medical billing and coding specialist

CLINOVEX Clinical Research Solutions

<ul><li>TRAINING PROVIDED FOR FRESHERS</li><li>Review and assign appropriate codes for both Hospital billed services</li><li>Ensure accuracy of ICD-10-CM, CPT, HCPCS, and modifier usage per payer guidelines</li><li>Evaluate and resolve claim denials, including medical necessity and timely filing issues</li><li>Provide feedback on payer denials and assist with the appeal process when appropriate</li><li>Reference and interpret UB04, CMS-1500, EOBs, and RAs to support coding validation</li><li>Collaborate with internal teams and external partners to resolve coding discrepancies</li><li>Maintain up-to-date knowledge of industry standards, payer-specific rules, and coding regulations</li><li>Work independently and maintain productivity standards in an onsite setting</li><li>Use electronic health record (EHR) systems and documentation tools to access and update coding information</li><li>Refer to written training resources and coding references as needed</li><li>T</li><li>TRAINING WILL BE PROVIDED FOR FRESHERS</li><li>Certified Billing and Coding Specialist (CBCS) or AAPC Coder Certification or Training will be provided</li></ul><ul><li>Strong knowledge of ICD-10-CM, CPT, HCPCS, UB04, and CMS-1500 forms</li><li>Familiarity with Medicare, Medicaid, HMOs, PPOs, and managed care plan guidelines</li><li>Proficient in medical terminology, healthcare documentation, and coding best practices</li><li>Strong comprehension, problem-solving, and conflict resolution skills</li><li>Excellent verbal and written communication skills in English</li><li>Ability to work independently with minimal supervisionPreferred Skills:</li></ul><ul><li>Experience working in a fully remote coding or RCM environment</li><li>Prior involvement in denial resolution and payer appeals</li><li>Comfortable using multiple healthcare platforms and EHR systems</li><li>Ability to analyze coding patterns and identify billing trends</li></ul>Job Type: Full-timePay: &#8377;10,000.00 - &#8377;15,000.00 per monthEducation:<ul><li>Bachelor's (Preferred)</li></ul>Work Location: In person

MEDICAL CODING INTERN BSC/MSC/NURSING/PHARMA

Advocate Aurora Health

<div>Major Responsibilities:<ul><li>
Review assigned codes, which most accurately describe each documented diagnosis and/ or procedure according to established CPT, HCPCS, and ICD-10-CM coding guidelines along with modifier usage and medical terminology. Monitor all coding accuracy at various levels of detail and maintain coding quality as needed. Track coding issues and review coding inaccuracies to highlight areas of improvement. Report or resolve escalated issues as necessary.</li><li>
Responsible for reviewing Clinician documentation and billed codes for Medical Group physicians and non-physician clinicians. Review of medical records in collaboration with key stakeholders such as Internal Audit, Compliance, and Clinic Operations. Responsible for completing all certified coder quality reviews. Working in collaboration with Coding Production Leads and Supervisors.</li><li>
Follows the prospective and/or retrospective review plan to sample employed Clinician's medical record documentation in comparison to services selected for billing, based on best practice methodologies which will be presented and reviewed with Clinicians to provide feedback on proper coding and documentation practices.</li><li>
Follows the necessary schedules for team assignments of documentation/coding accuracy. Conducts required, timely reviews per the established Clinician Documentation Review Plan and generates summary reports for Professional Coding leadership and Provider Compliance Committee. Develops mechanisms to identify specific quality issues for each Clinician to allow for focused follow-up reviews to identify improvement/correction of those elements for which the Clinician has received an education.</li><li>
Ensures compliance with the system Clinician Documentation Review Plan escalation process for any Clinician who is not successful in meeting the minimum acceptable thresholds. Provides feedback when documentation issues are identified that need improvement. Conducts focused reviews requested by the Compliance department, clinic administration, and Professional Coding leadership. Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation &amp; Coding Accuracy Plan and for the evaluation of coding quality standards.</li><li>
Identifies, evaluates and acts to resolve any barriers to meeting documentation standards. Provides education/feedback to the department Educators and Coding Liaisons. Maintains coding quality standardized reporting mechanisms. Provides standardized statistical reports of coding quality information to Professional Coding leadership and other appropriate parties.</li><li>
Identifies and trends coding quality issues/concerns. Recommends coding accuracy improvement strategies, including continued education and/or training plans. Provides feedback regarding coding guidelines, coding protocols/procedures, and system edits to continually improve coding processes and ultimately the overall coding quality program.</li><li>
Conducts scheduled and ad hoc coding quality reviews. Conducts regularly scheduled reviews of encounters where coding has been changed or deleted by Coding team members to ensure accuracy and provide education recommendations. Reviews abstracted and coded encounters for coding accuracy and completeness. Provides feedback on billing system edits as applicable.</li><li>
Provides results to Physician Coding leadership and education recommendations as needed. Collaborates with interdepartmental or cross-functional teams for assigned projects and provides departments with coding issues and updates to be shared with Clinicians.</li><li>
Utilizes chart review results to provide data-driven feedback to clinicians and management to improve coding accuracy and identify opportunities for improvement and re-training. Maintains up-to-date knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.</li></ul> 
Licensure, Registration, and/or Certification Required:<ul><li>
Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or</li><li>
Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or</li><li>
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or</li><li>
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or</li><li>
Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or</li><li>
Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and</li><li>
Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC).</li></ul> 
Education Required:<ul><li>
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.</li></ul> 
Experience Required:<ul><li>
Typically requires 5 years of experience in expert-level professional coding and at least 3 years of experience in the education of clinicians in physician revenue cycle processes, health information workflows, and medical record auditing experience.</li></ul> 
Knowledge, Skills &amp; Abilities Required:<ul><li>
Advanced knowledge of ICD, CPT, and HCPCS coding guidelines.</li><li>
Advanced knowledge of medical terminology, anatomy, and physiology.</li><li>
Advanced ability to identify coding quality issues/concerns and provide recommendations for improvement.</li><li>
Advanced ability to analyze trends and data and display them in a statistical reporting format.</li><li>
Advanced organization and communication (verbal and written) skills.</li><li>
Advanced ability to effectively train others through oral and/or written methods.</li><li>
Advanced organization, prioritization, and reading comprehension skills.</li><li>
Advanced analytical skills, with high attention to detail.</li><li>
Intermediate computer skills including the use of Microsoft Office, email, and exposure or experience with electronic coding systems or applications.</li><li>
Advanced knowledge of care delivery documentation systems and related medical record documents.</li><li>
Advanced interpersonal communication skills (oral and written) necessary to collaborate with Physicians, other clinicians, and Professional Coding Department team members and leadership.</li><li>
Ability to work independently and exercise independent judgment and decision-making.</li><li>
Ability to meet deadlines while working in a fast-paced environment.</li><li>
Ability to take initiative and work collaboratively with others.</li></ul> 
 
Physical Requirements and Working Conditions:<ul><li>
Exposed to normal office environment.</li><li>
Position requires travel which will result in exposure to road and weather hazards.</li><li>
Operates all equipment necessary to perform the job.</li></ul> 
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.</div>

Physician Coding Review Specialist

Provox Global Solutions

We are seeking a detail-oriented and highly organized Insurance Verification Specialist to join our team. As a key player in our healthcare organization, you will be responsible for verifying insurance information to ensure accurate billing and claims processing. If you have a strong background in insurance verification, attention to detail, and a commitment to ensuring a seamless experience for both patients and providers, we want to hear from you.Key Responsibilities:<ul><li>Review Scheduled Patients: Check the list of patients scheduled for the next day.</li><li>Prioritize Verification: Prioritize verification based on external factors that may impact the verification time, considering insurer processing times and appointment dates.</li><li>Complete PPO/HMO Forms: Fill out the PPO/HMO forms with information received from the clinic, patient/client, and the verification conducted with the insurance provider.</li><li>Database Entry: Store information in the designated database in a clear and legible manner.</li><li>Utilize Identification Methods: Use company-designated identification methods to confirm the patient's eligibility for medical center services.</li><li>Meet Verification Metrics: Adhere to verification compliance metrics, meeting both daily</li><li>Communication: Interact with patients to obtain additional insurance details or clarify information.</li><li>Problem Resolution: Investigate and resolve insurance-related issues, discrepancies, or challenges.</li><li>Customer Service: Provide excellent customer service to both internal and external stakeholders.</li></ul>Qualifications:<ul><li>Educational qualification Bachelor degree.</li><li>Proven experience in insurance verification within a healthcare setting.</li><li>Familiarity with medical terminology and coding.</li><li>Strong communication and interpersonal skills.</li><li>Detail-oriented with excellent organizational abilities.</li><li>Proficiency in using insurance verification software and electronic health record systems.</li></ul>Job Type: Full-timeApplication Question(s):<ul><li>Our office is located in Naval Anchorage, Islamabad. This is an on-site opportunity with shift timings from 6 PM to 3 AM. Are you comfortable with this shift arrangement?</li></ul>Experience:<ul><li>Verification of Benefits: 1 year (Required)</li><li>Dental Billing : 1 year (Required)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Dental Billing Specialist

Quironsalud

Primary Responsibilities:<ul><li>Must have appropriate DRG knowledge and experience</li><li>The Coder must undertake a thorough review of applicable documentation to assess the documentation requirement and determine the appropriate ICD-10-CM and/or CPT-4/codes to be reported, in conjunction with the applicable version of Official Guidelines.</li><li>Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered.</li><li>Understand the individual client payer contracts so as be able to process claims in submission.</li><li>Be able to process claims either in OP or IP scenario</li><li>Analyze and communicate coding and billing issue of the provider to the supervisors.</li><li>Have complete knowledge of Coding &amp; billing guidelines of the provider and payer.</li><li>Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.</li><li>To assist with documentation review and raise queries on completeness of EMR</li><li>Must also observe UAE code of ethics while assigning relevant code sets.</li><li>Preapproval and Precertification for claims requiring approval.</li><li>Making Cost estimates according to procedures</li><li>Monitoring and follow up on prior authorization for outpatient/inpatient services</li><li>Scanning of cases to identify lack of documentation by physician/ reports prior to submitting to payer</li><li>Contacting the payers/TPA for approval related matters. Communicates adequately with external parties.</li><li>Contacting the physician/nurses for further clarification to make the claim eligible for preapproval.</li><li>Identify and analyze problems, take action to resolve, apply sound judgment and take responsibility for their resolution</li><li>Inform and influence others by clear, concise expression of ideas and information in verbal and written as appropriate</li><li>Timely and meets deadlines.</li><li>Reporting trends related to preapproval to reporting TL /Supervisor</li></ul>Job Requirements:<ul><li>Bachelor in Life Sciences</li><li>Most relevant coding certification with updated membership to a body as accepted by the geographical governance area (AAPC or AHIMA).</li><li>Relevant experience of at least 1 year in medical coding.</li><li>Should at least have basic knowledge of Evaluation and Management services. Prior hands on experience would be an added advantage.</li><li>Experience in UAE coding will be an added advantage.</li></ul>Job Type: Full-time

Senior Insurance DRG Coder

Acidus Management Solutions Pvt Ltd

We are seeking a detail-oriented and experienced DME Medical Billing Specialist to join our team. The ideal candidate will be responsible for processing and submitting DME (Durable Medical Equipment) claims to insurance companies, ensuring compliance with billing policies and procedures, and following up on unpaid or denied claims.Key Responsibilities:<ul><li>Prepare and submit clean claims to Medicare, Medicaid, and commercial insurers for DME services</li><li>Review prescriptions, documentation, and authorizations to ensure compliance with payer requirements</li><li>Verify patient insurance coverage and obtain necessary authorizations or referrals</li><li>Follow up on unpaid claims, rejections, and denials in a timely manner</li><li>Post payments and adjustments accurately</li><li>Communicate with patients, insurance companies, and healthcare providers to resolve billing issues</li><li>Maintain current knowledge of billing regulations and payer requirements specific to DME</li><li>Ensure HIPAA compliance and patient confidentiality in all interactions</li></ul>Qualifications:<ul><li>Minimum 1&ndash;3 years of experience in DME medical billing</li><li>Strong knowledge of HCPCS codes, modifiers, and DME documentation requirements</li><li>Familiarity with Medicare, Medicaid, and private insurance billing guidelines</li><li>Proficiency in billing software (e.g., Brightree, Kareo, or similar platforms)</li><li>Excellent communication and organisational skills</li><li>Ability to work independently and meet deadlines.</li><li>Immediate Joiner.</li></ul>Contact- 9600886888 Email ID - hrtp@acidusms.comJob Type: Full-timePay: &#8377;20,000.00 - &#8377;30,000.00 per monthBenefits:<ul><li>Health insurance</li><li>Provident Fund</li></ul>Work Location: In person

DME Medical Billing Specialist AR Callers

Physicians Revenue Group

PRG Pakistan is Hiring! | AR Executive &ndash; RCM Specialist (Onsite | Lahore)Are you an experienced Accounts Receivable (AR) Executive with a strong background in Revenue Cycle Management (RCM) for the U.S. healthcare process? Join our team at PRG Pakistan and take the next step in your career!Position: AR Executive &ndash; RCM Specialist Location: Onsite &ndash; Lahore Experience Required: 2+ years (U.S. Healthcare preferred)Key Requirements:<ul><li>Solid understanding of the U.S. healthcare RCM process, including:</li><li>Denial Management</li><li>Payment Posting</li><li>Proficiency in medical billing software</li><li>Excellent communication skills</li></ul>How to Apply: Send your resume to: zainab8278@prgmd.com Or WhatsApp at: 0308-8882130Job Type: Full-timePay: Rs55,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Preferred)</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>2year: 1 year (Preferred)</li></ul>Location:<ul><li>Lahore (Preferred)</li></ul>Work Location: In person

AR Executive / RCM Specialist -Medical Billing

Modernizing Medicine, Inc.

<div><div>We are united in our mission to make a positive impact on healthcare. Join Us!
<ul>
<li>South Florida Business Journal, Best Places to Work 2024</li>
<li>Inc. 5000 Fastest-Growing Private Companies in America 2024</li>
<li>2024 Black Book Awards, ranked #1 EHR in 11 Specialties</li>
<li>2024 Spring Digital Health Awards, &quot;Web-based Digital Health&quot; category for EMA Health Records (Gold)</li>
<li>2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara)</li>
</ul>
Who we are:

We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany.</div> 
<ul>
<li>
The RCM coding specialist is a key position within the Modmed India Operations. Coders will be assigned to a group of practices under one or multiple specialties reporting to a specialty lead, while they are responsible for working on modifiers escalated by practice or Global Partners, a coder is responsible for observing and analyzing the areas and identifying opportunities to improve the process efficiency which will enhance the overall outcome for new and established customers.

Position Title &ndash; RCM Coding Specialist

Your Role
<ul>
<li>Audit the work done by Global Partners and provide timely feedback to teams to aid in the quick resolution of denied coding claims.</li>
<li>Review &amp; work on Coding denials from the Payers.</li>
<li>Serve as a point of contact as coding SME for coding questions and clarifications for the MMI team.</li>
<li>Review claims assigned to practices due to Coding issues in order to find out any trends and will work with CAs if practice education/ intervention is required.</li>
<li>Analyse coding denials to determine trends where preventive measures can be placed, such as scrub edits, provider training, action plans, coder training, etc.</li>
<li>Participates in coding educational opportunities (webinars, internal training, etc.). Will keep updated on the Payer Guidelines impacting on supplying the Codes.</li>
<li>If needed, may assist in the production coding of clients of various specialties and scopes of coding.</li>
</ul>
Skills &amp; Requirements:
<ul>
<li>5+ years of working experience in medical coding domain where minimum 2 years' experience as SME/Quality in coding with Multi speciality experience</li>
<li>Certification Mandatory - CPC</li>
<li>Having strong knowledge in Gastro, Orthopaedics, Ophthalmology, Dermatology and Podiatry is preferred.</li>
<li>Hands on knowledge of Coding Denials on providing the resolution.</li>
<li>Good knowledge of Payer Guidelines to resolve the Denials related to Coding.</li>
<li>Good writing and Verbal communication in English</li>
<li>Can work independently during the India Night Shift</li>
<li>Can run reports and analyze the trends and scenarios. A strong hand in MS Excel will be a plus</li>
<li>Expert in supplying/auditing/ analyzing the CPT, ICD Codes along with appropriate Modifiers</li>
<li>CPC from AAPC or CCS from AHIMA</li>
<li>Bachelors or Masters in Science with a background of Anatomy</li>
</ul>
</li></ul><div>ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:

India
<ul>
<li>Meals &amp; Snacks: Enjoy complimentary office lunches &amp; dinners on select days and healthy snacks delivered to your desk,</li>
<li>Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,</li>
<li>Allowances: Annual wellness allowance to support your well-being and productivity,</li>
<li>Earned, casual, and sick leaves to maintain a healthy work-life balance,</li>
<li>Bereavement leave for difficult times and extended medical leave options,</li>
<li>Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,</li>
<li>Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.</li>
</ul>
United States
<ul>
<li>Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution,</li>
<li>401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.</li>
<li>Generous Paid Time Off and Paid Parental Leave programs,</li>
<li>Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,</li>
<li>Company-sponsored Business Resource &amp; Special Interest Groups that provide engaged and supportive communities within ModMed,</li>
<li>Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,</li>
<li>Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,</li>
<li>Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.</li>
</ul>
PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote &quot;interviews,&quot; and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (first.lastname@modmed.com). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.</div></div>

RCM Coding Specialist

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