RN focused on verifying that coded diagnoses, procedures, revenue codes, and corresponding reimbursement methodologies accurately reflect the member's documented clinical condition, services rendered, and billed charges.
Responsibilities
Provides support for inpatient and outpatient clinical claim review activities.
Assess medical records for clinical accuracy, acuity alignment, and documentation integrity.
Reviews inpatient and/or outpatient claims to ensure diagnoses, procedures, revenue codes, itemized charges, and Diagnostic Related Groups (DRG) assignments accurately reflect the documented clinical condition and services provided.
Integrates ICD‑10 coding principles, DRG methodologies, revenue code logic, and evidence‑based clinical guidelines when reviewing claims.
Performs DRG validation reviews by verifying principal and secondary diagnoses, complications/comorbidities, procedure coding, severity level, and correct grouping logic.
Requirements
Registered Nurse (RN)
Nice to have: Certified Coding Specialist (CCS)
Nice to have: Registered Health Information Administrator (RHIA)
Nice to have: Registered Health Information Technician (RHIT)
Review Cardiac Catheterization, Electrophysiology (EP), and Interventional Radiology documentation, coding, and charge capture processes to ensure accuracy, completeness, regulatory compliance, and optimal reimbursement
Perform comprehensive audits and analyses of coding, billing, and charge capture practices to identify revenue leakage, compliance risks, and opportunities for process improvement
Research and resolve complex coding, documentation, billing, and reimbursement issues related to Cardiac Catheterization and Interventional Radiology services
Maintain expertise in CPT, HCPCS, ICD-10-CM, NCCI edits, Medicare guidance, and payer-specific policies, and communicate relevant updates to operational and clinical stakeholders
Serve as a subject matter expert and trusted resource for Cardiac Catheterization, EP Lab, and Interventional Radiology coding, billing, and revenue integrity practices
Medical coder under Article 28 FQHC program, will provide quality review of patient medical records and ensure accuracy of coding. Maintain records in accordance with accepted medical and legal standards.
Responsibilities
Evaluate medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the visit
Analyze medical record documentation for consistency and completeness for coding purposes using established criteria and regulations
Codes and/or reviews principal diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs with International Classification of Diseases (ICD10), Current Procedural Terminology (CPT), Heath Care Financing Administration Common Procedure Coding Systems (HCPCS–all levels), and any other coding classification systems that may be required
Perform edit checks on data entered prior to transmittal and correct errors as indicated
Assist data processing staff in revising the EMR/EPM master file as requested
The Appointment Coordinator answers incoming calls, provides callers with pertinent information, and transfers calls to the appropriate party as requested. This role coordinates patient appointments, pre-registers patients, and manages all aspects of physician template management for Peachtree Orthopedics.
Responsibilities
Answer incoming calls and direct them to the appropriate extensions.
Assists the scheduling team with daily questions arising from scheduling issues.
Cancels and reschedules entire clinics as necessary.
Pre-registers each new patient by obtaining all required demographic and insurance information.
Schedules appointments for all locations based on availability, location, time, doctor, payor mix, and injury status.
Requirements
High school diploma or general education degree (GED)
The Senior Billing Compliance Analyst provides advanced support to the health system’s billing compliance program by performing complex audits, leading data analytics activities, and guiding prevention and monitoring strategies.
Responsibilities
Conducts and manages Hospital and Professional billing compliance audits, reviews projects and investigations.
Identifies significant issues within scope of the audit/review/project/investigation ensuring billing compliance with appropriate statutes, rules and regulations.
Develops on-going billing compliance training and awareness initiatives.
Analyzes and evaluates information related to the regulatory healthcare environment by monitoring the appropriate state, federal and industry websites, publications, and journals.
Develops billing compliance related documents including stakeholder input, review, and approval.
Requirements
High school diploma or GED
Bachelor’s degree in Business, Healthcare Administration, or Health Information Management
Nice to have: Certified Healthcare Compliance (CHC) from the Healthcare Compliance Association (HCCA)
Nice to have: Audit Process and Data Analysis experience
Responsible for reviewing and coding medical records and documentation for healthcare services rendered to ensure accurate coding using standardized systems.
Locations (2)
Clinton, Mississippi, United States
United States
Requirements
High school diploma/GED
Nice to have: Associate's degree in health information management or medical coding
Clinical Validation Reviewer (RN) - Inpatient Coding & ReimbursementNewMolina Healthcare · US
Charge Capture - Coding Analyst - RemoteNewUnitedHealth Group · Remote, US
Claims Escalation & Denials Appeals SpecialistNewNorthpoint Recovery Holdings, LLC · Remote
Medical CoderNewPROMESA R.H.C.F. · Bronx, US
Appointment CoordinatorNewPeachtree Orthopaedic Clinic · Atlanta, US