5 audit specialist jobs found

Medical Coding Education Associate Sr (Hospital / Professional Claims) Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. The Medical Coding Education Associate S r is responsible for the comprehensive analysis of complex claims data to generate refined and industry-relevant concepts that govern the prosperity of the company across all business lines and client interactions. Engages with providers and other internal external...

Medical Coding Education Associate Sr (Hospital / Professional Claims) Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. The Medical Coding Education Associate S r is responsible for the comprehensive analysis of complex claims data to generate refined and industry-relevant concepts that govern the prosperity of the company across all business lines and client interactions. Engages with providers and other internal external...

Medical Coding Education Associate Sr (Hospital / Professional Claims) Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. The Medical Coding Education Associate S r is responsible for the comprehensive analysis of complex claims data to generate refined and industry-relevant concepts that govern the prosperity of the company across all business lines and client interactions. Engages with providers and other internal external...

Company : Highmark Inc. Job Description : JOB SUMMARY This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including...

Location: Remote - Ohio Department: HIM Revenue Cycle Weekly Hours: 40 Status: Full time Shift: Days (United States of America) Job Summary: As a Coding Specialist, you will conduct audits of physician/provider documentation and coding for office and surgical procedure encounters. You will research and communicate government and private insurance carrier coding/billing policies and provide regularly scheduled education for providers and staff on appropriate coding and billing. In this role, you will review code change requests and conduct review of coding denials or other payer requests. The above summary is intended to describe the general nature and level of work performed in this role. It should not be considered exhaustive. REQUIREMENTS Associate degree, preferably in a health information management or related field Extensive knowledge of ICD-10, CPT and HCPCS coding. Minimum of 3 years of physician/professional...