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Health Plan Coding Contractor (Dental & Vision Experience Preferred)

Role Type: Contract

Experience Level: 2 - 3 year minimum preferred

Work Arrangement: Remote eligible (certain time zones preferred)

Hourly Rate Range - $30 / hour - $34/hour

Overview

We are seeking two Health Plan Coding Contractors to support backend medical benefit configuration and coding for health plan implementations. One of the roles requires specific experience in dental and vision coding.

These contractors will work closely with internal operations teams and implementation stakeholders to build, configure, and maintain accurate benefit structures within a health plan platform. The work involves handling protected health information (PHI), reviewing plan documents, and translating benefit details into coded system configurations.

Candidates should be comfortable working in a collaborative environment with operational leaders while also managing technical coding responsibilities independently.

Key Responsibilities

Health Plan Coding & Configuration

• Perform backend medical benefit coding and configuration within the claims adjudication system.
• Translate complex plan documentation such as Summary Plan Descriptions (SPDs) and Evidence of Coverage (EOC) into accurate system configurations.
• Support the build and implementation of member benefits based on plan documentation and contractual agreements.
• Work with internal teams to ensure coded benefits align with operational and compliance requirements.

Quality Assurance & Compliance

• Conduct validation and quality checks to ensure coding accuracy, consistency, and compliance with applicable regulations.
• Perform audits on coded benefits to ensure correct implementation across systems.
• Identify and resolve edge cases or complex benefit scenarios affecting claim processing.

Cross-Functional Collaboration

• Partner with internal operational managers on backend initiatives and process improvements.
• Work closely with implementation and launch teams responsible for onboarding new health plans and coordinating with insurance partners.
• Collaborate with operations teams to support benefit updates, claim processing accuracy, and issue resolution.

Process & Workflow Support

• Assist with workflow processes related to benefit configuration changes, including:
• Creating system rules to pause impacted claims when updates are required
• Conducting manual review to ensure proper claim adjudication
• Monitoring results before releasing claims back into automated processing

Required Qualifications

• Minimum 2years - 3 year of experience in medical coding, health plan coding, or benefit configuration.
• Experience working with health plan benefit structures or claims systems.
• Dental and vision coding experience required for one role.
• Familiarity with payer or third-party administrator (TPA) environments is preferred.
• Strong attention to detail and ability to interpret complex plan documentation.
• Ability to manage tasks independently while collaborating with cross-functional teams.

Preferred Qualifications

• Experience working with enterprise benefit platforms such as Facets, QNXT, HealthRules, or similar systems.
• Knowledge of healthcare regulatory frameworks affecting benefit design and claims processing.
• Prior experience supporting health plan implementations or benefit builds.

Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Position Summary

The Revenue Cycle Manager directs the overall functions of the department, aiming to maximize revenue collection and improve cash flow. Additionally, this position focuses on fostering positive relationships with patients, physicians, and other stakeholders, ensuring a smooth and efficient billing process while maintaining high standards of customer service.

Responsibilities:

• Oversee the daily operations of the billing and coding department, including staff scheduling, work assignments, and ensuring timely and accurate completion of tasks.
• Ensure that billing and coding processes adhere to company, state, and federal regulations.
• Serve as the primary expert and point of contact for all coding and billing processes within the organization.
• Evaluate, analyze, and implement reimbursement codes and billing practices, including managing additions, changes, and deletions in the EMR system.
• Resolve complex coding discrepancies by thoroughly reviewing medical records to ensure accurate diagnosis coding.
• Analyze patient billing complaints and observations, identifying areas for improvement and implementing corrective procedures to ensure best billing practices.
• Assist with the ongoing recruitment, hiring, training, and development of billing and coding staff.
• Ensure proper staffing levels, monitor employee leave, and manage overtime usage effectively.
• Regularly monitor departmental productivity and provide timely, constructive feedback to employees.
• Serve as a resource for physicians and other staff members regarding billing and coding information and guidance.
• Assist in the development and implementation of policies and procedures related to billing and coding operations.
• Proactively manage and communicate significant coding issues, project statuses, and address barriers or successes in a timely manner.
• Maintain up-to-date knowledge of regulatory changes impacting coding requirements and ensure staff education and compliance.
• Report emerging issues or trends promptly and take corrective action as needed.
• Support EMR system implementations and upgrades, providing coding resources for testing to ensure optimal performance post-implementation.
• Assist in the preparation and analysis of the departmental budget, ensuring resources are allocated effectively.
• Regular, predictable on site attendance
• Perform other duties as assigned to support the department and organizational goals.

Education/Experience:

• Bachelor's degree in health information management, Business Administration, Finance, or a related field preferred; or equivalent work experience.
• Certification in medical coding (e.g., CPC, CCS, or COC) is strongly preferred.
• Minimum of 3-5 years of experience in medical billing and coding, including hands-on experience with coding systems (CPT, ICD-10, HCPCS) and insurance claims management.
• Previous experience in a leadership or supervisory role within a billing and coding department, with demonstrated ability to manage and develop staff.
• Familiarity with Electronic Medical Records (EMR) systems and experience with system implementations or upgrades.
• In-depth knowledge of federal, state, and payer-specific billing regulations and compliance requirements.
• Strong background in reviewing medical records and ensuring accurate coding to maximize reimbursement.
• Experience with financial and budgeting processes related to billing departments.
• Prior experience in healthcare revenue cycle management or similar roles within a healthcare setting.

PanCare provides a comprehensive benefits package to include medical, dental and vision insurance. In addition, to health coverage, we offer 14 paid holidays and 3 weeks of paid vacation per year. Employees are also eligible to participate in our 403(b) plan with a 6% employer match and 3% base employer contribution.

Immediate need for a talented Bioinformatics Research Associate II . This is a 12+months contract opportunity with long-term potential and is located in Waltham, MA (Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-08726

Pay Range: $40 - $50/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Manager Notes:
• DIL: bio to support next-gen sequencing group. Some are in the lab, some are writing codes and analytical pipelines, working with Client coding and development systems, collaborating with the lab team, lots of coding, working with quality teams to ensure meeting metrics.
• Should have experience with at least one or two of the following. e.g., FastQC, Bowtie2, SAMtools, NCBI BLAST+, Nextflow, etc.). NGS pipeline development.
• 9-5 some wiggle room if they need to come in earlier leave earlier, Onsite but if they need a day or two here and there they can request a day to work remote A strong candidate would have Coding experience, papers published on coding, need next gen sequencing analysis, gene therapy group so if they have some exp in that or bio that would be a great advantage.
• Relevant experience is more important than a degree for the role.
• Does not want to see anyone with zero coding experience. No mention of the tools list would be a hard pass.
• Support computational needs for the development and validation of NGS-based assays.
• Work closely with a multi-disciplinary team of scientists and engineers to implement genomic analytical solutions for programs spanning precandidate selection through late phase clinical development.
• Develop, execute, and maintain NGS analysis pipelines for execution in cloud-based computational environments.
• Keep records of development work and testing in a GxP environment utilizing electronic notebook solutions.
• Represent the group at internal meetings.

Key Requirements and Technology Experience:

• Key Skills;Should have experience with at least one or two of the following. e.g., FastQC, Bowtie2, SAMtools, NCBI BLAST+, Nextflow, etc.)
• Minimum of 1 year of experience with NGS, spanning knowledge and hands-on dry-lab experience.
• Scripting experience in coding languages (e.g., bash, awk, Python, R, etc.).
• A strong candidate would have Coding experience, papers published on coding, need next-gen sequencing analysis, and gene therapy.
• Degree in a relevant computer science discipline with a minimum of 3 years of relevant industry experience.
• Minimum of 1 year experience with NGS, spanning knowledge and hands-on dry-lab experience.
• Expertise in bioinformatics with a working understanding of genomic analysis solutions (e.g., FastQC, Bowtie2, SAMtools, NCBI BLAST+, Nextflow, etc.).
• Scripting experience in coding languages (e.g., bash, awk, Python, R, etc.).
• Understanding of NGS platforms, specifically those utilizing the synthesis by sequencing technique (i.e., Illumina platforms).
• Ability to work independently and adapt under aggressive and/or changing timelines.
• Familiarity with the software development lifecycle (e.g., Git).
• Automated unit testing for test-driven design (TDD).
• Familiarity with basic molecular biology techniques (e.g., ligation, PCR, and qPCR) as well as nucleic acid extraction and analysis techniques (e.g., Nanodrop, DNA fragment analyzers, ddPCR, etc.).
• Knowledge of and experience with other sequencing platforms (i.e., SMRT sequencing).
• Prior experience in leading the internalization of custom NGS analysis pipelines is highly preferred.
• Wet-lab method development experience to support NGS workflows.

Our client is a leading Pharmaceutical Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Hybrid Details: Dallas, TX - Hybrid

Duration: 3 months to start

Pay range: $25-$31/hr W2

Job Description:

Job Summary:

Responsible for reviewing clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM/CPT4 codes and modifiers for billing, internal and external reporting, research, and regulatory compliance. Accurately code conditions and procedures as documented in the ICD-10-CM & CPT4 Official Guidelines for Coding and Reporting. Typically reports to Coding Manager

Minimum Qualifications:

• Education: High School Diploma or GED required
• Associate Degree in medical area, preferred

• Licenses/Certifications: One of the following licenses is required:Certified Coding Specialist (CCS), or
• Certified Professional Coder (CPC), or
• Registered Heath Information Technician (RHIT), or
• Certified Medical Coder (CMC) or
• Certified Coding Associate (CCA)

Experience / Knowledge / Skills:

• Two (2) years outpatient Neurosurgery (preferred), Required 2 Years outpatient E/M coding experience required, six (6) months of HCC experience preferred
• Ability to code Neurology for physicians
• Effective oral and written communication skills.
• EPIC Experience Preferred

Principal Accountabilities:

• Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for outpatient encounters.
• Utilizes technical coding principals and APC reimbursement expertise to assign appropriate ICD-10-CM diagnoses, CPT 4 and modifiers.
• Reviews documentation to extract and enter data accurately for other abstracting fields.
• Follow coding compliance policies, official coding guidelines, regulatory requirements and internal policies and procedures affecting the coding process.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
• Ability to communicate with providers, leadership and clinical staff; Query and provide guidance on documentation/coding
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
• Other duties as assigned.

#LI-Hybrid

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• The Medical Records Director (Non-Nurse) maintains the patients’ clinical records, including coding, auditing, and providing pertinent staff education regarding recordkeeping procedures in accordance with all applicable laws, regulations, and Life Care standards. Serves as the designated Privacy Officer for the facility.
  
• Reports to Executive Director (ED)
  

• 
  
• Bachelor’s degree OR an equivalent combination of education and experience
  
• Credentialed as a Registered Health Information Administrator (RHIA) OR as a Registered Health Information Technician (RHIT) OR have a degree in a health related field with extensive training and demonstrated competence in the HIM field
  
• Training in post-acute care health information management
  

• 
  
• Demonstrate knowledge of State and Federal legal requirements relating to documentation, confidentiality, and legal issues pertaining to health information
  
• Demonstrate efficient usage of complex computer software systems
  
• Functional knowledge in field of practice
  
• Make independent decisions when circumstances warrant such action
  
• Knowledgeable of medical records practices and procedures as well as the laws, regulations, and guidelines governing medical records functions in the post-acute care facility
  
• Implement and interpret the programs, goals, objectives, policies, and procedures of the medical records department
  
• Perform proficiently in all competency areas including but not limited to: medical coding, auditing, clinical records, privacy official responsibilities, supervisory responsibilities, patient rights, and safety and sanitation
  
• Maintains confidentiality of all proprietary and/or confidential information
  
• Understand and follow company policies including harassment and compliance procedures
  
• Displays integrity and professionalism by adhering to Life Care’s Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training
  
• Promotes a culture of integrity, maintains an “open door” policy, and does not participate in or allow retaliation against those who report good faith concerns
  
• Actively implements the compliance program and Code of Conduct and ensures 100% participation by department staff
  

• 
  
• Audit and complete ongoing review of all patients’ clinical records to ensure documentation and performance compliance
  
• Maintain current, overflow, and discharged record filing systems
  
• Serve as the facility’s Privacy Officer for HIPAA compliance
  
• Understand and apply LTC payment systems, including Medicare
  
• Use ICD-10-CM coding
  
• Use CPT/HCPCS coding systems
  
• Effectively communicate with physicians, nursing staff, and allied health personnel
  
• Interview, hire, train, evaluate, counsel, and supervise medical records staff
  
• Exhibit excellent customer service and a positive attitude towards patients
  
• Assist in the evacuation of patients
  
• Demonstrate dependable, regular attendance
  
• Concentrate and use reasoning skills and good judgment
  
• Communicate and function productively on an interdisciplinary team
  
• Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours
  
• Read, write, speak, and understand the English language
  
• Must be able to lift 35 lbs floor to waist, lift 35 lbs waist to shoulder, lift and carry 35 lbs, and push/pull 35 lbs
  

Date Posted:

Country:

Location:

Position Role Type:

U.S. Citizen, U.S. Person, or Immigration Status Requirements:

Security Clearance Type:

Security Clearance Status:

At Raytheon, the foundation of everything we do is rooted in our values and a higher calling – to help our nation and allies defend freedoms and deter aggression. We bring the strength of more than 100 years of experience and renowned engineering expertise to meet the needs of today’s mission and stay ahead of tomorrow’s threat. Our team solves tough, meaningful problems that create a safer, more secure world. 

The Effector Digital Products (EDP) department develops electronics for our weapon system products. We are responsible for the architecture, design, and documentation of deliverable FPGA embedded processing. We engage at the outset of the weapon system development and follow our designs through deployment. Our products are deployed all over the world, from the ground to exoatmospheric environments and into space. 

 
As a Principal FPGA Design Engineer you will develop FPGA designs for all major vendors and device families including: Xilinx, Altera, and Microsemi. Designs are implemented using VHDL for the following applications: gigabit serial interfaces, Radio Frequency (RF) and Electro-Optical (EO) DSP, controls, data links, embedded processing and processor interfaces.

Designers work with circuit card designers and systems engineers to develop requirements, architect new parts, collaborative modeling of algorithms, partition and perform code development, simulation, and place and route. Designs are verified against requirements using both directed test and constrained random methodologies. Design support is expected from requirements definition through integration and test. Design documentation and configuration management are required.

This position is 100% ONSITE in Tucson, Arizona.

What You Will Do

• Deliver production-quality FPGA releases from initial proof of concept to production

• Architect FPGA-based systems to determine parts, interfaces, and Concept of Operations (CONOPS)

• Translate system-level requirements into FPGA requirements.

• Design and code in VHDL for reliability and maintainability.

• Verify designs utilizing self-checking techniques with directed and constrained random tests, while tracking functional and code coverage.

• Drive projects and execute program schedules on time and budget.

• Create complete documentation including requirements, verification plans, and user’s guides.

• Manage moderately sized projects or processes

• Viewed as subject-matter expert within discipline

• Able to operate with minimal oversight from manager

• Coaches, reviews, and delegates work to junior engineers

• Support internal and external technical reviews

• Support customer interactions and relations

• Make improvements to processes, systems or products to enhance overall performance

Qualifications You Must Have

• Bachelor’s Degree in Electrical Engineering, Computer Engineering or Electrical Engineering Technology

• A minimum of eight (8) years of experience to include the following:

  • FPGA/ASIC design (VHDL and/or Verilog coding) or FPGA/ASIC verification (SystemVerilog coding)

  • Xilinx or Microsemi devices and flow tools

  • Delivering FPGA/ASIC solutions to system level applications

  • Hands on experience with integration and debug of FPGA/ASIC devices

• The ability to obtain and maintain a US security clearance prior to the start date. U.S. citizenship is required as only U.S. citizen are eligible for a security clearance.

Qualifications We Prefer

• ​FPGA design experience in one or more of the following areas:

  o Radar processing techniques

  o Image processing techniques for visual and infrared sensors

  o Embedded systems design using ARM, Microblaze, or Nios processors

  o Gigabit serial interfaces and multi-gigabit transceivers (MGT’s)

• Experience leading technical teams and programs

What We Offer

Our values drive our actions, behaviors, and performance with a vision for a safer, more connected world. At RTX we value: Safety, Trust, Respect, Accountability, Collaboration, and Innovation.

• This position offers relocation

Learn More & Apply Now!

Please consider the following role type definition as you apply for this role:

Employees who are working in Onsite roles will work primarily onsite . This includes all production and maintenance employees, as they are essential to the development of our products.

This position requires a security clearance. DCSA Consolidated Adjudication Services (DCSA CAS), an agency of the Department of Defense, handles and adjudicates the security clearance process. More information about Security Clearances can be found on the US Department of State government website here:

This position is in beautiful Tucson, AZ. Tucson has a friendly, caring and laid-back atmosphere, combined with the innovation and energy of a metropolitan region and recognized as one of America’s 10 Best Small Cities. Surrounded by beautiful mountains, colorful Sonoran Desert landscape and majestic saguaro cacti, Tucson is blessed with some of nature’s best work. Tucson is known for its bright blue skies, and with more than 310 sunny days per year, Tucson’s fantastic weather lets residents enjoy the outdoors year-round.

Tucson, AZ:

#LI-CV1

As part of our commitment to maintaining a secure hiring process, candidates may be asked to attend select steps of the interview process in-person at one of our office locations, regardless of whether the role is designated as on-site, hybrid or remote.

RTX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status, or any other applicable state or federal protected class. RTX provides affirmative action in employment for qualified Individuals with a Disability and Protected Veterans in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans’ Readjustment Assistance Act.

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