clinical coder

TEEMA Group

<div><h2 class="jobSectionHeader">Role Summary</h2>
The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a critical role in ensuring coding accuracy, regulatory compliance, and appropriate reimbursement across inpatient and outpatient services.
In this role, you will conduct detailed retrospective claims reviews, provide expert-level coding analysis, and support cross-functional teams including medical directors, claims operations, and quality management. This position is ideal for a highly analytical professional who thrives in a fast-paced, remote environment and is passionate about accuracy, compliance, and continuous improvement in healthcare operations.<h2 class="jobSectionHeader">
Duties &amp; Responsibilities</h2><ul><li>
Serve as a subject matter expert for ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding</li><li>
Perform DRG validation and retrospective medical claims reviews</li><li>
Analyze inpatient and outpatient claims for coding accuracy and reimbursement determinations</li><li>
Prepare clear, detailed determination letters and written review outcomes</li><li>
Identify coding discrepancies, potential fraud, and quality concerns</li><li>
Provide training, mentorship, and guidance to clinical coding staff</li><li>
Collaborate with cross-functional teams to support coding inquiries and review findings</li><li>
Research and apply medical policies, benefits, limitations, and current coding guidelines</li><li>
Ensure timely completion of coding reviews in alignment with performance standards</li><li>
Maintain accurate and thorough documentation within medical management and claims systems</li><li>
Escalate complex or high-risk cases to the Medical Director as appropriate</li></ul><h2 class="jobSectionHeader">
Required Qualifications</h2><ul><li>
High School Diploma or GED</li><li>
Active credential in one of the following:<ul><li>
Certified Inpatient Coder (CIC)</li><li>
Certified Coding Specialist (CCS)</li><li>
Registered Health Information Technician (RHIT)</li></ul></li><li>
Minimum of five (5) years of clinical coding experience (facility and/or professional)</li><li>
Minimum of three (3) years of inpatient and/or outpatient claims processing experience</li><li>
Experience working in a fast-paced, production-driven environment</li><li>
Ability to obtain and maintain a favorable background investigation</li><li>
U.S. Citizenship required</li></ul><h2 class="jobSectionHeader">
Desired Qualifications</h2><ul><li>
Experience within managed care, health insurance, or private healthcare industry</li><li>
Familiarity with government healthcare programs and regulatory guidelines</li><li>
Advanced expertise in inpatient facility coding and DRG validation</li><li>
Strong analytical, critical thinking, and problem-solving skills</li><li>
High attention to detail with strong organizational capabilities</li><li>
Ability to manage large volumes of complex information independently</li><li>
Effective communication and collaboration across multidisciplinary teams</li><li>
Proficiency in Microsoft Word, Excel, and multi-system environments</li></ul><h2 class="jobSectionHeader">
Location &amp; Work Type</h2>
100% Remote (must reside in an approved state) 
Full-time position<ul><li>
Independent home office work environment required</li><li>
Prolonged computer use and sitting required</li><li>
Flexibility to support varying work schedules as needed</li></ul>
#Workwolf</div>

Sr. Inpatient Clinical Coder

LaSante Health Center

<div>
 
 LaSante Health Center
 
 is seeking a detail-oriented in-person
 
 Medical Coder
 
 to ensure accurate coding and abstraction of patient encounters. The ideal candidate will possess strong analytical skills, attention to detail, and expertise in coding conventions.
 
 
 
 Responsibilities
 
 :
 
 
 <ul>
 <li>
 Code and abstract patient encounters accurately.
 </li>
 <li>
 Research data for reimbursement needs.
 </li>
 <li>
 Analyze medical records for documentation deficiencies.
 </li>
 <li>
 Review documentation to support diagnoses and procedures.
 </li>
 <li>
 Audit clinical documentation for accuracy.
 </li>
 <li>
 Assign codes for reimbursement and compliance.
 </li>
 <li>
 Provide coding guidance to care providers.
 </li>
 <li>
 Identify and resolve billing issues
 </li>
 <li>
 Complete additional tasks as assigned by supervisor.
 </li>
 <li>
 Ensure compliance with payer guidelines and supports revenue cycle integrity
 
 
 
 </li>
 </ul>
 
 Qualifications
 
 :
 
 
 <ul>
 <li>
 Experience necessary
 </li>
 <li>
 Must be a Certified Medical Coder, CPC / CPC-A
 </li>
 <li>
 Must be capable of working in a fast paced environment
 </li>
 </ul>
</div>

Medical Coder

ECLARO

<div>
 
 Job Number: 26-00718
 
 
 
 Progress on your journey to success! ECLARO is currently recruiting for an
 
 Outpatient Coder
 
 in the
 
 Chicago, IL
 
 area for one of our clients.
 
 
 ECLARO&rsquo;s client is a leading provider of healthcare workforce software and solutions. If you&rsquo;re up to the challenge, then take a chance at this rewarding opportunity!
 
 
 
 Position Overview:
 
 
 
 <ul>
 <li>
 Outpatient Coder - specifically ED coding and strong hospital charge related ED.
 </li>
 <li>
 AHIMA Certification required - RHIA, RHIT, or CCS. Strong academic and regional medical center coding experience required.
 
 
 </li>
 </ul>
 
 Responsibilities:
 
 
 
 <ul>
 <li>
 Review clinical documentation in order to assign diagnostic and procedural codes for outpatient medical records according to the appropriate classification system
 </li>
 <li>
 Ensures accurate, timely, and appropriate assignment of ICD-10, CPT/HCPCS, and modifiers for the purposes of billing, internal and external reporting, research, and compliance with regulatory and payer guidelines
 </li>
 <li>
 Monitors documentation turnaround time and productivity, and follows up on deferred accounts or with physicians and other clinical staff as needed
 </li>
 <li>
 May be tasked with generating reports and/or analyzing data related to evaluation and management code utilization, CPT code application, denials, reimbursement per contracted terms, etc.
 </li>
 <li>
 Provides coding feedback to providers, clinical department leadership, and revenue cycle team
 </li>
 <li>
 Assist coding educators with education regarding documentation improvement
 </li>
 <li>
 Escalate coding and documentation issues to revenue cycle leadership, and assist facilitating corrective action plans
 </li>
 <li>
 Assists with design and implementation of workflow updates and coding tools
 </li>
 <li>
 Support denial team on coding related denials
 </li>
 <li>
 Special projects as assigned
 
 
 </li>
 </ul>
 
 Pay Rate:
 
 $33.00-$36.00/Hour
 
 
 
 Shift:
 
 Day 5x8-Hour (08:00 - 16:30);
 
 Job Duration:
 
 26 weeks
 
 
 
 If hired, you will enjoy the following ECLARO Benefits:
 
 
 
 <ul>
 <li>
 401k Retirement Savings Plan administered by Merrill Lynch
 </li>
 <li>
 Commuter Check Pretax Commuter Benefits
 </li>
 <li>
 Eligibility to purchase Medical, Dental &amp; Vision Insurance through ECLARO
 
 
 </li>
 </ul>
 If interested, you may contact:
 
 
 
 Sofia Dela Torre
 
 
 
 
 Sofia.DelaTorre@eclaro.com
 
 
 
 
 (332) 206-0779
 
 
 
 
 Sofia Dela Torre | LinkedIn
 
 
 
 
 Equal Opportunity Employer:
 
 ECLARO values diversity and does not discriminate based on Race, Color, Religion, Sex, Sexual Orientation, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status, in compliance with all applicable laws.
</div>

Outpatient Coder

Wellmark Blue Cross and Blue Shield

<div>
 
 Why Wellmark
 
 : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we&rsquo;ve built our reputation on over 80 years&rsquo; worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors&ndash;our members. If you&rsquo;re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
 
 
 Learn more about our unique benefit offerings here.
 
 
 
 Job Description
 
 
 
 As a Health Services Coding Analyst, you will provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance. You will ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams. To do this, you will research and analyze system and business issues, develop high-level requirements, test and implementsolutions, and audit and document outcomes. The Health Services Coding Analyst also serves as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services.
 
 
 
 Must be willing to work core business hours of 8 AM - 5 PM Central Time.
 
 
 
 
 Candidates located in Iowa or South Dakota preferred. This role is remote eligible and will require candidates to provide high-speed internet at their work location.
 
 
 
 
 Qualifications
 
 
 
 
 Preferred Qualifications - Great to have:
 
 
 
 <ul>
 <li>
 Prior health plan experience.
 
 
 </li>
 </ul>
 
 Required Qualifications - Must have:
 
 
 
 <ul>
 <li>
 Associate degree or direct and applicable work experience preferred.
 </li>
 <li>
 Certified Professional Coder (CPC) required.
 </li>
 <li>
 Clinical background which may include either formal education or training in a clinical or health-related discipline (such as nursing, medical assisting, surgical technology, health information management, or a related field) and/or direct work experience in a clinical or healthcare setting.
 </li>
 <li>
 7+ years&rsquo; or related health care experience in provider payment, claims, medical coding, or similar.
 </li>
 <li>
 Demonstrated expertise and knowledge of medical coding and terminology.
 </li>
 <li>
 Demonstrated strong attention to detail with the ability to multitask.
 </li>
 <li>
 Strong interpersonal skills including clear and concise written and verbal communication.
 </li>
 <li>
 Inquisitive nature, enthusiastic about developing and enacting new processes.
 </li>
 <li>
 Strong workflow management skills with sense of ownership, drive and initiative to continuously improve outcomes.
 </li>
 <li>
 Ability to communicate concepts clearly and concisely to individuals and groups and motivate others to achieve success with an eye toward promoting a culture of collegiality and excellence.
 </li>
 <li>
 Demonstrated ability to obtain relevant information by relating and comparing data from different sources.
 </li>
 <li>
 Proficiency in Microsoft Office applications including experience with spreadsheets, process mapping, presentation and word processing.
 </li>
 <li>
 Ability to adhere to quality and production metrics.
 </li>
 <li>
 Some experience with and continued interest in coaching and mentoring others.
 </li>
 <li>
 Demonstrated ability to consistently meet department work schedule.
 
 
 </li>
 </ul>
 
 Additional Information
 
 
 
 
 What you will do:
 
 
 
 <ul>
 <li>
 Leadership in Coding Analysis: Lead the analysis of the most complex Wellmark medical policy content and implementation of system edits to support its intent. Medical policy coding requirements are implemented, tested, documented and audited to assure compliance.
 </li>
 <li>
 Maintain the claims processing system infrastructure to ensure compliance with regulatory and accreditation bodies and vendor supported technical requirements and ensure accurate claims adjudication.
 </li>
 <li>
 Translate complex medical policy language into precise, actionable coding criteria for integration into claims systems and configuration platforms.
 </li>
 <li>
 Serve as coding subject matter expert for complex or escalated utilization management.
 </li>
 <li>
 Collaborate with Utilization Management nurses, medical directors, and claims teams to resolve coding-related denials, overrides, and policy interpretation questions.
 </li>
 <li>
 Contribute to the full lifecycle of medical policy creation, revision and interim review, including drafting coding sections, researching emerging procedures/devices, and ensuring policies reflect current coding conventions (AMA CPT, ICD10, HCPCS).
 </li>
 <li>
 Conduct impact analyses of proposed policy changes on coding, reimbursement, and operational workflows.
 </li>
 <li>
 Work directly with Health Services leadership, Medical Review staff, leadership within Claims and Customer/Provider Services and Network Engagement, Medical Directors to provide medical coding expertise and PGE rule knowledge to resolve complex claims and/or customer and provider issues.
 </li>
 <li>
 Maintain coding integrity by monitoring utilization trends to identify and resolve system configuration issues.
 </li>
 <li>
 Work with Medical Policy Leadership in the development and optimization of coding configuration standards and best practices.
 </li>
 <li>
 Work with payment integrity, business support, and data analytics teams to edit, develop, and implement Optum, Cotiviti, and Cognizant edits.
 </li>
 <li>
 Contribute to the achievement of corporate and UM Product Team objectives by independently serving as primary points of contact and UM Product Team Subject Matter Expert/Guest Star to provide expertise to support the various claims processing systems, including but not limited to PGE rules and table maintenance (FACETS and STAR). This will include attendance to various virtual cross-functional team meetings, as well as in-person attendance and participation in quarterly Iteration Planning meeting.
 </li>
 <li>
 Update coding files as required by code set revisions, HIPAA-AS, medical policy development and implementation, regulatory requirements, FEP and Blue Card guidelines, or as needed to support other internal processes.
 </li>
 <li>
 Participate in cross functional meetings or initiatives to support the goal of managing medical benefit expense.
 </li>
 <li>
 Provide expertise in the areas of medical coding PGE rule knowledge and medical policy configuration rules to support projects and broad organization initiatives. Consult with leadership as business decisions are made and retain and archive documentation of decisions made. Comply with regulatory standards, accreditation standards and internal guidelines; remain current and consistent with the standards pertinent to the Medical Policy team.
 </li>
 <li>
 Mentor and train Coding Specialist as well as provide specific topic training related to medical policy administration/PGE rules to other operational areas such as customer and provider service as needed.
 </li>
 <li>
 Other duties as assigned.
 
 
 </li>
 </ul>
 
 Remote Eligible:
 
 You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other &lsquo;moments that matter&rsquo; as well.
 
 
 
 
 An Equal Opportunity Employer
 
 
 
 
 
 The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
 
 
 
 
 Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com
 
 
 
 
 Please inform us if you meet the definition of a "Covered DoD official".
 
 
 
 At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants
 
 
 Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.
</div>

Health Services Coding Analyst (CPC Required)

Al Taie Center for Laparoscopic and Bariatric Surgery

Al Taie Center is a premier healthcare facility specializing in laparoscopic and obesity surgery, led by Dr. Abdulsalam Al Taie, Consultant General, Bariatric &amp; Laparoscopic Surgeon. With locations in Dubai and Abu Dhabi, we are committed to delivering exceptional patient care using the latest medical technologies. We are currently looking for a skilled and experienced Insurance Coder to join our Abu Dhabi team.Role OverviewWe are seeking a detail-oriented Insurance Coder who is experienced in UAE healthcare insurance practices and holds their own valid UAE visa. The ideal candidate will have a minimum of 2 years of hands-on experience in medical coding and insurance claims processing within the UAE.Key Responsibilities<ul><li>Accurately assign ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedures, and medical services.</li><li>Review medical records and documentation to ensure coding accuracy and completeness.</li><li>Process and follow up on insurance claims (pre-authorizations, submissions, rejections, and resubmissions).</li><li>Liaise with insurance companies and HAAD/DOH authorities to resolve claim discrepancies.</li><li>Ensure compliance with UAE healthcare regulations, DOH standards, and payer-specific guidelines.</li><li>Maintain patient confidentiality and adhere to medical ethics and data privacy standards.</li><li>Coordinate with physicians and clinical staff to clarify documentation and coding details.</li><li>Prepare coding and billing reports for management review.</li><li>Stay updated on coding guidelines, payer policy changes, and regulatory updates.</li></ul>Qualifications &amp; RequirementsRequirementDetailsEducationDiploma or Bachelor's degree in Medical Coding, Health Information Management, or a related fieldCertificationCertified Professional Coder (CPC) or Certified Coding Specialist (CCS) &ndash; mandatoryExperienceMinimum 2 years of experience as a Medical/Insurance Coder in the UAEVisa StatusMust have own valid UAE visa (Family/Sponsored visa) &ndash; mandatoryKnowledgeIn-depth knowledge of ICD-10-CM, CPT, HCPCS, DOH/HAAD regulations, and UAE insurance claim processesLanguagesEnglish (fluent) &ndash; Arabic is a plusSkillsStrong attention to detail, analytical thinking, proficiency in medical billing software and EHR systemsAvailabilityImmediate joiners preferredApplication Question(s):<ul><li>Do you have your own Visa?</li></ul>Experience:<ul><li>Insurance coder: 2 years (Required)</li></ul>Work Location: In person

Insurance Coder

Savista

<div>Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
The Pro Fee Coder will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement. Coder II may validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals. The Coder II performs documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coder II may interact with client staff and providers.
DUTIES AND RESPONSIBILITIES:<ul><li>
Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types which may include but not limited to: Ancillary (Diagnostic)/ Recurring; Hospital, Clinic; Physician Pro Fee; Technical Fee or Evaluation and Management, any associated chart capturing with any patient type.</li><li>
Review and analyze facility records to ensure that APC assignments and/or Evaluation and Management codes accurately reflect the diagnoses/procedures documented in the clinical record.</li><li>
Abstract clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures and discharge disposition is selected.</li><li>
Complete assigned work functions utilizing appropriate resources. May act as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.</li><li>
Maintain strict patient and provider confidentiality in compliance with all HIPAA Guidelines.</li><li>
Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.</li><li>
Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.</li><li>
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.</li></ul>
SKILLS AND QUALIFICATIONS:<ul><li>
Candidates must successfully pass pre-employment skills assessment. Required:</li><li>
An active AHIMA (American Health Information Association) credential including but not limited to RHIA, RHIT, CCS, CCA, or an active AAPC (American Academy of Professional Coders) credentials COC (formerly CPC-H), CCS-P, or CPC or related specialty credential.</li><li>
Two years of recent and relevant hands-on coding experience</li><li>
Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets</li><li>
Ability to consistently code at 95% threshold for quality while maintaining client-specific and/or Savista production and/or quality standards</li><li>
Proficient computer knowledge including MS Office including the ability to enter data, sort and filter excel files, (Outlook, Word, Excel)</li><li>
Must display excellent interpersonal and problem-solving skills with all levels of internal and external customers</li></ul>
PREFFERED SKILLS:<ul><li>
Recent and relevant experience in an active production coding environment strongly preferred</li><li>
Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience</li><li>
Experience using RCx, Cerner, NextGen (a plus)</li><li>
Academic and Split-Share experience</li></ul>
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $22.08 - $34.69 an hour. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
California Job Candidate Notice</div>

Profee Coder - Hospitalist

Search 2560+ Clinical coder jobs near you this June. New roles added regularly across leading industries. Apply today.

2560 clinical coder jobs Near Me

Sr. Inpatient Clinical Coder

Sr. Inpatient Clinical Coder

Medical Coder

Outpatient Coder

Health Services Coding Analyst (CPC Required)

Insurance Coder

Profee Coder - Hospitalist