What Is A Remote Medical Coder Jobs in Usa

Job description:

Employment type: Contract (initial 3 months; likely extension)

Schedule: Full-time, Monday–Friday (flexible daytime hours)

Location: Remote (U.S. only)

About the Role

We’re hiring an experienced Inpatient Medical Coder to support acute-care facility coding for a Level I Trauma Hospital. The ideal candidate is AHIMA-credentialed, highly accurate with ICD-10-CM/PCS and MS-DRG/APR-DRG assignment.

Key Responsibilities

• Review inpatient medical records and assign ICD-10-CM/PCS codes with appropriate DRG assignment (MS-DRG/APR-DRG as applicable).
• Ensure compliance with AHIMA, AHA Coding Clinic, CMS, and facility guidelines.
• Query providers per policy to clarify documentation and support compliant code/DRG selection.
• Meet or exceed productivity and 95–98%+ quality standards.
• Collaborate with HIM/CDI teams to resolve discrepancies and optimize documentation integrity.
• Maintain HIPAA compliance and safeguard PHI in a remote work setting.

Required Qualifications

• AHIMA credential: CCS, RHIT, or RHIA (active and in good standing).
• 3+ years recent inpatient facility coding experience.
• Expert knowledge of ICD-10-CM/PCS, DRG methodologies, POA indicators, and encoder/reference tools (e.g., 3M, TruCode).
• Strong understanding of payer guidelines, Medicare regulations, and official coding guidelines.
• Reliable high-speed internet and a secure remote workspace.

Preferred Qualifications

• Level I or Level II Trauma Hospital Experience
• Experience partnering with CDI teams and responding to coder queries/audits

What We Offer

• Competitive contract rates (W-2 or 1099 depending on engagement).
• Consistent case volume and supportive HIM leadership.
• Potential for contract extension and additional projects.
• 40 Hours of PTO
• Health and Vision Benefits
• Paid Holidays
• 401K

How to Apply

Submit your resume highlighting:

• Active AHIMA credential(s) and credential number,
• Years of inpatient coding experience,
• Epic experience details (modules, years, environments),
• Recent productivity/quality metrics (if available), and
• Availability and preferred hourly rate.

Equal Opportunity Employer. We celebrate diversity and are committed to an inclusive workplace.

Job Type: Full-time

Benefits:

• Health insurance
• Paid time off
• Vision insurance

Experience:

• RECENT inpatient coding: 3 years (Required)

License/Certification:

• AHIMA: CCS, RHIT or RHIA Certification (No AAPC Certs) (Required)

CitiMed is a unique medical facility that provides exclusive healthcare amenities to our community. The range of medical and rehabilitative services offered has been specifically selected to treat traumatic injury patients. We provide a variety of health services including diagnostic and rehabilitation. Our vision directs the evolution of our practice, as we strive to improve our services to the community. All CitiMed offices are multilingual and staffed with individuals to make any experience pleasant. You can learn more about us at is growing rapidly, and we are looking for many qualifying individuals to be a part of our team! With the support and hard work of all our employees, CitiMed continues to make its way down a successful road. CitiMed maintains a work culture that allows our team members to feel supported and confident in their work. We offer many learning opportunities with room for professional growth. If the responsibilities interest you and believe you have met the requirements, we strongly encourage you to apply!

Job Description:

We are seeking a highly skilled and detail-oriented Certified Medical Coder with expertise in Pain Management and Orthopedic coding to join our dynamic team. The ideal candidate will possess a strong understanding of coding guidelines and regulations, ensuring accurate coding for optimal reimbursement and compliance.

Key Responsibilities:

• Accurate Coding: Assign appropriate ICD-10, CPT, and HCPCS codes for pain management and orthopedic services, including surgical procedures, injections, and diagnostic tests.
• Documentation Review: Analyze medical records, operative reports, and provide documentation to ensure completeness and accuracy of coding.
• Compliance: Ensure coding practices adhere to federal, state, and payer-specific regulations, including NCCI edits and LCD/NCD guidelines.
• Denial Management: Collaborate with billing and clinical staff to address coding-related denials and implement corrective actions.
• Education & Training: Provide feedback and education to providers and staff with documentation requirements and coding updates.
• Quality Assurance: Participate in internal audits and quality improvement initiatives to maintain high coding accuracy standards.
• Data Analysis: Utilize coding data to identify trends, opportunities for revenue enhancement, and areas for process improvement.

Qualifications

• Certification: Active AAPC certification (CPC, COSC, or CANPC) or AHIMA equivalent (CCS, CCS-P).
• Experience: Minimum of 3 years of coding experience in pain management and orthopedic specialties.
• Knowledge: Proficient in ICD-10-CM, CPT, HCPCS Level II coding systems, and medical terminology related to musculoskeletal and pain management services.
• Technical Skills: Experience with EHR systems and coding software (e.g., EncoderPro, 3M).
• Analytical Skills: Strong attention to detail and ability to interpret complex medical documentation.
• Communication: Excellent verbal and written communication skills for effective collaboration with healthcare providers and staff.

Preferred Qualifications:

• Advanced Certification: COSC (Certified Orthopedic Surgery Coder) or CANPC (Certified Anesthesia and Pain Management Coder).
• Audit Experience: Familiarity with conducting coding audits and implementing compliance strategies.
• Regulatory Knowledge: Understanding of CMS guidelines, HIPAA regulations, and payer-specific policies.

We are seeking a detail-oriented Certified Risk Adjustment Coder to join our healthcare team. This role involves working directly within a clinical or administrative unit to ensure accurate and compliant coding of medical procedures, diagnoses, and services. The ideal candidate will be embedded in day-to-day operations, collaborating closely with physicians, nurses, and billing staff to support efficient documentation and reimbursement processes.

This is a hybrid role, and requires 3 days a week in the office

Key Responsibilities:

• Review and analyze patient medical records to assign appropriate ICD-10, CPT, and HCPCS codes.
• Ensure coding accuracy and compliance with federal regulations, payer policies, and internal standards.
• Collaborate with healthcare providers to clarify documentation and resolve coding discrepancies.
• Submit coded data to billing systems to initiate insurance claims and support reimbursement.
• Maintain and update patient data for long-term tracking and reporting.
• Participate in audits and quality reviews to ensure coding integrity.
• Stay current with changes in medical coding guidelines, CMS updates, and payer requirements.
• Support internal compliance and contribute to external audit readiness.

Qualifications:

• Certified Risk Adjustment Coder (CRC) Certification
• Minimum 2–3 years of experience in medical risk adjustment coding, preferably in an embedded or integrated healthcare setting.
• Familiarity with value-based care and risk-bearing contracts.
• Strong understanding of medical terminology, anatomy, and disease classification systems.
• Proficiency with Electronic Health Records (EHR) and coding software.
• Working knowledge of Microsoft Office.
• Excellent attention to detail and analytical skills.
• Ability to work collaboratively in a fast-paced clinical environment.

Preferred Skills:

• Experience with inpatient, outpatient, or specialty coding.
• Ability to engage with providers.
• Familiarity with payer-specific coding requirements and reimbursement processes.
• Strong communication skills for cross-functional collaboration.
• Knowledge of HIPAA and confidentiality protocols.

About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: The Junior Quality Improvement Coder is responsible for providing director support to all departmental QI initiatives. In this role, the Junior QI Coder will partner with the Director to collaborate with network providers and IPA’s to improve the quality of care through quality improvement activities that will include RAF, HEDIS, CMS Star Ratings and other health plan reporting.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Analyze data from contracted IPA network providers that allows for proper review of data to evaluate HEDIS and Risk Adjustment Factor.
• Conduct internal reviews of documentation and billing on a timely basis.
• Identify coding and billing risk areas, conduct focused reviews. Ensure accurate coding by utilizing official coding resources, Medicare manual and policies.
• Collaborate and educate provider practices on CMS guidelines for Star Measures (Part C & D). Review and advise on appropriate documentation and coding for HEDIS and RAF reporting.
• Prepare summary reporting of the coding review results as requested.
• Participate in ongoing discussions concerning data collection and analysis for HEDIS gaps in care. Re-educate providers as needed.
• Apply official CPT/HCPCS and ICD10 coding guidelines, internal guidelines, and state specific Medicare/Medicaid coding instructions to review and analyze professionally coded services and coding queries.
• Collaborate with internal departments and external partners to review and implement projects to improve delivery of services and quality of care.
• Participate in provider and interdepartmental conference calls and meetings that support exceptional customer service.
• Attend health plan meetings as requested by department leadership.
• Regular and consistent attendance.
• Other duties as assigned.

EDUCATION and/or EXPERIENCE:

• 0 - 1 year of prior experience as a coder in a quality improvement role within a health plan, IPA or medical group.
• Certified Coding certificate required.
• Strong understanding of coding principals including, HEDIS, Medicare Star ratings and Risk Adjustment.
• Strong understanding of the principals of HIPAA and able to maintain confidentiality.
• Able to build rapport with external providers and partners and internal teams.
• Professionally present data and findings that support internal goals and objectives.

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Free catered lunches

Position Details

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 892 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Active - Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 80.00

Shift: Flexible Hours and/or Flexible Schedule

Location: 210 South Florida Avenue Lakeland, FL

Pay Rate: Min $19.37 Mid $24.22

Position Summary

Under the direction of the Coding and Clinical Documentation Improvement Manager, reviews clinical documentation and diagnostic results, as appropriate, to extract data and apply appropriate ICD-10-CM, CPT, and/or HCPCS codes and modifiers to outpatient encounters for reimbursement and statistical purposes. Communicates with physicians, Physician Advisor or other hospital team members as needed to obtain optimal documentation to meet coding and compliance standards. Abstracts clinical and demographic information in ICD-10 CM, CPT, and HCPCS codes and modifiers into the computerized patient abstract. Participates in ongoing continued education to assure knowledge and compliance with annual changes.

Position Responsibilities

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Standard Work Duties: Coder II - Outpatient

• Assigns and sequences diagnostic and procedural codes using appropriate classification systems utilizing official coding guidelines. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding
• Abstracts and enters coded data as well as correct surgeon, anesthesiologist and procedure date. Assures appropriate information such as pathology and operative reports are present in the medical record prior to final coding for coding accuracy and appropriate APC assignment.
• Maintains appropriate level of coding and abstracting productivity and quality for outpatient diagnostic, Emergency Department, Family Health Center, ambulatory surgeries, observations, and other recurring services as per established minimum per hour requirement.
• Demonstrates competence in coding and abstracting requirements by maintaining less than 5% error rate for all ICD-10-CM and/or PCS, CPT, and HCPCS codes and modifiers.
• Continuously reviews changes in coding rules and regulations including in Coding Clinic, CPT Assistant, CMS, and other payer guidelines.
• Prioritizes coding functions as directed by the Manager, and organizes job functions and work assignments to efficiently complete tasks within the established time frames.
• Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
• Works collaboratively with the Discharge Not Final Billed (DNFB) clerks to prioritize workload daily.
• Reviews appropriate outpatient work queues daily to address coding reviews, edits and corrections.
• Reviews appropriate outpatient work queues daily to address coding reviews, edits and corrections.

Competencies & Skills

Essential:

• Computer Experience, especially with computerized encoder products and computer-assisted coding applications.
• Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision.
• Knowledge of anatomy and physiology, pharmacology, and medical terminology.

Qualifications & Experience

Essential:

• High School or Equivalent

Nonessential:

• Associate Degree

Essential:

• High School diploma with Associate Degree from accredited HIM program or certificate in coding from an accredited college.

Other information:

Certifications Essential: CCS

Certifications Preferred: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

Experience Essential:

2-5 years acute care hospital outpatient coding experience within the past five years, or 5-7 year's experience in a multi-disciplinary clinic including surgeries and/or Emergency Department coding.

Certified Risk Adjustment Coder (CRC)

Hybrid | Des Moines, IA (Onsite Tues–Thurs, Remote Mon/Fri)

$40/hour | 6-Month Contract with Potential for Conversion

We are seeking a Certified Risk Adjustment Coder (CRC) to support Medicare Risk Adjustment initiatives through detailed HCC medical record reviews and direct provider engagement. This role is ideal for someone confident, collaborative, and comfortable working onsite with provider teams to drive documentation accuracy and performance improvement.

This position requires onsite presence Tuesday–Thursday in Des Moines, IA with 10% local travel, and remote flexibility on Mondays and Fridays.

Position Overview

This role performs concurrent medical record reviews to ensure accurate capture of HCC conditions and appropriate documentation reflecting patient severity of illness. The coder will collaborate closely with physicians, clinical leadership, and provider engagement teams to improve documentation practices and support compliance with CMS guidelines.

Key Responsibilities

• Conduct comprehensive reviews of medical records for accurate HCC diagnosis capture
• Validate diagnosis codes within Clinical Documentation Improvement (CDI) alerts
• Identify missed or unsupported diagnoses and initiate provider queries
• Ensure compliance with CMS, ICD-10-CM, and Risk Adjustment guidelines
• Interact directly with physicians to improve documentation quality
• Analyze findings and present documentation improvement opportunities
• Support provider education initiatives and track performance metrics
• Maintain strong collaboration with clinical leadership and network performance teams

Required Qualifications

• Active CRC certification (required)
• Minimum 3–5 years of HCC coding and provider query experience
• Experience conducting medical record reviews for Medicare Risk Adjustment
• Strong knowledge of ICD-9/ICD-10 coding guidelines
• Ability to confidently communicate with providers and clinical leadership
• Advanced proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint)
• Experience working within multiple EMR systems
• Ability to manage deadlines and high-volume workload with accuracy

Preferred Qualifications

• 5+ years of clinical chart review or HCC medical record review
• Clinical background (RN, CDI certification, or related credentials)
• Experience presenting documentation findings to leadership teams
• Bachelor’s degree in a related field (preferred)

What We’re Looking For

• Strong communicator who can professionally engage and educate providers
• Detail-oriented with high accuracy and analytical ability
• Self-starter who can work independently and onsite within a collaborative environment
• Comfortable receiving and delivering feedback

If you are a confident Risk Adjustment professional who enjoys provider interaction and driving documentation excellence, we would love to connect.

Inpatient Coder III

Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.

JOB SUMMARY:

Under limited supervision, reviews medical records and performs coding on all diagnoses and procedures (both medical and surgical) according to applicable coding guidelines. Assigns and verifies the correct diagnostic related grouping (DRG) for all inpatient-designated account types. Applies the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient's treatment. Maintains the confidentiality of patient records and procedures.

MINIMUM QUALIFICATIONS:

• Education/Specialized Training/Licensure: High school diploma or GED. Certified Coding Specialist (CCS) credential required. RHIA/RHIT credential preferred

• Work Experience (Years and Area): 5 years minimum of Inpatient coding experience. Inpatient Coding in Trauma Level 1 teaching facility preferred

• Equipment Operated: 3M encoder interfaced with EPIC electronic medical record billing system

SPECIAL REQUIREMENTS:

Communication Skills:

Writing /Composing: Correspondence, Reports

Other Skills: Analytical, Medical Terms, P.C., Anatomy and Physiology

Work Schedule: Holidays, Flexible, Eligible for Telecommute (remote)

Other Requirements:

• Knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
• Knowledge of classification systems ICD-10-CM, AND ICD-10-PCS nomenclature, coding rules, guidelines, and proper sequencing
• Knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid Services (CMS), and the ICD-10-CM and ICD-10-PCS Official Coding Guidelines for assignment of diagnostic and procedure codes Knowledge of JCAHO, Privacy Act of 1974, and HIPAA standards affecting medical records and their impact on reimbursement
• Knowledge of ethical coding principles and revenue cycle activities
• Skill in interpreting and applying ethical coding standards, understanding federal and state laws and regulations, and following professional practice standards for health care organization coding

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Work Hours per Biweekly Pay Period: 80.00

Shift: Monday - Friday

Location: 210 South Florida Avenue Lakeland, FL (Remote)

Pay Rate: Min $63,793.60 Mid $79,747.20

Position Summary

Under the direction of the facility Coding and Reimbursement Manager, conducts coding quality reviews and audits of chart documentation to assess accuracy, ensure compliance with federal and payer policies, and identifies areas for improvement for hospital outpatient coding. Develops and delivers training on coding accuracy and compliance, staying updated on regulations and providing expert guidance to coders. Provides ongoing coding education and training to coding team and serves as mentor to all new coding team members. Serves as a subject matter expert and resource for coders, providers, and other staff on coding questions, regulatory changes, and best practice. Prepares reports of findings and meets with coders and Coding Leadership to provide education and training on accurate coding practices and compliance issues.

Has thorough knowledge of acute care facility guidelines, modifiers, sequencing rules and the NCCI (National Correct Coding Initiative) edits, OCE (Outpatient Code Editor) edits, Official Guidelines for Coding and reporting for ICD-10-CM/PCS, CPT-4, and HCPCS coding conventions, APC payment classifications and Medicare Conditions of Participation. Will assist the Coding and Reimbursement Manager on preparing presentations and/or interdepartmental feedback.

Responsible for conducting coding and billing training programs for billing and coding specialists. Other duties will include implementing coding department policies and procedures and assisting with reviewing and appealing coding denials.

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Standard Work: Outpatient Coding Quality Educator Specialist

• Actively participates in team development, achieving dashboards, and in accomplishing departmental goals and objectives.
• Performs internal quality assessment reviews on outpatient facility coders to ensure compliance with national coding guidelines and the LRH coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Helps to coordinate and direct the day-to-day coding educational activities. Facilitates and provides coding educational classes/presentations to staff, as required/when needed.
• Communicates outcomes to the coding team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Responsibilities also include assisting Coding Leadership in root cause analysis of coding quality issues, performing account reviews, and preparing training documents to assist with coding quality action plans.
• Assists in the review, improvement of processes, education, troubleshooting and recommend prioritization of issues. Researches coding opportunities and escalates as needed. Communicates Coding topics and/or question trends to Coding Leadership for global education.
• Prepares and presents coding compliance status reports to the Coding and Reimbursement Manager and Health Information Management AVP.
• Assists in ensuring coding staff adherence with coding guidelines and policy. Demonstrates and applies expert level knowledge of medical coding practices and concepts.
• Coaches and mentors coding staff as they develop and grow their coding skills. Provides skilled coding support through regularly scheduled coding meetings and as the need arises. Provide one-on-one coaching and support to coding professionals, offering constructive feedback and guidance to improve coding accuracy and documentation practices.
• Assists Coding Leadership with outpatient coding denials.
• Create educational materials, such as manuals, handouts, and multimedia presentations, that effectively communicate complex coding concepts and guidelines.
• Orients, develops and coordinates on-the-job training of instructing them on systems and policies and procedures in accordance to coding compliance guidelines.

Competencies & Skills

Essential:

• Computer experience especially with computerized encoder applications, computer-assisted-coding applications, spreadsheets, and databases.
• Extensive regulatory coding, (ICD-10-CM, CPT-4, HCPCS, Modifiers, and APCs, and associated reimbursement knowledge. Strong knowledge of medical terminology, pharmacology and anatomy and physiology.
• Data Analysis - able to analyze, interpret and share data in a presentation format. Ability to plan and execute educational programs and presentations.
• Communicates clearly and concisely, verbally and in writing. Able to work effectively with other employees, providers and external parties.
• Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision.

Qualifications & Experience

Essential:

• Associate Degree
• Bachelor Degree

Essential:

• Health Information Management or other Healthcare degree

Other information:

Experience essential:

5+ years acute care hospital outpatient coding experience and/or coding auditing

5-10 years of educational experience in a facility or consulting setting.

Certification essential:

CCS, CPC, RHIT, or RHIA

Certification preferred:

RHIA

Revenue Cycle Clinical Documentation Manager – Urgent Care

If you are a Production Coder, Multi-Specialty Coder, Manager of Coding and Clinical Documentation, Manager of Clinical Documentation integrity, Manager of Documentation Excellence and Coding, or Director of Clinical Documentation Improvement with 5 years of healthcare RCM leadership experience in Coding / Clinical Documentation improvement (CDI), then you need to read on...

Revenue Cycle Clinical Documentation Manager Opportunity Description

Our client is a well-established National Urgent Care organization. They have a current opening for a Revenue Cycle Clinical Documentation Manager based in the Nashville, TN, Tampa, FL, or Denver, CO markets. This is a Remote position. RHIA, RHIT, or CPC certifications are highly preferred.

Revenue Cycle Clinical Documentation Manager Job Requirements

• Five years of healthcare experience in Coding / Clinical Documentation (CDI)
• RHIA, RHIT, CPC certifications are highly preferred
• Bachelor's degree required

Revenue Cycle Clinical Documentation Manager Job Responsibilities

• Helps to manage all Coding and Coding-related process flows
• Provides clinical documentation improvement, working with center staff and vendors as necessary
• Manages coding education for Urgent Care Centers and BPO Vendors

The core responsibility of Pena4’s Client Success division is to ensure clients receive the highest level of service from Pena4. The team focuses on building and maintaining client relationships beginning with implementation, production management, performance metrics, managing the overall client engagement, long-term growth and retention.

Role Overview

The Assistant Vice President of Client Operations (AVP) will lead Pena4’s client operations with respect to all client deliverables including implementation, client services and production. This will be done through well-organized processes/procedures, plans, staffing, metrics, and oversight. This position is a leadership role and is expected to develop, implement and oversee the company’s short-term as well as long term initiatives with respect to delivery of service to clients, client growth, client satisfaction, client retention.

The AVP, Client Operations, is also responsible for providing consulting services and acting as an HIM subject matter expert to existing and new clients. In addition, the AVP must ensure that existing client revenue is achieved and grow each client’s revenue by an established target to be determined annually by senior management.

Key Responsibilities

Provide leadership to the Client Services/Success, Production, and Implementation teams responsible for delivering services to clients and oversee the day-to-day operations of each respective department, in collaboration with the domestic and offshore management teams.

Strategic Management & Leadership

• Participate in strategy planning with leadership team to develop, execute, and manage the company’s long-term goals and revenue targets
• Serve as subject matter expert in the planning, development and implementation of new projects, software applications, business lines, and services
• Develop departmental budgets and revenue budgets and targets for each client.
• o Provide financial oversight and monitoring of budgets to ensure targets are met
• o Monitor revenue for all clients and service lines, prepare variance and projection reports
• o Ensure relevant financial data is presented to the President & COO and leadership team
• Interact regularly with the leadership team and department heads to ensure that operational priorities are aligned with delivery of services to clients
• Partner with all teams to enhance profitability, productivity and efficiency in operations

Client Implementation

• Guide new clients through the implementation process and provide overall support
• Schedule kickoff meetings, create and manage implementation project plans, coordinate development and updating of Account Protocols (volume, workflow diagram, and key processes), determine staff requirements
• Define success criteria and milestones with the client
• Ensure smooth setup and training
• Coordinate setup in internal systems, request access, provide project plan updates, set meeting agendas, capture minutes, and provide status reports
• Implement checks/balances to ensure optimal client operations and ensure new client engagement is live within specified timeframe
• Ensure seamless handoffs from Sales to Client Services and consistent with client expectations and experience

Relationship Management and Client Services

• Manage overall client engagement and serve as the primary point of contact post-sale
• Develop revenue budgets and weekly revenue projection for each client
• Understand client goals and challenges to build trusted, long-term client relationships
• Conduct standing meetings and QBR’s with clients and the leadership team
• Prepare and send meeting agendas, minutes and action items
• Manage the capacity planning along with the production team’s schedules, workloads, TAT, production and utilization
• Manage system access for resources, work with client services and client’s help desk to ensure access is created and working, initiate access removal requests
• Scheduling of resources, and coordination of PTO requests
• Assignment of cases to resources (coding, auditing, and QA) based on pre-existing resource alignments provided by coding management
• Assign Central Learning cases to production coders as needed
• Create service requests and scheduled calendar events in Guru, perform data entry of completed cases and respective time for each coder
• Review and close weekly invoices, address discrepancies with finance and/or client

Value Delivery & Outcome Tracking

• Ensure clients are achieving measurable results
• Monitor all contract deliverables (commitments, volume, value reports, reconciliation of accounts, invoicing, etc.)
• Utilize performance metrics to track and report productivity
• Ensure and measure customer satisfaction

Retention & Churn Prevention

• Proactively address risks to success
• Identify early warning signs of dissatisfaction and resolve issues before they escalate
• Coordinate contract renewals

Customer Escalations & Feedback

• Collect and relay client feedback to SME’s and leadership teams, triage as necessary
• Serve as the primary liaison for customer escalations, coordinating with Coding, Quality, CDI, and Billing leadership to ensure timely responses and resolution
• Document and track all escalations and concerns, maintaining clear visibility across internal teams and ensure consistent communication back to the client
• Facilitate escalation meetings and debriefs with internal stakeholders to align on issue root causes, resolution plans, and customer messaging
• Collaborate with internal teams to build and monitor action plans, ensuring all commitments made to the customer are completed and followed through
• Ensure customer expectations are managed appropriately, including realistic timelines, mitigation steps, and regular updates on progress
• Escalate internal delays or barriers proactively to appropriate leaders to avoid further customer dissatisfaction
• Track post-resolution satisfaction and trends to identify patterns and drive continuous service improvement in partnership with delivery teams
• Represent the client voice internally, influence improvements and roadmap priorities

Growth & Expansion Support

• Develop strategic plans to increase revenue of existing clients (targets to be determined annually based on company goals)
• Identify upsell, cross-sell opportunities, and contract expansions
• Expand horizontal footprint within each client by contacting other departments, building relationships, and gaining interest
• Support clients as their needs evolve and align internal teams around client goals
• Act as consultant and subject matter expert for existing and new clients

Perform additional duties as assigned and assist with other tasks as requested.

Required Skills & Qualifications

Experience:

· Minimum of seven (7) years applied management experience in directing and overseeing client operations within the for-profit revenue cycle consulting industry

· Minimum five (5) years of experience leading offshore teams in India

Education:

· College degree required; graduate degree a plus, preferably Health Information Management or Business Management/Administration

Credentials/Certifications:

· AHIMA, AAPC, or other relevant credentials preferred, but not required, such as RHIA, RHIT, CCS, CPC.

Skills & Knowledge:

• Working knowledge of ICD-10-CM/PCS, CPT, and payment methodologies (DRGs, APCs, etc.), medical coding, medical billing, coding auditing, education, and staffing
• Strong knowledge of HIPAA, and other privacy laws and regulations, and ability to analyze risks and solve compliance challenges
• Excellent customer service, project management, planning, budgeting, reporting, people management, communication, public speaking, and interpersonal skills
• Strong organizational, analytical, and problem-solving abilities and techniques
• Data analytics, cost analysis, and ability to develop business plans
• Strong proficiency in Microsoft Office

Physical Job Requirements

• Ability to travel between office and client locations (international travel when needed)
• Ability to operate standard office equipment for prolonged periods (pc/laptop, phone, keyboard, mouse, monitor, printer/scanner/copier, etc.)
• Ability to perform repetitive hand and wrist motions (typing, data entry)
• Ability to sit extended periods of time, with occasional standing and walking in the office
• Ability to communicate effectively in person, by phone, and via electronic means
• Ability to lift and carry objects typically up to 15 pounds such as files or office supplies
• Ability to maintain focus in a typical office environment with moderate noise levels

Limitations and Disclaimer

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor in compliance with Federal and State Laws. Requirements are representative of minimum levels of knowledge, skills and/or abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Continued employment remains on an “at-will” basis.

All job requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.

Join us to lead transformative initiatives that elevate our client operations while fostering a dynamic, collaborative workplace focused on excellence!

For more details, please connect with Afra Aleem at 6 Ext 112 or email her at

**Local to South Carolina candidate required**

**W2 candidate needed**

Job Title: Clinical Analyst

Duration: 12 Months

Start Date: ASAP

Location: Columbia, SC 29201 (Hybrid (20% onsite - must be available to come onsite periodically)

Position Type: Contract

Interview Type: Webcam

Required Skills:

• 5+ years in healthcare insurance; medical review, program integrity, or appeals.
• 5+ years working with IT developers/programmers in a payor environment.
• 5+ years Medical Coding in payer environment.
• 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
• 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
• Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

Additional skills:

• 5+ years written and oral communications skills, strong proficiency in English.

Preferred Skills:

• 5+ years’ experience in policy remediation.
• 5+ years claims processing systems experience.
• 5+ years knowledge of Microsoft Office
• 5+ years Optum Encoder and/or other medical coding software programs

V Group Inc. is a New Jersey-based IT Services and Products company, strategically organized into multiple business units: Public Sector, Enterprise Solutions, Ecommerce, and Digital. Within our Public Sector unit, we specialize in delivering IT Professional Services to Federal, State, and Local governments. We hold multiple contracts across 30+ states across US, which include NY, CA, FL, GA, MD, MI, NC, OH, OR, CO, CT, TN, PA, TX, VA, MN, NM, VT, and WA. If you're considering a career opportunity with V Group or exploring a partnership, I welcome you to reach out to me with any questions about our services and the unique advantages we offer to consultants. And please feel free to share my contact information with others who may benefit from connecting with us.

Website: : : :

Position Summary:

The Director of Patient Outcomes (DPO) is responsible for the accurate and timely collection, documentation and transmission of the Patient Assessment Instrument (PAI) and for the operation and management of the Case Management Department. The position is a member of the Hospital Leadership Team and collaborates with physicians, clinical staff, and coders. Primary responsibilities include: educating clinical staff on accurate collection of data contained in the PAI and functional outcome measures (FOM), length of stay management, and oversight of clinical and financial coordination of patient treatment plans to ensure timely, cost-effective, individualized service delivery.

Pay: Rate of pay is based on years of experience and qualifications.

Minimum Qualifications:

• Clinical License required (SLP, PT, OT, or RN preferred) Other licensure/certification to be considered based on appropriate qualifications
• Minimum 2 years’ experience in rehabilitation or a closely related field
• Case management experience preferred

Desired Qualifications:

• Experience with IRF-PPS and IRF-PAI Scoring preferred
• Experience with Medicare guidelines for discharge planning and UR preferred
• Management experience preferred

Knowledge, Skills and Ability Requirements:

• Strong leadership skills required
• Excellent verbal and written communication skills
• Strong organizational, time management and prioritization skills
• Strong analytical and critical thinking skills
• Detail-oriented, able to meet strict time frames

Join our team and you will experience a total rewards package to support your health, life, career and retirement including:

• A supportive and collaborative work environment
• Opportunities to progress in function, skill, and pay
• A competitive wage scale
• A comprehensive health and wellness package including medical, dental, and prescription drug coverage

We offer a benefits package that will best suit your family’s needs. You can choose from a variety of medical coverage plans that best fit your lifestyle. You also have the option to enroll in additional perks such as 401k, life insurance, and disability plans.

• Bradenton Rehabilitation Hospital at Tampa is an EEO employer - M/F/Vets/Disabled

Position Details

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Work Hours per Biweekly Pay Period: 80.00

Shift:

Location: 1324 Lakeland Hills Blvd Lakeland, FL

Pay Rate: Min $161,200.00 Mid $215,300.80

Position Summary

The Physician Advisor serves as a liaison between the clinical document improvement (CDI) team, which includes hospital coders; members of the Hospital's administration; the Medical Staff of the hospital; and the hospital's Utilization Management to facilitate the development and implementation of clinical documentation improvement initiatives. The Physician Advisor is pivotal in leveraging his or her clinical position to demonstrate the association of care delivery with specificity in documentation. The Physician Advisor is responsible for conducting clinical reviews referred by the Utilization Management, Coding and Clinical Documentation Improvement departments. The Physician Advisor will assist with reviews and appeals of DRG and medical necessity denials.

Position Responsibilities

People At The Heart Of All We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Supervisor/Team Lead Capabilities

• Demonstrates accountability for shift/team operations and care/service delivery to support achievement of organizational priorities.
• Coaches front line team members to support ongoing professional development and hardwire technical and professional capabilities.
• Creates a high performing team by building strong relationships, delegating work and nurturing commitment and engagement.
• Manages team conflict/issues implementing appropriate corrective actions, improvement plans and regular performance evaluations.
• Applies change management best practices and standard work to support departmental changes and ensure effective team transition.
• Promotes a healthy and safe culture to advance system, team and service experien

Standard Work: Physician Advisor

• Acts as a liaison between the CDI professionals, Health Information Management, and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, HCC/risk adjustment in addition to Diagnosis Related Group (DRG) assignment.
• Perform concurrent and retrospective reviews of selected health records as it pertains to CDI and coding validation, and participate in the development of clinically appropriate and compliant provider queries to further clarify documentation.
• Educates individual hospital staff physicians about International Classification of Diseases (ICD) coding guidelines and clinical terminology to improve their understanding of severity, acuity, risk of mortality, HCC/risk adjustment and DRG assignments on their individual patient records.
• Assists with the evaluation and appeal of concurrent and restrospective denials and retrospective DRG downgrades. May perform peer-to-peer meetings as required.
• Participates in the coding and CDI programs and identifies potential areas for improved documentation of services. Also participates in the Coding and CDI meetings and provides ongoing education to the team members.
• Provides peer to peer communication to affect the appropriate response for those cases where the physician fails to respond or questions the need for queries.
• Responsible for writing and submitting appeals (multiple levels as needed) specifically around medical necessity, non-covered services, authorizations, and inpatient/observation stay related denials. May perform peer-to-peer meetings as required.
• The Physician Advisor is pivotal in leveraging his or her clinical position to demonstrate the association of care delivery with specificity in documentation through effective communication and education of the respective parties.
• Provides his or her expert opinion in relation to clinical validity assessments, and, furthermore, the development of clinically robust and appropriate queries.
• Serves as second level reviewer for UM, providing guidance on appropriate/alternate levels of care based on InterQual guidelines and other appropriate criteria.

Competencies & Skills

Essential:

• Broad knowledge base of clinical medicine across all specialties.
• Basic coding guidelines regarding the selection of the principal diagnosis and reporting additional diagnoses and procedures; understanding the DRG system; levels of comorbidities; and concepts of risk adjustment, severity of illness, risk of mortality, case mix index, prospective payment, hospital acquired conditions, patient safety indicators.
• Organize tasks effectively and efficiently and the ability to act independently through the application of critical thinking skills.
• Computer skills appropriate to position
• Excellent written and verbal communication skills.

Qualifications & Experience

Essential:

• Medical Degree

Essential:

• Licensed to practice medicine in the state of Florida, shall be board certified in internal medicine, and shall meet any other reasonable professional criteria established by LRH or the hospital.

Other information:

Experience Essential:

- Minimum of two years of experience in conducting coding and CDI reviews.

- Knowledge of coding guidelines and how it translates from clinical documentation.

- Knowledge of DRGs, Risk of Mortality, Severity of Illness, Mortality Rate, HCC/risk adjustment, CMI and the impact of clinical documentation/coding in relation to these metrics.

- Excellent computer skills with prior exposure to use of Microsoft Office suite

Job Summary

The Director of Revenue Management directs all UCSF Health revenue integrity strategy and initiatives across hospital and professional billing environments. The Director oversees the Revenue Integrity (RI) team and has enterprise responsibility for Charge Description Master (CDM) governance, pricing, accurate and compliant charge capture, documentation alignment, revenue monitoring, and proactive identification and mitigation of denial risk.

Responsibilities include the structure and maintenance of the CDM and professional fee schedules; development, implementation, and oversight of policies and processes related to compliant charging and coding practices; pricing strategy, analysis, and modeling; and proactive monitoring of gross revenue performance and revenue risk.

The Director collaborates extensively with clinical departments, Health Information Management, Patient Financial Services, Compliance, Internal Audit, Health Plan Strategy, Finance, and Information Technology teams to ensure revenue integrity requirements are embedded into operational and technical workflows. This includes partnership with IT and Epic application teams to optimize system design, automation, testing, and validation of charge capture and billing workflows to ensure accuracy, efficiency, and safeguarding of revenue.

The Director interacts with executives, other directors, internal and external auditors, compliance leadership, operational leaders, physicians and their staff, and UC system counterparts. External contacts include state and federal agencies, regulatory bodies, vendors, and external auditors.

The Director contributes to short- and long-range planning for revenue cycle strategies, processes, tools, and systems; establishes departmental goals, budgets, and staffing plans; and develops policies that affect revenue integrity and revenue cycle functions across UCSF Health. Errors in judgment or failure to achieve objectives may result in significant financial loss, compliance risk, or operational disruption.

The final salary and offer components are subject to additional approvals based on UC policy.

Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement.

The salary range for this position is $144,200 - $350,000 (Annual Rate).

To learn more about the benefits of working at UCSF, including total compensation, please visit: Description

The Revenue Management Department provides enterprise governance, strategic oversight, and operational leadership for revenue integrity across UCSF Health, encompassing both hospital and professional billing environments. The department is responsible for ensuring compliant, accurate, and defensible revenue practices through oversight of charge capture, documentation alignment, coding integration, pricing governance, and Charge Description Master (CDM) and professional fee schedule management.

The department partners closely with clinical leadership, Finance, Compliance, Health Information Management, Patient Financial Services, and Information Technology to embed revenue integrity requirements into operational and technical workflows. This includes supporting system design, automation, analytics, and controls to safeguard revenue, reduce variability, mitigate compliance risk, and support transparent and sustainable reimbursement practices. The Revenue Management Department serves as a strategic liaison between operational and technical teams and plays a critical role in enterprise revenue performance, regulatory readiness, and system-wide initiatives.

Required Qualifications

• Bachelor’s degree in relevant field such as, Business, Management, or Health Administration; or equivalent experience
• Ten (10) years of experience in hospital and professional revenue cycle leadership, charge description master maintenance, clinical charge capture, coding, government/third-party reimbursement, or similar healthcare experience
• Possession of 1 or more of the following certifications:
• CPAM – Certified Professional in Ambulatory Management (MGMA)
• CHRI – Certified Healthcare Revenue Integrity (AAPC)
• CHC – Certified in Healthcare Compliance (HCCA)
• CPC – Certified Professional Coder (AAPC)
• CCS – Certified Coding Specialist (AHIMA)
• Experience in managing and/or developing charge description master, fee schedules, and charge capture processes, policies, and/or procedures
• Practical experience using hospital information systems, Epic preferred, and computer proficiency with PC applications (e.g. Microsoft Office)
• Practical experience and knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Revenue codes
• In-depth knowledge of overall revenue cycle processes, specifically revenue integrity, including industry trends
• Demonstrated leadership experience in a healthcare setting, preferable within a medical facility or health system
• Knowledge of applicable laws, regulations, requirements, standards and practices pertaining to patient confidentiality and information management
• Demonstrated analytical and decision-making skills
• Demonstrated professional interpersonal and communication skills
• Excellent organizational, time management, and project management skills; ability to manage multiple, competing priorities
• Detail-oriented, good organizational skills, and ability to be self-directed
• Ability to present to and interact with all levels of hospital management and physician leaders
• Ability to plan, document, direct, monitor and coordinate workflows

Preferred Qualifications

• Master’s degree in related health care or business area and/or equivalent experience/training

About UCSF

At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what’s possible for the patients we serve – a promise we share with the professionals who make up our team.

Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report – UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence – also known as our PRIDE values.

In addition to our PRIDE values, UCSF is committed to equity – both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at

Join us to find a rewarding career contributing to improving healthcare worldwide.

Equal Employment Opportunity

The University of California 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, disability, age, protected veteran status, or other protected status under state or federal law.

Organization

Health

Job Code and Payroll Title

006580 REVENUE CYCLE HC MGR 2

Job Category

Accounting / Finance, Financial, Professional and Managerial, Supervisory / Management

Bargaining Unit

99 - Policy-Covered (No Bargaining Unit)

Employee Class

Career

Percentage

%

Location

Emeryville, CA

Campus

Emeryville

Work Style

Flexible

Shift

Days

Shift Length

8 Hours

Additional Shift Details

Monday - Friday, 8 a.m. - 5 p.m.