Job Family: Medical Assistant Travel Required: None Clearance Required: None What You Will Do: Clinical Denial Specialist will be under the direct supervision of the RN Supervisor/Manager. Focus will be placed on DRG Validation reviews and Clinical Denials. This candidate will need to be highly organized, adaptable to change and willing to collaborate on a day basis. What You Will Need: - High school Diploma or equivalent - Minimum 3+ years of experience in healthcare administration, insurance verification, or medical billing - Ability to assist with end of month reporting (charts, graphs, pivot charts) - Proficiency in EHR systems and insurance portal - Microsoft Office Experience What Would Be Nice To Have: - UM, Clinical Denials experience in a Hospital or Payer - Medical Assistant preferred #LI-DNI The annual salary range for this position is $44,000.00-$74,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. What We Offer: Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: - Medical, Rx, Dental & Vision Insurance - Personal and Family Sick Time & Company Paid Holidays - Position may be eligible for a discretionary variable incentive bonus - Parental Leave - 401(k) Retirement Plan - Basic Life & Supplemental Life - Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts - Short-Term & Long-Term Disability - Tuition Reimbursement, Personal Development & Learning Opportunities - Skills Development & Certifications - Employee Referral Program - Corporate Sponsored Events & Community Outreach - Emergency Back-Up Childcare Program About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

1.0 FTE Full time Day - 08 Hour R2654265 Remote USA 108700001 Rev Cycle Hospital IP Coding Finance & Revenue Cycle If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a Stanford Health Care job. A Brief Overview Requires review of medical record documentation to accurately assign International Classification of Diseases (ICD-10-CM/PCS), as well as assignment of the Medicare Severity Diagnosis Related Group (MS-DRG) / All Patient Refined - Diagnosis Related Group (APR-DRG) and abstracts specific data elements for each account in compliance with federal and state regulations. This position codes the majority of patient types of inpatient records, including more complex cases such as Intensive Care. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Standards of Ethical Coding, as well as all American Hospital Association (AHA) Coding Clinic guidance. Follows Stanford Health Care policies and procedures and maintains required quality and productivity standards. Reviews, abstracts and assigns accurate and ethical ICD-10-CM/PCS codes to inpatient services. Ensures compliance with third party, State and Federal regulations. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, and other services provided. Obtains missing information and/or clarifies existing information. Completes volume of work from work queues per departmental productivity standards. Groups codes and completed product into payment group. Analyzes information for optimal and approprite reimbursement. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures. Uses appropriate software to validate information. Utilizes Epic, 3M Coding and Reimbursement System (Encoder), 3M CDIS, 3M Audit Expert, MS Office, and other software as appropriate to compile and validate medical information. Locations Stanford Health Care What you will do - Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnosis and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group (MS-DRG) or All Patient Refined Diagnosis Related Group (APR-DRG). The Inpatient Coding Specialist II is responsible for verification of the patient's discharge disposition, assignment of the correct sources of admission for state regulation reporting purposes, and ensuring the appropriate present on admission (POA) indicators are assigned to each code. The assigned codes must support the reason for the visit that is documented by the provider in order to support the care provided. - Correctly abstracts required data per facility specifications. - Responsible for monitoring Discharged Not Billed accounts, and as a team, ensuring timely, compliant processing of inpatient accounts through the revenue cycle. - Collaborates with Clinical Documentation Specialists (CDSs) and members of the medical staff to ensure completeness of documentation in the medical records so that appropriate codes, and, ultimately, the correct Diagnosis Related Group (DRG) may be assigned. - Responsible for ensuring accuracy and maintaining established quality and productivity standards. - Demonstrates a high degree of independence in performance of responsibilities, working effectively without direct supervision. Exhibits strong time management, problem solving and communication skills. - Possesses critical thinking, good judgment and decision making skills. - Demonstrates excellent written and oral communication skills. - Remains abreast of current Centers for Medicare and Medicaid Services (CMS) requirements as well as Correct Coding Initiative (CCI) edits, Hospital Acquired Conditions (HACs), Patient Safety Indicators (PSIs), and when applicable, National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs,) including the addition of appropriate modifiers to ensure a clean claim the first time through. - Maintains competency and accuracy while utilizing tools of the trade such as the 3M encoder, 3M Audit Expert process (3M AES), 3M Clinical Documentation Improvement System (3M CDIS) and abstracting systems, as well as all reference materials. - Follows all established Stanford Health Care policies and procedures. - Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth. Education Qualifications - High School Diploma or GED equivalent Experience Qualifications - Five (5) years of progressively responsible and directly related work experience Required Knowledge, Skills and Abilities - Successful completion of the Coder Proficiency Exam (pre-hire) - Ability to adapt to and deal with change and ambiguity - Ability to plan, organize, prioritize, work independently and meet deadlines - Ability to comply with the American Health Information Management Association’s Code of Ethics and Standards and apply Uniform Hospital Discharge Data Set (UHDDS) standards - Ability to establish and maintain effective working relationships - Ability to manage, organize, prioritize, multi-task and adapt to changing priorities - Ability to solve technical and non-technical problems - Ability to utilize the ICD-10-CM/PCS and CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record documentation; assign accurate codes for grouping of MS-DRGs and APR-DRGs - Ability to work effectively through and with others - Knowledge of diagnosis/procedure DRG grouping schemes such as MS-DRGs and APR-DRGs - Knowledge of health information systems for computer application to medical records - Ability to foster effective working relationships and build consensus - Ability to work effectively with individuals at all levels of the organization - Knowledge of CCI (Correct Coding Initiatives) and CMS compliance issues - Knowledge of computer systems and software used in functional area - Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases Licenses and Certifications - RHIA - Registered Health Information Administrator or - RHIT - Registered Health Information Technician or - CCS - Certified Coding Specialist These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: - Know Me: Anticipate my needs and status to deliver effective care - Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health - Coordinate for Me: Own the complexity of my care through coordination Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. Base Pay Scale: Generally starting at $65.12 - $73.34 per hour The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

• The Senior Coder is responsible for performing coding audits and review of outpatient provider services to support coding optimization and compliance for the medical group. • This is an entry level position supporting multiple specialties across the medical group with coding for evaluation and management and procedural services. • In addition to the audit and review work, the Senior Coder will work side by side with outpatient providers providing ongoing feedback, coaching, and support with the code entry process, documentation, ICD-9, ICD-10, and HCC coding in alignment with current medical group reimbursement requirements. • The Senior Coder works with the clinic staff, Physician's Business Office, to correct errors and resolve billing questions.

Currently hiring a fully remote Credentialing SpecialistIcon Health is a leading provider of value-based musculoskeletal (MSK) care, collaborating with payers and providers to enhance outcomes and experience for individuals. The company partners with health plans and risk-bearing providers to assume accountability for reduced total cost of care. By combining technology-enabled MSK providers with proactive care coordination and decision support services, Icon Health delivers multidisciplinary, evidence-based care. We founded Icon Health on the conviction that every patient should be genuinely delighted with their care experience. By prioritizing patient-centered practices, ensuring clear care goals across the entire clinical team, and placing clinicians at the heart of care delivery, we aim to transform a fragmented system into one that truly serves patients. Our model uses a team-based approach to care, integrating musculoskeletal expertise and primary care to achieve better patient outcomes. At Icon Health, we foster a culture that embraces bold thinking, rapid iteration, and practical problem-solving. We seek team members who relish challenging the status quo and thrive in vertically integrated roles—where ideas can swiftly move from concept to execution without layers of red tape. Above all, we value individuals who are eager to roll up their sleeves, tackle obstacles head-on, and create innovative solutions that improve the lives of our patients and our clinical partners. Responsibilities - Manage the full lifecycle of credentialing and recredentialing for telehealth providers across multiple states including: - Verifying provider credentials including state licenses, board certifications, DEA registrations, education and training, work history, malpractice coverage, National Practitioner Data Bank (NPDB) queries - Ensuring credentialing processes meet NCQA, Joint Commission, and CMS standards where applicable. - Maintaining accurate credentialing records in the credentialing database or provider management system. - Tracking and managing state licensure applications and renewals for telehealth providers. - Maintaining a comprehensive database of provider licenses and expiration dates. - Monitoring and ensuring compliance with state-specific telehealth regulations and licensing requirements. - Coordinating payer credentialing and enrollment with commercial and government payers across multiple states. - Completing and submitting payer enrollment applications and maintain follow-up until approval. - Maintaining CAQH profiles and ensure provider information is current and attested - Assisting with credentialing audits and prepare documentation for internal and external reviews. - Collaborating with provider recruitment, medical staff services, compliance, and operations teams to ensure timely onboarding. - Providing credentialing status updates to internal stakeholders. - Assisting providers with documentation requirements and application completion. - Maintaining credentialing data in provider management systems. - Generating reports on credentialing status, expirations, and compliance. - Monitoring credentialing timelines to ensure providers are approved before service delivery. Required Qualifications: We are always looking for new team members who will add to our company’s DNA and have a strong passion for impact. - 5+ years of credentialing experience in healthcare. - Demonstrated experience credentialing telehealth providers across multiple states. - Experience with payer enrollment and provider credentialing applications. - Familiarity with CAQH, NPDB, NPI registry, and state licensing boards. - Knowledge of telehealth regulatory requirements and multi-state licensure processes. - Strong organizational skills with the ability to manage multiple providers and deadlines simultaneously. - Proficiency in credentialing databases, Microsoft Office, and provider management systems. Preferred Qualifications: - Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred. - Experience credentialing for virtual care or digital health organizations. - Experience with multi-state Medicaid and commercial payer enrollment. - Familiarity with credentialing platforms such as Modio, MedTrainer, Verity, symplr, or similar systems. Compensation: - $50K-$60K Annually - Yearly Salary Commensurate with Experience - Hours: Full Time (Hours are Monday-Friday no nights or weekends) - Benefit Package Available - Employee funded 401K