Certified professional coder jobs in Atlanta, GeorgiaCreate job alerts

Be inspired. Be valued. Belong. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: • Comprehensive health benefits that start day 1, • Student Loan Repayment Assistance & Reimbursement Programs, • Family-focused benefits We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: • Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition., • Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG., • Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed., • Works with Coders and CDSs to draft and initiate physician queries., • Performs reviews in a timely manner to maintain DNFB target of 4 days., • Provides Coding development with coordination of educational and training programs regarding technical coding and clinical topics for the coding staff., • Coordinates remediation when required., • Coordinates with the Coding leadership, Quality nurses and the CDS team to educate physicians, nursing, and other clinical staff to improve documentation., • Review¿s DRG Reassignment letters and assists in formulating Appeal letters MINIMUM QUALIFICATIONS: • Certified Coding Specialist (CCS) certification., • RHIA/RHIT preferred., • Minimum five (5) years experience with coding ICD-10 in an acute care setting., • Previous experience in performing DRG coding audits., • Possesses knowledge of DRG and grouping methodologies (MS DRG's and AP DRG's); in particular what diagnoses / procedures impact DRG assignment., • Basic computer skills in word processing and spreadsheet utilization., • Excellent interpersonal skills to develop relationships necessary to facilitate and educate., • Excellent prioritization and organizational skills. Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at ___. Please note that one week's advance notice is preferred.

Job DescriptionJob Summary: The Claim Examiner Team Lead is a key resource for the Claim Examiner team, leveraging advanced expertise in claim adjudication, payment integrity and regulatory compliance. This position does not include direct supervisory responsibilities or formal performance reviews. Instead, the Team Lead provides support, coaching, and technical guidance to claim examiners, ensuring accuracy, efficiency, and adherence to CMS and company standards. Acting as a mentor, process improvement lead, and operational reviewer, the Team Lead drives continuous improvement, supports fraud, waste and abuse (FWA) prevention initiatives and collaborates with cross-functional teams to optimize claims processes and professional development. Key Responsibilities: Team Leadership and Enablement • Provide direction, mentorship, and technical support for Claim Examiners, fostering a collaborative and high-performance environment., • Act as the primary resource for escalated claims and technical questions, offering expert advice and facilitating team learning., • Contribute to the development and delivery of training materials and workshops, supporting ongoing professional development., • Lead and support onboarding of new Claim Examiners, ensuring effective orientation to claims processes, company policies, and regulatory requirements., • Serve as a resource for new team members during their initial training period helping them integrate into the team and build foundation skills. Claim Adjudication and Payment Integrity • Utilize in-depth knowledge of claims adjudication processes to ensure accurate and timely processing of Medicare Supplement claims., • Review and analyze complex claims for proper application of policy provisions and regulatory requirements., • Support payment integrity by verifying claims are processed correctly, assisting in identifying and correcting payment errors, and collaborating on payment integrity reviews. Fraud, Wast, and Abuse (FWA) Prevention • Review claims for signs of fraudulent activity or proper hilling practices., • Assist in enforcing policies and procedures to prevent, detect and address FWA in claims processing., • Conduct investigations into suspected FWA activities and educate team members on prevention strategies. Regulatory Compliance and Quality Assurance • Ensure claims processing complies with CMS guidelines, state regulations, and company policies., • Conduct regular audits of claims to maintain high standards of quality and compliance., • Stay informed about changes in Medicare regulations and communicate updates to the team. Claim Edit Logic Review and Collaboration • Serve as an operational reviewer and subject matter expert for claim edit logic, providing input and feedback to technical, compliance, and analytics team., • Participate in requirements gathering, validation, and documentation of logic changes, supporting audit readiness and continued improvement., • Collaborate with IT and analytics teams on the implementation and optimization of claim edit logic, without direct responsibility for technical development or system configuration. Process Improvement and Operational Excellence • Identify opportunities for process improvements and efficiencies in claim indexing, queue management and workflow., • Lead or participate in process improvement initiatives, leveraging data analytics and trend analysis to drive operational enhancements., • Prepare actionable insights for management review. Stakeholder Collaboration and Enablement • Facilitate resolution of complex claims issues and drive alignment with CMS policies., • Provide expert guidance and support to claim examiners and customer service representative regarding claim-related inquiries and escalations., • Collorate with cross-functional teams (compliance, IT, analytics, customer service) to ensure seamless integration of new rules and system enhancements. Qualifications: Experience: • 3+years of experience in healthcare claims analysis, medical coding, payment integrity or healthcare data analytics., • Experience with Medicare payment methodologies and reimbursement rules preferred., • Experience with clinical coding (CPT, HCPCS, ICD, NDC) and regulatory research preferred. Certifications: • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or similar preferred credentials. Skills: Technical and Analytical: • Advanced proficiency in SQL and Excel; experience with data visualization tools (Tableau, Power BI) and large datasets., • Strong analytical, communication and problem-solving skills., • Deep understanding of medical coding systems (CPT, HCPCS, ICD, DRG, NCD) and healthcare reimbursement methodologies. Communication and Collaboration: • Excellent verbal and written communication skills; able to explain technical concepts to non-technical audiences and document logic/rationale for edits., • Ability to work independently and collaboratively in cross-functional teams (technical, business operations, provider facing). Quality and Process Improvement • Strong attention to detail and commitment to accuracy in edit development, testing, and documentation., • Experience in quality assurance, UAT testing and continuous improvement of claims editing. Problem Solving and Initiative: • Demonstrated ability to analyze root causes, troubleshoot issues and propose solutions for claims editing and payment integrity challenges., • Proactive in identifying opportunities for edit optimization, regulatory compliance and operational efficiency. Work Environment / Physical Requirements: The work environment is a standard office setting with typical office equipment. This role involves professional collaboration with colleagues and clients. Responsibilities may involve extended periods of sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching, stooping, and lifting office items weighing up to 25 pounds.

Job DescriptionJob Summary: The Medicare Supplement Claims Research Analyst serves as a subject matter expert in Medicare Supplement claims, coding guidelines and regulatory compliance. This role is responsible for reviewing, analyzing, and adjudicating claims to ensure accuracy, payment integrity and compliance with company and CMS policies. The Research Analyst interprets and applies complex regulatory and clinical guidance, translating it into actionable claim edit logic and rule sets that drive automated claims adjudication. The Research Analyst develops, maintains, and optimizes claim edit logic to ensure alignment with current policies and industry standards, supports fraud, waste and abuse prevention, and prepares reports and presentation for management. Leveraging data analytics and claims management systems, the Research Analyst identifies trends, recommends process improvements, and collaborates with cross-functional teams to drive cost savings and service excellence. Strong analytical research, communication skills, adaptability, and a commitment to ethical standards are essential. Key Responsibilities: Reference Library and Policy Governance • Architect and maintain a centralized version-controlled Reference Library for all edit and adjudication policies ensuring rapid retrieval and audit traceability., • Define structure, taxonomy, and standard fields (i.e., owner, effective/last reviewed, approvals, citations)., • Guide periodic reviews and updates; maintain version history and citation integrity. Claim Edit Logic Development and Optimization • Translate Medicare policies, fee schedules, and coding guidelines into actionable claim edit logic and rule sets for automated claims adjudication, • Specify trigger and exclusion criteria using real claim data elements; develop guardrails and hierarchies for payment integrity rule development., • Test, validate, and document logic changes for system configuration and audit readiness. Data Analytics and Trend Analysis • Develop predictive models to identify emerging fraud/overpayment patterns, operational leakage, and cost saving opportunities., • Quantify impact of edit logic and recommended rule updates or process changes., • Analyze claims data to identify potential fraud, waste, and abuse; collaborate with internal teams to investigate suspicious activity., • Support the development and refinement of algorithms for fraud detection. Regulatory Compliance and Policy Translation • Interpret and apply Medicare policies, coding guidelines (CPT, HCPCS, ICD), and regulatory requirements to claims processing and edit logic., • Convert authoritative regulatory and clinical guidance into plain language job aids and policy pages for consistent use by Claim Examiners and Customer Service Representatives. Change Control, Traceability, and Audit Readiness • Link policy pages, rule IDs, configuration tickets, test validation for end-to-end traceability., • Maintain complete change logs and version history for all logic and policy updates., • Prepare documentation packets for internal and external audits. Stakeholder Collaboration and Enablement • Facilitate resolution of complex claims issues and drive alignment with CMS policies., • Provide expert guidance and support to Claim Examiners and Customer Service Representatives regarding claim-related inquiries and escalations. Continuous Improvement • Identify opportunities for process improvements and efficiencies in claim indexing and queue management., • Stay informed about industry trends, best practices, and regulatory changes; recommend and implement process improvements to enhance claims accuracy and operational efficiency. Qualifications: Experience: • 3+years of experience in healthcare claims analysis, medical coding, payment integrity or healthcare data analytics., • Experience with Medicare payment methodologies and reimbursement rules., • Experience with clinical coding (CPT, HCPCS, ICD, NDC) and regulatory research preferred. Certifications: • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or similar preferred credentials. Skills: Technical and Analytical: • Advanced proficiency in SQL and Excel; experience with data visualization tools (Tableau, Power BI) and large datasets., • Ability to aggregate, filter, and tabulate results from complex healthcare data sources., • Experienced writing business logic for claims edits and translating regulatory/clinical references into actionable rules., • Familiarity with claims management systems and healthcare payment platforms. Coding and Regulatory: • Deep understanding of medial coding systems (CPT, HCPCS, ICD, DRG, NCD) and healthcare reimbursement methodologies., • Ability to research, interpret and apply regulatory updates and Medicare policies to claims logic and edit development. Communication and Collaboration: • Excellent verbal and written communication skills; able to explain technical concepts to non-technical audiences and document logic/rationale for edits., • Ability to work independently and collaboratively in cross-functional teams (technical, business operations, provider facing). Quality and Process Improvement • Strong attention to detail and commitment to accuracy in edit development, testing, and documentation., • Experience in quality assurance, UAT testing and continuous improvement of claims editing. Problem Solving and Initiative: • Demonstrated ability to analyze root causes, troubleshoot issues and propose solutions for claims editing and payment integrity challenges., • Proactive in identifying opportunities for edit optimization, regulatory compliance and operational efficiency. Work Environment / Physical Requirements: The work environment is a standard office setting with typical office equipment. This role involves professional collaboration with colleagues and clients. Responsibilities may involve extended periods of sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching, stooping, and lifting office items weighing up to 25 pounds.

Job Description Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation into precise codes that reflect the complexity and severity of a patient's health status. You will: • Review, analyze, and code diagnostic information in a patient's medical record based on client specific guidelines for the project., • The coder will ensure compliance with established ICD-10 CM, third party reimbursement policies, regulations and accreditation guidelines., • Coders must meet and maintain a 95% coding accuracy rate., • AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC, or CRC)., • A minimum of 2 years HCC coding experience, while certified., • Full understanding and knowledge of ICD-10, medical terminology, medical abbreviations, pharmacology and disease processes., • Ability to be flexible in the work environment., • Ability to work in a fast paced production environment while maintaining high quality., • Must be able to follow instructions, meet deadlines and work independently., • Excellent written and verbal communication skills, problem solve, ability to work in a remote environment, and time management skills., • Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data., • Must be able to use Microsoft Office with no training. To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion. This job is not eligible for employment sponsorship. Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here. Know Your Rights, explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, Datavant does not and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay. At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not affect your application or hiring process in any way. Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, by selecting the 'Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here. Requests for reasonable accommodations will be reviewed on a case-by-case basis. For more information about how we collect and use your data, please review our Privacy Policy.

Job DescriptionJoin Our Team at Peachtree Orthopedics and Help Others "Get Better"At Peachtree Orthopedics, we're on a mission to make a difference in healthcare, and we're looking for dedicated individuals to join our team. With nine convenient offices across Greater Atlanta, we're committed to providing top-notch care and your skills and passion can make a real impact. We're not the largest practice in Atlanta, but we take pride in delivering dedicated and compassionate care to everyone who walks through our doors. If you're ready to be part of a team that values your contribution and offers room for growth, consider joining us in our mission to help others "Get Better."Our CulturePeachtree Orthopedics has a rich history of 70 years in business and has earned recognition as a Top Workplace by the Atlanta Journal Constitution for 6 consecutive years. We take pride in our family-oriented, dedicated, passionate, and hardworking culture. When you join our team, you become a part of a community that values excellence in healthcare while working in a supportive and nurturing environment.Why Choose Peachtree Orthopedics?At Peachtree Orthopedics, we offer more than a job; we offer an opportunity to be part of something extraordinary: • Limitless Growth: Propel your career with abundant professional development opportunities within our dynamic organization., • Empathetic Culture: Immerse yourself in a supportive, lively work culture that values your well-being and celebrates your contributions., • Monitors effectiveness of collection efforts and maintains insurance billings are current within the established time frame specified in the department policy., • Compiles and prepares various status reports for management in order to analyze trends and make recommendations., • Create a cross functional training manual for revenue cycle staff and other departments that incorporates, as well as, aligns the company’s strategy and culture of Certainty and Operational excellence., • Performance counseling staff with behavioral/attitudinal problems. Implements the necessary guidelines on discipline management for erring employees, in accordance with company policies, rules and regulations, due process, and government regulations., • Enforces all policies and procedures of the CBO., • Analytical - Synthesizes complex or diverse information; collects and researches data; uses intuition and experience to complement data., • Continuous Learning - Assesses own strengths and weaknesses; seeks feedback to improve performance; pursues training and development opportunities; strives to continuously build knowledge and skills., • Job Knowledge - Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; keeps abreast of current developments; requires minimal supervision; displays understanding of how job relates to others; uses resources effectively., • Use of Technology - Demonstrates required skills; adapts to new technologies; troubleshoots technological problems; uses technology to increase productivity; keeps technical skills up to date., • Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics., • Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service ; responds to requests for service and assistance; meets commitments., • Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods., • Cooperation - Establishes and maintains effective relations; exhibits tact and consideration; offers assistance and support to co-workers; works cooperatively in group situations; works actively to resolve conflicts., • Managing Customer Focus - Promotes customer focus; establishes customer service standards; provides training in customer service delivery; monitors customer satisfaction; develops new approaches to meeting customer needs., • Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings., • Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed., • Written Communication - Writes clearly and informatively., • Change Management - Develops workable implementation plans; communicates changes effectively; builds commitment and overcomes resistance; monitors transition and evaluates results., • Performance Coaching - Defines responsibilities and expectations; sets goals and objectives; gives performance feedback; motivates for increased results; recognizes contributions; encourages training and development., • Team Leadership - Defines team roles and responsibilities; supports group problem solving; ensures progress toward goals; acknowledges team accomplishments., • Delegation - Delegates work assignments; gives authority to work independently; sets expectations and monitors delegated activities., • Leadership - Inspires and motivates others to perform well; effectively influences actions and opinions of others., • Managing People - Includes staff in planning, decision-making, facilitating and process improvement; takes responsibility for subordinates' activities; makes self available to staff; develops subordinates' skills and encourages growth; fosters quality focus in others; improves processes, products and services.., • Quality Management - Looks for ways to improve and promote quality; demonstrates accuracy and thoroughness., • Conflict Resolution - Maintains objectivity., • Business Acumen - Understands business implications of decisions., • Diversity - Shows respect and sensitivity for cultural differences., • Ethics - Works with integrity and principles., • Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values., • Adaptability - Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events., • Personal Appearance - Dresses appropriately for position; keeps self well groomed., • Achievement Focus - Measures self against standard of excellence., • Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time., • Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals.; completes tasks on time or notifies appropriate person with an alternate plan., • Initiative - Undertakes self-development activities; seeks increased responsibilities; asks for and offers help when needed., • Innovation - Generates suggestions for improving work., • Judgment - Exhibits sound and accurate judgment., • Planning/Organizing - Uses time efficiently., • Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality., • Quantity - Meets productivity standards; completes work in timely manner; strives to increase productivity; works quickly., • High school diploma or general education degree (GED). Bachelor's degree preferred. Minimum 3 or more years of medical billing and account follow up experience. 3 or more years of EDI, ERA and EFT Experience required. Previous supervisory experience preferred., • Must be familiar with CPT, HCPCS and ICD-9 codes and CMS regulations, Familiarity with UB 04 claim form completion, knowledge of Medicare, Managed care and commercial insurances products and plans. Good knowledge of correct billing and collection practices in ASC setting. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Must be able to deal with aggressive, hostile and sometimes irrational behavior of patients and family members and have the ability to respond to all patients in a calm and professional manner. Peachtree Orthopedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) certification is a plus. Revenue Cycle Manager -Physician Practice. Ready to hire a Revenue Cycle Manager with Physician Practice experience, up to $80K's, DOE, in Atlanta, 30342.

Job Description About Us PBACO supports independent physicians with the tools, services and incentives to thrive - without giving up control. We collaborate with like-minded hospital systems and care centers to create a seamless, integrated experience that improves outcomes and lowers costs. You're not just a participant - you're our partner. Position Overview The Healthcare Practice Transformation Specialist will serve as a key liaison between physician practices and our organization. This role combines EHR training, clinical documentation review, risk adjustment coding, and billing support. The ideal candidate will be a Certified Professional Coder (CPC) with strong experience in Medicare, risk adjustment, and healthcare analytics. Key Responsibilities • Manage and support a physician network to ensure successful EHR integration and troubleshooting., • Consult with medical practices to analyze workflows, configure EHR systems, and develop customized training plans., • Train physicians and office staff on EHR best practices, regulatory compliance, and specialty-specific workflows., • Review clinical documentation and medical records to ensure accurate ICD-10, CPT, and HCPCS coding for risk adjustment and quality gap closure., • Conduct coding audits and provide education to providers on compliant documentation., • Monitor payer guidelines and coding updates, especially for Medicare Advantage and accountable care organizations., • Assist with billing, claims submission, payment posting, and collections as needed., • Perform financial analysis and reporting using Microsoft Excel (pivot tables, trend analysis)., • Analyze denial reports, identify trends, and recommend corrective actions., • Support quality improvement initiatives by ensuring accurate coding for chronic conditions., • Answer patient billing and claims questions in a professional and clear manner., • Maintain compliance with HIPAA, coding regulations, and company policies., • Certified Professional Coder (CPC) or equivalent certification., • Experience with Medicare Advantage (MA) plans, risk adjustment, or insurance companies., • High school diploma or GED required; associate’s or bachelor’s degree preferred., • 2+ years of medical coding, billing, or risk adjustment experience., • Proficiency in EHR systems (Athena, eClinicalWorks, or similar) and MS Office Suite (Excel expertise strongly preferred)., • Strong knowledge of ICD-10, CPT, and HCPCS coding and regulatory compliance., • Excellent communication and training skills for working directly with providers and staff. This position requires 50-75% local travel and is eligible for a car allowance. BACO supports independent physicians with the tools, services, and incentives to thrive—without giving up control. We collaborate with like-minded hospital systems and care centers to create a seamless, integrated experience that improves outcomes and lowers costs. You’re not just a participant—you’re our partner. PBACO supports independent physicians with the tools, services, and incentives to thrive—without giving up control. We collaborate with like-minded hospital systems and care centers to create a seamless, integrated experience that improves outcomes and lowers costs. You’re not just a participant—you’re our partner. PBACO supports independent physicians with the tools, services, and incentives to thrive—without giving up control. We collaborate with like-minded hospital systems and care centers to create a seamless, integrated experience that improves outcomes and lowers costs. You’re not just a participant—you’re our partner.