed Physicians/APPs, including Locum Tenens, residents, and students, ensuring documentation accuracy from the start.
Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks, escalating non-coding issues to appropriate teams.
Serve as the primary contact for coding inquiries, coordinating with internal teams to resolve complex issues such as NCCI bundling and high-complexity charge edits.
Monitor Epic work queues (charge review, follow-up, claim edit) to ensure timely and accurate charge submissions and reduce claim denials.
Collaborate across departments—including CMOs, Clinical Informatics, Risk Adjustment, and Population Health—to enhance documentation practices and system optimization.
Participate in specialty and department meetings, identifying trends and delivering targeted education to improve coding and documentation accuracy.
Refine Epic documentation tools, including templates, order entries, diagnosis lists, and SmartSets/SmartPhrases, to improve efficiency and accuracy.
Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA’s Standards of Ethical Coding, while maintaining expert knowledge of evolving policies.
Promote a culture of ethical coding and continuous improvement, supporting clinicians with timely updates, feedback, and education to ensure accurate reimbursement and compliance.

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

New

Clinician Coding Liaison - Medical Based Specialties

This position delivers coding education, provides individualized documentation f...

Location

United States

Salary:

35.50 - 53.25 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification, or Coding Specialist (CCS) certification, or Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA) or Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC). Additional credential preferred.
Completion of advanced training in revenue cycle management through a recognized or accredited program, equivalent in scope and rigor to post-secondary education. High school diploma or GED required.
Typically requires 4 years of experience in expert-level professional coding.
Advanced Coding Expertise: In-depth knowledge of ICD, CPT, and HCPCS coding guidelines, ensuring accurate and compliant coding practices.
Medical Terminology & Anatomy: Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment.
Epic & Reporting Solutions: Advanced knowledge of Epic and other reporting tools to analyze data, generate reports, and optimize workflow efficiencies.
Critical Thinking & Analytical Skills: Highly proficient in problem-solving and analytical thinking with strong attention to detail.
Interpersonal Communication: Excellent verbal and written communication skills, with the ability to educate and collaborate effectively with physicians, APCs, clinical leadership, and coding teams.
Advanced Computer Skills: Proficiency in Microsoft Office Suite, electronic coding applications, and email communication.
Organizational & Prioritization Skills: Ability to efficiently manage multiple tasks, set priorities, and meet deadlines in a fast-paced environment.

Job Responsibility

Deliver proactive coding education through newsletters, scorecards, and presentations, covering CPT (E&M, modifiers), ICD-10-CM, HCPCS, Risk Adjustment, payer requirements, and rejection resolutions.
Lead onboarding and compliance training for all employed Physicians/APPs, including Locum Tenens, residents, and students, ensuring documentation accuracy from the start.
Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks, escalating non-coding issues to appropriate teams.
Serve as the primary contact for coding inquiries, coordinating with internal teams to resolve complex issues such as NCCI bundling and high-complexity charge edits.
Monitor Epic work queues (charge review, follow-up, claim edit) to ensure timely and accurate charge submissions and reduce claim denials.
Collaborate across departments—including CMOs, Clinical Informatics, Risk Adjustment, and Population Health—to enhance documentation practices and system optimization.
Participate in specialty and department meetings, identifying trends and delivering targeted education to improve coding and documentation accuracy.
Refine Epic documentation tools, including templates, order entries, diagnosis lists, and SmartSets/SmartPhrases, to improve efficiency and accuracy.
Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA’s Standards of Ethical Coding, while maintaining expert knowledge of evolving policies.
Promote a culture of ethical coding and continuous improvement, supporting clinicians with timely updates, feedback, and education to ensure accurate reimbursement and compliance.

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

Senior Physician, Patient Safety

Join our dynamic Patient Safety team as a Senior Physician where you'll leverage...

Location

United States; Canada , Remote; Alberta

Salary:

Not provided

Parexel

Expiration Date

Until further notice

Requirements

Experience in clinical medicine (general or specialist qualifications) which is expected to be kept up to date
Good knowledge of drug safety and the drug development process
Good knowledge/understanding of medical terminology
Relevant experience in pharmacovigilance/ Drug Safety/ Clinical Practice
3 - 5 years previous experience in pharmacovigilance and/or medical monitoring is required
US Board Certification/board eligibility or regional equivalent for Canada
Bachelor of Medicine, Bachelor of Surgery (MBBS) / Doctor of Medicine (MD)/ Medically qualified from an acknowledged Medical School
Completion of at least basic training in clinical medicine (residency, internship etc.)
Demonstrated success in technical proficiency and scientific creativity
Good presentation and verbal/written communication skills

Job Responsibility

Maintaining a good working knowledge of the Adverse event/Safety profile of assigned products, labeling documents, data handling conventions, client’s guidelines and procedures, and global drug safety regulations and guidelines
Maintaining an awareness of global regulatory requirements, reporting obligations and organizing workload to ensure compliance with internal and regulatory timelines for adverse event reporting
Performing medical review of cases not limited to (including complex and challenging cases requiring expert judgement)), clinical trial, and literature cases including combination products {drug-device}) according to client/Parexel Standard Operating Procedures (SOPs
as applicable) and liaising with the client, as require
Writing Pharmacovigilance/Marketing Authorization Holder (MAH) comment and assessing company causality
Review appropriateness of medical content in narrative for medical coherence
Assessing seriousness, listedness / expectedness of reported events
Providing medical inputs to case processing team
Raising appropriate follow-up queries for relevant information from the reporter/HCP (Health Care Professional)
Review and verify appropriate selection of adverse events from source documents, assign appropriate Medical Dictionary for Regulatory Activities (MedDRA) code, review narrative

What we offer

Flexible approach to work that meets your personal needs
Work from home
Benefits vary by country
Investment in your professional and personal development

Appeals Specialist I

Responsible for all activities associated with requests for Provider Billing Dis...

Location

United States , Portland

Salary:

25.00 - 30.00 USD / Hour

Apex Systems

Expiration Date

Until further notice

Requirements

Excellent verbal and written communication skills
Intermediate computer skills (e.g. Microsoft Word, Excel, Outlook)
Knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs)
Knowledge of claims processing and clinical services operations
Demonstrated initiative and analytical ability in identifying problems, researching issues, developing solutions, and implementing a course of action
Ability to listen and communicate appropriately in a manner that promotes positive, professional interaction while maintaining confidentiality and sensitivity in all aspects of internal and external contacts
Ability to present complex medical and reimbursement information to others and to be diplomatic and persuasive regarding health plan benefits, claims and eligibility
Ability to switch from one task or type of work to another as the business needs require
Ability to effectively prioritize work to meet strict timelines while maintaining quality and consumer centric focus
High school diploma or GED and a minimum 4 years’ experience in customer Service, Claims, or Clinical Services or equivalent combination of education and work experience

Job Responsibility

Responsible for all activities associated with appeal analysis, decision-making and closure
Appeal Intake – Validate intake determinations regarding timeliness, member benefits, employer group, and provider contract provisions for each appeal. Document information in appropriate system
Appeal Analysis – Review claim coding and claim processing history, medical policy and reimbursement policies, regulatory and legal requirements, benefit contracts, and/or provider contracts. Collect and catalogue supporting documentation and formulate an appeal recommendation. Document information in appropriate system. Apply knowledge and experience to answer a variety of increasingly complex inquiries from members, providers, and provider representatives. Collaborate effectively with coding specialists, appeal nurses, physician reviewers, and others as necessary to reach timely decisions on appeals
Decision & Closure – Make non-clinical appeal determinations as permitted by department business processes and guidelines. Follow department’s processes to receive a clinical review and decision from licensed health professionals. Present complex cases to appeal panels, document decisions, communicate determinations to members, providers or their representatives. Document information in appropriate system(s)
External review process – Oversee set-up of appeals for external review organizations, including document collection and coordination, communication with all parties, and other responsibilities as an intermediary between the provider and the external review organization. Ensure external review information is documented in appropriate system. Prepares letters and cases for external review as needed. Implement external review decisions
Interpersonal and Communication – Provide information, education and assistance to members, providers, and their representatives. Facilitate the member’s or provider’s’ understanding of the appeal process and of the information necessary to effectively process an appeal. Be a courteous advocate to the member or provider when requesting supporting information. Work cooperatively and effectively across all business areas to resolve
Systems and data – Track appeals in appropriate systems and assist in the maintenance of files. Assist with compilation of reports on appeals, including trends, number of cases, decisions, suggestions for process improvement, types of appeals, and compliance with timelines
Support, apply and promote Provider or Member Appeal Policies & Procedures
Adhere to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work
Manage a defined caseload within department productivity and quality expectations and provide back up for other appeals staff

What we offer

Medical, dental, vision, life, disability, and other insurance plans
ESPP (employee stock purchase program)
401K program with company match after 12 months
HSA (Health Savings Account on the HDHP plan)
SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions
Corporate discount savings program
On-demand training program
Access to certification prep and a library of technical and leadership courses/books/seminars after 6+ months of tenure
Certification discounts and other perks to associations that include CompTIA and IIBA
Dedicated customer service team for Consultants

Fulltime

New

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

Client Partner

Location

India , Noida

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Minimum 1 to 4 years of experience in IPDRG medical coding -US Healthcare
Any Graduate
associate’s degree in health information management, Medical Coding, or a related field preferred
Specialization: Inpatient DRG
Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification required.

Job Responsibility

Assign DRG Codes: Accurately assign DRG codes to inpatient records using ICD-10- CM/PCS coding systems based on clinical documentation and physician notes. Ensure codes reflect the correct diagnosis, procedures, and the overall complexity of care.
Clinical Documentation Review: Review and analyze medical records to verify diagnoses, procedures, and treatments. Work with physicians and healthcare providers to clarify and improve clinical documentation when needed for proper coding.
DRG Assignment: Utilize the DRG methodology to ensure accurate and consistent DRG assignment based on the severity of illness (SOI) and risk of mortality (ROM), among other factors. Apply coding conventions and guidelines as per CMS (Centers for Medicare & Medicaid Services) and payer requirements.
Continuous Education: Keep up to date with coding guidelines, coding technology, and industry changes related to DRGs, including changes in ICD-10-CM/PCS, federal regulations, and insurance payer policies.
Billing Support: Work closely with the billing department to resolve coding issues and ensure that all claims are processed correctly and promptly for reimbursement. Ensure timely submission of all inpatient claims for accurate payment processing

Medical Director of Revenue Integrity

The Physician Advisor is a key member of the healthcare organization’s leadershi...

Location

United States , Cheyenne

Salary:

Not provided

Cheyenne Regional Medical Center

Expiration Date

Until further notice

Requirements

Hold and maintain or able to obtain an unrestricted medical license in the state of Wyoming
Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
Familiarity with InterQual and MCG is preferred
Strong understanding of Medicare Two Midnight Rules
Member of the American College of Physician Advisors (ACPA)
Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or ACPA is required within 6 months of hire
Ability to build rapport with medical staff and hospital leadership to obtain the buy-in and collaboration necessary to achieve desired outcomes
Prefer Internal Medicine specialist with a background in Hospital Medicine
Maintain active medical practice in their specialty (Can accommodate clinical time up to 0.15 FTE in the specialty (depending on availability))
Demonstrates behavior that supports the organization’s mission

Job Responsibility

Provide functional leadership for the revenue integrity team Including CDI, Coding and Utilization Review
Responsible for oversight revenue integrity optimization
Lead value-based care initiatives for the organization
Chairs the Utilization Management Team
Review medical records of patients identified by case managers or as requested by the healthcare team including physicians to perform quality and utilization oversight
Perform medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews
Conduct Peer to Peer discussion with Payor Medical Directors when requested
Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay, and potential quality issues
Provide necessary clinical education to UR Case Managers regarding clinical criteria and appropriate use of screening tools
Educates individual hospital staff physicians about ICD-10 and DRG coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records

What we offer

403(b) with 4% employer match
ANCC Magnet Hospital
$10,000 relocation bonus
$3,500 in CMEs
216 hours of PTO
Robust Benefits Package

Physician Coding Review Specialist

Advocate Health Care

Location:
United States

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 29, 2026

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