Medical Billing and Coding Remote Jobs in Michigan (US)
This page tracks remote medical billing and coding openings that are location-eligible for Michigan.
This page tracks remote medical billing and coding openings that are location-eligible for Michigan.
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Role Description This position is in the Health Information Management section at the Richard L. Roudebush VA Medical Center. MRTs (Coder) analyze, abstract, and classify medical data from patient health records across hospital and physician-based settings, including offices, group practices, multi-specialty clinics, and specialty centers. They assign ICD, CPT, and HCPCS codes and may also provide staff education on coding and documentation. Responsibilities - Identifies the principal diagnosis and principal procedure (when applicable) for every inpatient discharge, also identifies significant complications and/or co-morbidities treated or impacting treatment to correctly determine the proper Diagnosis Related Group (DRG). - Upon patient admission to the Community Living Center/Nursing Home Care Unit, codes the admission diagnosis for use by unit staff. - All diagnoses and procedure codes are selected from the current version of the ICD coding system. - Conducts re-reviews of codes abstracted for patient encounters (inpatient and outpatient) identified by the VERA committee to determine if based on the documentation the specific VERA coding requirements were followed; corrects coding as needed to ensure proper patient classification in the VERA program. - Codes inpatient professional fee services for identified inpatient admissions. - Code selection is based upon strict compliance with regulatory fraud and abuse guidelines and VA specific guidance for optimum allowable reimbursement. - Establishes the primary and secondary diagnosis and procedure codes for outpatient professional and technical fee encounters following applicable regulations, instructions, and requirements for allowable reimbursement; links the appropriate diagnosis to the procedure and/or determines level of E/M service provided. - Understands the nuances of the CPT coding system for Third Party Insurance cost recovery and accurately interprets instructional notations; bundles encounters when appropriate; uses established processes to communicate potential billing issues to Consolidated Patient Account Center (CPAC) staff. - Codes all identified surgical procedures; applies ICD and CPT coding guidelines and selects proper codes using the current code set and the encoder product suite; adds Anesthesia and Pathology codes for all billable surgical cases, which may involve creating the encounters. - Updates codes for current inpatient and Contract Nursing Home admissions for quarterly census and as directed for billable long stay (30+ days) admissions to reflect all patient conditions and care up to the census date or to the requested billing date. - May be required to review and enter coded data from paid Community Care claims using documentation (e.g., hard-copy claims) obtained from non-VA facilities. - May code diagnoses for VA registries such as Agent Orange, Ionizing Radiation, Persian Gulf, Prisoner of War, etc. Work Schedule Monday - Friday. Employees are scheduled for an 8-hour working shift and may choose a start time anytime at or after 7:00 AM ET, provided their workday concludes no later than 5:00 PM ET. This position requires work to be performed within the Eastern Time Zone (ET) and adherence to a standard business-day schedule. All work, meetings, and collaborative activities must occur within these hours, and employees must remain available for work-related communications during this timeframe. Pay - Competitive salary and regular salary increases. When setting pay, a higher step rate of the appropriate grade may be determined after consideration of higher or unique qualifications or special needs of the VA (Above Minimum Rate of the Grade). Paid Time Off - 37-50 days of annual paid time off per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year). Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. Parental Leave - After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child. Child Care Subsidy - After 60 days of employment, full-time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs for eligible children up to the monthly maximum of $416.66. Retirement - Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. Insurance - Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement). Telework This position is currently authorized for telework - Location negotiable, incumbent must live within 50 mile radius of a VA Medical Center. To meet the Return to Office Executive Order requirements, selected candidates may be required to Return to Office. This will be discussed during the interview process. Virtual This position is currently designated as remote. Remote work is defined as full-time employment conducted outside of a VA facility or in VA-leased spaces. The option for remote work will be assessed continuously, and the selected individual may need to return to a VA office if required. Education Requirements Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. - Transcripts must be official or unofficial college transcripts. A copy of your certificate/degree or screenshot of your current classes are not a replacement of your transcript and they will not be used in the qualifying process. - Transcripts must include the following information: - Your Name - Name of the college or university - Full address of the college or university - Degree Received - Date Conferred Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records; OR, - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, medical coding, and introduction to health records); OR, - Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. - Experience/Education Combination: Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. Certification - Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either: - Apprentice/Associate Level Certification through AHIMA or AAPC. - Mastery Level Certification through AHIMA or AAPC. - Clinical Documentation Improvement Certification through AHIMA or ACDIS. Grade Determinations - Medical Records Technician (Coder-Inpatient) GS-08: One year of creditable experience equivalent to the next lower grade level. Physical Requirements The work is primarily sedentary. Typically, the employee may sit comfortably to do the work. However, there may be some walking; standing; bending. No special physical demands are required to perform the work.
Led by CEO Scott Reiner and President Bill Wing, Adventist Health is a faith-based, nonprofit healthcare system servicing western regions of the United States. The company believes
Role Description Reviews SDS and OBV records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Records types including same day surgery and observation encounter types. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work. Qualifications - High School Education/GED or equivalent: Required - Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred - Working knowledge of hospital Cerner EMR (electronic medical record): Required - Three years' coding and health care experience: Required - AHIMA Certified Coding Specialist (CCS): Required Requirements - Abstracts and assigns ICD-10-CM diagnosis codes and CPT procedure codes from the SDS and OBV patient record to ensure accurate APC assignment and to provide information required for reimbursement and statistical data submissions. - Validates appropriate dates of service against documentation in the EMR for SDS/OBV encounters. - Completes required abstract fields in registration conversation on SDS/OBV encounter for OSHPD and other data submissions. - Uses knowledge of modifier use to ensure accurate application on various payor types. - Communicates with appropriate departments related to charge corrections/modifications. - Audits medical records to ensure proper coding is completed and to ensure compliance with federal and state regulatory agencies. - Follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. - Reviews, understands and applies quarterly coding clinics, coding guidelines and coding conventions of ICD-10-CM references. - Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accuracy of documentation and physician coding practices. - Analyzes content of reports and software edits to facilitate revisions with appropriate departments - NCCI edits. - Follows up coding holds, revenue cycle department holds including related and all other email communication. - Maintains required online Healthstream education courses. - Attends meetings and training pertaining to coder education, audit reviews, staff meetings, outpatient coder roundtable meetings, and SDC to OBV charges. - Performs other job-related duties as assigned. Benefits - Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. - Adventist Health participates in E-Verify. Visit E-Verify Participation and Right to Work notices for more information.
At HealthPartners, we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work. Nonprofit, integrated health care organization providing health insurance in six states. High-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. Bringing together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improves lives around the world. Commitment to increasing diversity and inclusion in our workplace, advancing health equity in care and coverage, and partnering with the community as advocates for change.
Role Description Join our team at Regions Hospital as a Health Information Coding Analyst II, Outpatient Same Day Surgery Coder. As a coding analyst, you will support multiple sites and actively participate within a team who performs a wide variety of complex coding scenarios to ensure accurate assignment of ICD-10 and CPT Codes. - Completes coding analysis of each individual patient stay. - Provides accurate diagnoses, procedures and other relevant database information for optimal financial reimbursement, collection of unique and pertinent information and accumulation of statistical data. - Perform related duties as assigned. Work schedule: - FTE: 1.0 (40 hrs. weekly) Remote, Monday-Friday Flexible. - Candidates must live in MN, WI, IA, ND, or SD. Qualifications - Education: Graduate from an associate or bachelor’s degree program in health information, completion of a coding specialist program or successful completion of AHIMA or AAPC coding credential exam. - Experience: 3-5 years’ experience in ICD-10/CPT coding. - Licensure/Registration/Certification: CCA (Certified Coding Associate), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), HCS (Homecare Coding Specialist), CEDC (Certified Emergency Department Coder), CCS-P (Certified Coding Specialist-Physician based), RHIT (registered health information technician), or RHIA (registered health information administrator). Requirements - Education: Graduate from an associate or bachelor’s degree program in health information or completion of a coding specialist program. - Experience: 5+ years’ experience in ICD-10/CPT coding. Prefer Same Day Surgery Coding Experience. - Licensure/Registration/Certification: CCA (Certified Coding Associate), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), HCS (Homecare Coding Specialist), CEDC (Certified Emergency Department Coder), RHIT (registered health information technician), or RHIA (registered health information administrator). Benefits - Regions Hospital offers a competitive benefits package (.5 FTE or greater) that includes medical insurance, dental insurance, 401K with match, disability insurance, fertility coverage, and tuition reimbursement. - On-site employee fitness center and clinic for convenient care. - Center for Employee Resilience providing support and evidence-based practices. - Qualified non-profit employer under the federal Public Service Loan Forgiveness program. - Proud to be a Beyond the Yellow Ribbon Company. Company Description At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work. - We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. - We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improves lives around the world. - At HealthPartners, everyone is welcome, included and valued. - We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description The Coding Denials & Auditing Supervisor is responsible for the oversight of coding denial resolution, coding quality auditing, and compliance monitoring across professional fee services. This role ensures accurate, complete, and compliant coding practices while reducing denial volume, improving first-pass yield, and supporting revenue integrity initiatives. The Supervisor leads a team of coding denial specialists and/or auditors, drives root cause analysis, and partners with coding, charge capture, and provider teams to identify trends and implement sustainable process improvements. Schedule: Monday to Friday, 8:00 am to 5:00 pm EST Location: Remote Nationwide You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities - Denials Management Oversight - Supervise daily operations of coding denial work queues, ensuring timely and accurate resolution of payer denials - Establish productivity and quality expectations for denial staff and monitor performance against targets - Review complex denials and provide guidance on appropriate coding corrections, appeals, or education opportunities - Identify denial trends (e.g., bundling, modifier usage, medical necessity) and escalate systemic issues - Auditing & Quality Assurance - Oversee routine and targeted coding audits (prospective and retrospective) to ensure compliance with applicable coding standards - Ensure audits are conducted using CPT®, ICD-10-CM, HCPCS, CMS, and payer-specific guidelines - Validate audit accuracy, scoring methodology, and consistency across auditors - Maintain audit schedules aligned with compliance requirements and organizational priorities - Performs other duties as assigned Qualifications - High School Diploma/GED - CCS, CPC, or equivalent certification required - 5+ years of professional coding experience - 5+ years of experience in denials management, auditing, or coding quality review - Access to a designated quiet workspace in your home (separated from non-workspace areas) and is able to secure Protected Health Information (PHI) - Must live in a location where there is a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service - Ability to work Monday through Friday 8:00 am to 5:00 pm EST Preferred Qualifications - 5+ years of professional coding experience multi-specialty preferred - 1+ years of prior supervisory or leadership experience - CEMA certifications Soft Skills - Ability to work independently and maintain good judgment and accountability - Demonstrated ability to work well with health care providers - Strong organizational and time management skills - Ability to multi-task and prioritize tasks to meet all deadlines - Ability to work well under pressure in a fast-paced environment - Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others - Ability to collaborate with your work team Benefits - Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays - Medical Plan options along with participation in a Health Spending Account or a Health Saving account - Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage - 401(k) Savings Plan, Employee Stock Purchase Plan - Education Reimbursement - Employee Discounts - Employee Assistance Program - Employee Referral Bonus Program - Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
GeBBS Healthcare Solutions is committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, or any other status protected by applicable federal, state, or local law. We embrace and encourage the unique perspectives and contributions of all employees, including those who identify as LGBTQIA+. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. We strive to create a diverse and inclusive work environment and are an equal opportunity employer.
Role Description As an Outpatient Facility Coding Specialist, you will play a crucial role in coding all diseases, operations, and procedures for outpatients in accordance with ICD-10-CM, UHDDS, and AMA CPT-4 standards. Your expertise in large trauma Level I facilities will be invaluable in ensuring the accuracy and compliance of our coding practices. - Code all outpatient procedures according to client specifications. - Abstract patient data, ensuring accuracy and compliance with client policies. - Stay updated on coding policies and procedures; seek clarification on ambiguous information. - Utilize healthcare abstracting software and ICD-10 data sets. - Initiate physician queries following client-specific procedures. - Monitor and communicate regulatory changes to the Coding Supervisor. Qualifications - Credentialed medical coder with at least 3 years of experience. - AHIMA preferred, AAPC may be considered. - Coders with CIRCC or CPC credentials (professional interventional cardiology). - Coders with CCS, RHIT, or RHIA credentials with strong interventional radiology/cardiology experience. - Strong attention to detail and commitment to accuracy. - US Based Candidates Only. Company Description GeBBS Healthcare Solutions is a leader in Health Information Management and Revenue Cycle Management. We are dedicated to fostering a culture of excellence and collaboration in the healthcare industry.
Role Description This Medical Records Technician (Coder-Outpatient and Inpatient) position is in Business Office services at the VA Bedford Healthcare System, located at the Bedford location. This position is full time at 40 hours per week. Responsibilities: - Medical Record Technicians (MRT) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings. - Analyze and abstract patients' health records and assign alpha-numeric codes for each diagnosis and procedure. - Possess expertise in International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS). - Provide education related to coding and documentation. - Some duties may include but are not limited to: - Performing a comprehensive review of the patient health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capture. - Correcting any identified data errors or inconsistencies in a timely manner to ensure acceptance in the national VA database within established timelines. - Directly consulting with the professional staff for clarification of conflicting or ambiguous clinical data. - Ensuring provider documentation is complete and supports the diagnoses and procedures coded. - Utilizing the facility computer system and software applications to correctly code, abstract, record, and transmit data to the national VA database. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Service. - English Language Proficiency: MRTs (ROI) must be proficient in spoken and written English, as required by 38 U.S.C. §7403(f). - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management. - Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more. Requirements - GS-7: One year of creditable experience equivalent to the next lower grade level. - GS-8: One year of creditable experience equivalent to the next lower grade level. - Ability to analyze the health record to identify all pertinent diagnoses and procedures for coding. - Ability to accurately perform the full scope of outpatient coding and inpatient facility coding. - Skill in interpreting and adapting health information guidelines that are not completely applicable to the work. Benefits - Work Schedule: Monday-Friday, 7:00am to 3:30pm. - Pay: Competitive salary and regular salary increases. - Paid Time Off: 37-50 days of annual paid time off per year. - Parental Leave: Up to 12 weeks of paid parental leave after 12 months of employment. - Child Care Subsidy: Eligible for a childcare subsidy up to 25% of total eligible childcare costs. - Retirement: Traditional federal pension and federal 401K with up to 5% in contributions by VA. - Insurance: Federal health/vision/dental/term life/long-term care. - Telework: Not Authorized. - Remote: This position is being filled as remote. - Virtual: This is not a virtual position.
American Public University System (APUS) is an Online University based in Charles Town, WV. Our University has over 100,000 students. Our emphasis is educating our nation’s military and public services communities with quality and affordable education. APUS provides partnership and commitment in helping students realize the dream of a higher education and the opportunities that brings. It is the policy of American Public University System (APUS) to afford equal opportunity to all qualified persons. We treat all qualified individuals equally as to their recruitment, hiring, assignments, advancements, compensation, and all other terms and conditions of employment. American Public University System (APUS) does not discriminate on the basis of race, color, religion, creed, sex, age, national origin, sexual orientation, or physical, mental, or sensory disability, or any other characteristic protected by law. #LI-Remote
Role Description Part-time and full-time teaching faculty share our commitment to learning, teaching, interaction with students and faculty, service to our communities of practice, and scholarship. They are united by the common goal of inspiring academic excellence in students with a broad range of interests and experiences consistent with the Community of Inquiry Framework, as adopted by American Public University System (APUS) for cognitive presence, teaching presence, and social presence. They are key to creating a rewarding online learning experience for students by engaging them, challenging them, and supporting them. They contribute to and participate in a range of activities related to effectiveness and excellence in teaching and student retention. Faculty members remain aware of discipline content intent for the courses they teach. They follow APUS guidelines, processes, and methods and are responsive to mentoring and coaching. When Applying: - Upload a CV and a copy of unofficial transcripts, master's degree and above. Student issued/unofficial copies are acceptable. - Please do not send us official copies, unless specifically asked. Responsibilities - Teaching excellence. - Deliver online lessons to undergraduate and/or graduate students. - Initiate, facilitate, interact, and moderate online classroom forums. - Be a faculty leader in your classes embracing fully the Community of Inquiry Framework of Teaching Presence, Cognitive Presence, and Social Presence. - Evaluate and grade students' class work, assignments, and papers within the timeframe set forth by APUS policy providing effective feedback to guide student learning and success. - Comply with APUS guidelines and expectations for quality faculty engagement online. - Engage in the classroom and reply to emails, etc. at least every other day, including one day during the weekend. - Remain aware of classroom procedures and use of instructional materials. - Participate in professional development to enhance teaching skills and effective online learning strategies. - Conduct scholarly research and participate in professional engagement activities. - Attend discipline specific and administrative meetings as scheduled. - Maintain ‘discipline’ knowledge by participating in one’s own discipline-related professional communities. - Support APUS initiatives and departments. General Work Requirements - All APUS faculty are required to complete the “Engaging the First‐Year Student Certification” course (APUS110), offered through the Center for Teaching and Learning (CTL). It must be completed within six months of the hire date. - Graduate Faculty must complete the Graduate Faculty Certification (APUS501) within 90 days of hire. - Specific requirements related to your Graduate / Undergraduate Faculty designation, duties, and performance expectations are outlined on the Course Assignments issued with respect to each course to be taught. - You agree to comply with and be bound by all policies with respect to work product and intellectual property rights set forth in the APUS Faculty Handbook, the APUS Employee Handbook, the APEI Employee Handbook, and applicable Course Assignments. - You will be expected to perform your duties in a remote, professional working environment of your choice. APUS assumes no responsibility for injuries occurring in your selected workspace or damages related to your real or personal property resulting from your employment with APUS. Requirements - Master's degree in Health Info Management, Data Analytics, Computer Science, or a closely related field from a regionally accredited institution is required. - Two years of experience in a Health Info Management field is required. - College-level teaching experience is preferred. - Online teaching experience is preferred. - Record of excellence in teaching. - RHIA or RHIT certification is strongly preferred. - Other preferred certifications include, CCS, CPC, CHDA, CHPS, CPHIMS, or related. Areas of Expertise - Healthcare Reimbursement Methodologies - Healthcare Delivery Systems and Clinical Documentation - Compliance and Regulatory Standards - Health Informatics and Analytics - Clinical Informatics /Population & Community Informatics - Population Health - Health Systems Leadership Informatics - Electronic Health Records and Health Information Systems - Data Governance, Data Quality, and Interoperability - Healthcare Operations and Workflow Improvement - Clinical Documentation Improvement - Healthcare AI / Artificial Intelligence in Healthcare - Digital Health Technologies Compensation and Benefits Information regarding our faculty benefits may be found here: Faculty Benefits . Please Note - Applicants selected to proceed in the hiring process with conferred degrees from foreign institution(s) will require a course-by-course evaluation completed by a National Association of Credential Evaluation Services (NACES) approved agency. - All charges associated with official transcripts and foreign transcript evaluations are the responsibility of the applicant and are not reimbursed by APUS. Company Description American Public University System (APUS) is an Online University based in Charles Town, WV. Our University has over 100,000 students. Our emphasis is educating our nation’s military and public services communities with quality and affordable education. APUS provides partnership and commitment in helping students realize the dream of a higher education and the opportunities that brings. It is the policy of American Public University System (APUS) to afford equal opportunity to all qualified persons. We treat all qualified individuals equally as to their recruitment, hiring, assignments, advancements, compensation, and all other terms and conditions of employment. American Public University System (APUS) does not discriminate on the basis of race, color, religion, creed, sex, age, national origin, sexual orientation, or physical, mental, or sensory disability, or any other characteristic protected by law.
Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Role Description Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. - Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. - Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. - Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. - Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. - Builds positive relationships between providers and the business by providing coding assistance as needed. - Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education. - Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors. - Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry. Qualifications - At least 2 years medical coding experience, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC). - Certified Coding Specialist (CCS). - Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge. - Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). - Ability to effectively interface with staff, clinicians, and management. - Excellent verbal and written communication skills. - Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Risk Adjustment Coder (CRC). - Certified Professional Payer – Payer (CPC-P). - Certified Coding Specialist – Physician Based (CCS-P). - Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model. - Background in supporting risk adjustment management activities and clinical informatics. - Experience with risk adjustment data validation. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia.
Role Description Are you a newly certified medical coder looking to launch your career in a dynamic and fast-growing healthcare environment? Join a federally certified Independent Review Organization (IRO) that provides expert medical review services to government agencies, insurers, TPAs, and self-funded employers. This is a unique opportunity to be part of a team supporting a high-impact initiative driven by the No Surprises Act, with a mission to resolve complex claim disputes and ensure fair payment outcomes. CANDIDATES WITH PREVIOUS MEDICAL CODING EXPERIENCE WILL NOT BE CONSIDERED What You’ll Do - Review and validate claim data to determine appropriate payment outcomes. - Analyze CPT codes and supporting documentation to identify the correct party in disputed claims. - Work primarily with emergency services claims, including ambulance and air ambulance cases. - Operate within a proprietary claims management system. - Collaborate with internal teams to clear a significant backlog of cases. Note: This is not a coding-heavy role. You’ll use your coding knowledge to interpret and validate claims, not to perform coding tasks. Qualifications - CPC or CPC-A certification (required). - 2-3 years of Medical Collections experience - must have experience with denials/appeals (required). - Familiarity with emergency services billing is a plus, but not required. - Strong attention to detail and ability to make objective decisions. - Adaptability and eagerness to contribute to a newly built team. Benefits - Medical, dental & vision. - Critical Illness, Accident, and Hospital. - 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available. - Life Insurance (Voluntary Life & AD&D for the employee and dependents). - Short and long-term disability. - Health Spending Account (HSA). - Transportation benefits. - Employee Assistance Program. - Time Off/Leave (PTO, Vacation or Sick Leave). Job Type & Location This is a Contract to Hire position based out of Houston, TX. Pay and Benefits The pay range for this position is $25.00 - $25.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jun 9, 2026.
Role Description The Professional Fee Coder is part of a team which has full responsibility for the efficient and accurate flow of coded charges. Applies the appropriate diagnoses, surgical and procedural codes to individual patient health information for data retrieval, analysis and claims processing. Works closely with departments to optimize reimbursement, ensure charge capture, reduce late charges and provide feedback to providers. Provides physicians routine feedback on documentation and compliance standards. Resolves pre-bill edits and appropriate follow-up. Exercises judgment within generally defined practices and policies in selecting methods and techniques for obtaining solutions. Receives no instructions on routine work and general instructions on new assignments. Qualifications - Associate’s degree in a work-related field/discipline from an accredited college or university. Relevant experience in lieu of degree may be considered (requires approval). - Relevant experience in lieu of degree is in addition to the experience requirements for this position. Requirements - Two (2) years of progressively responsible and directly related work experience. - Ability to adapt to and deal with change and ambiguity. - Ability to foster effective working relationships and build consensus. - Ability to plan, organize, prioritize, work independently and meet deadlines. - Ability to solve technical and non-technical problems. - Ability to utilize the ICD-9-CM & CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups. - 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 - CPC and/or CCSP - Certified Professional Coder. - RHIT - Registered Health Information Technician. - RHIA - Registered Health Information Administrator. - CCS - Certified Coding Specialist. Benefits - Base Pay Scale: Generally starting at $52.37 - $58.98 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.
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