Works daily correspondence from patients and insurance companies and handles inquiries appropriately and in a timely manner
Processes denials from insurance companies as appropriate according to coding and specific insurance policies and procedures
Processes aging reports according to established Central Business Office guidelines and maintain current report
Remains current with assigned insurance company publications and is knowledgeable regarding policies, procedures and coding guidelines for insurance company/network for which the representative is responsible
Requirements
High school diploma or GED
Associate degree preferred
Nice to have: Background in medical insurance billing
Nice to have: Certified Professional Coder Certificate (CPC)
Approval Officer responsible for reviewing and verifying pre‑authorization requests for medical services, ensuring compliance with insurance regulations, coding services accurately, and managing related reporting and communication with insurers and internal departments.
Responsibilities
Evaluate pre‑authorization requests for medical necessity
Accurately code service description codes using ICD, CPT, DRG, HCPCS
Respond to insurance/TPA queries and liaise with concerned departments
Receive, evaluate and escalate second opinion cases and case management requests
Prepare daily activity reports and assist with monthly reporting
Requirements
Bachelor's degree in Medicine or equivalent medical degree from a recognized university
The position audits and reports on the accuracy of procedural billing, payment consideration and accuracy in reimbursement based on the correct interpretation and application of codes, modifiers and payment rules.
Responsibilities
Performs audits and reports on the accuracy of procedure coding, facility E&M coding, ICD-10 coding and billing.
Reviews insurance payments for reimbursement accuracy, which is based on correct interpretation of clinical data and application of codes, modifiers and payment rules.
Reviews and audits institutional coding and billing from multiple departments and entities across the organization.
Assists in training personnel in correct documentation processes and coding guidelines.
Oversees on-going projects that are within the scope of this position.
Requirements
Bachelor's degree in a health sciences related area
RHIA certification
RHIT certification
CPC certification
Nice to have: Inpatient and outpatient transplant / speciality related billing
Medical Coding Auditor responsible for reviewing and validating medical claims, ensuring compliance with state and federal guidelines, and providing clinical and coding expertise in a telecommuting environment.
Responsibilities
Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims
Determines accuracy of medical coding/billing and payment recommendation for claims
Interprets state and federal mandates, benefit language, and reimbursement policies
Determines appropriate level of service using Evaluation and Management coding principles
Provides detailed clinical narratives on case outcomes
Facilitate the donation process through a 24/7 contact center, guiding grieving families, managing legal consent, and coordinating logistics nationwide.
Compensation
$20.00/hr starting | $22.00/hr after 90 days
Responsibilities
Respond promptly to incoming donor referrals
Guide grieving families through donation and consent process
Coordinate real-time logistics with funeral homes, hospice programs, and hospitals nationwide
Maintain meticulous donor documentation
Follow established organizational, medical, and regulatory guidelines
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