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We are seeking a detail-oriented and experienced Certified Medical Coder specializing in Gastroenterology (GI) to join our team. The ideal candidate will ensure accurate coding of diagnoses, procedures, and services in compliance with ICD-10-CM, CPT, and HCPCS guidelines, supporting optimal reimbursement and regulatory compliance. Job Responsibilities for the Certified Medical Coder: • Review and accurately assign codes for GI-related procedures, diagnoses, and services from clinical documentation., • Ensure compliance with CMS, payer-specific guidelines, and HIPAA regulations., • Collaborate with physicians and clinical staff to clarify documentation and resolve coding discrepancies., • Conduct audits and provide feedback to improve documentation quality., • Stay current with coding updates, payer policies, and industry best practices., • Assist with denial management and revenue cycle optimization. Job Requirements for the Certified Medical Coder: • Certification: CPC, COC, or CCS required (AAPC or AHIMA)., • Experience: Minimum 2 years of medical coding experience, with a focus on Gastroenterology preferred., • Strong knowledge of ICD-10-CM, CPT, HCPCS, and GI-specific coding guidelines., • Familiarity with E/M coding and modifier usage., • Proficiency in medical terminology, anatomy, and physiology., • Excellent attention to detail and organizational skills., • Ability to work independently and meet deadlines. For more information, please APPLY today!

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 DescriptionWe are looking for a detail-oriented Medical Coder to join our team on a long-term contract basis. In this role, you will be responsible for accurately reviewing and coding inpatient medical records using established standards and guidelines. This position is based in Atlanta, Georgia, and offers the opportunity to contribute to the efficiency and compliance of healthcare documentation processes. Responsibilities: • Review inpatient medical records to assign accurate ICD-10-CM and CPT codes., • Ensure all coding practices comply with regulatory requirements, payer policies, and official guidelines., • Collaborate with healthcare professionals to clarify clinical documentation and resolve coding discrepancies., • Stay updated on coding standards, payment systems, and healthcare regulations., • Participate in audits and quality improvement initiatives to ensure coding accuracy., • Protect the confidentiality and integrity of patient information throughout the coding process., • Meet established productivity and accuracy benchmarks to support organizational goals., • Assist in staff training efforts to enhance coding knowledge and compliance.• Proven experience in medical coding, including proficiency in ICD-10 and CPT coding systems., • Certification in medical coding (e.g., CPC, CCS, or equivalent)., • Strong understanding of outpatient and inpatient coding guidelines., • Familiarity with healthcare regulations and payer policies., • Ability to work collaboratively with clinical and administrative teams., • Excellent attention to detail and organizational skills., • Knowledge of prospective payment systems and healthcare compliance standards.

Job Description Remote Medical Biller & Coder (Entry-Level & Experienced) Company: Rooted Talent Solutions Location: Remote (Work From Home) Job Type: Independent Contractor (1099) Schedule: Flexible | Part-Time and Full-Time Opportunities ???? About the Role Rooted Talent Solutions is actively seeking remote medical billers and coders to join our healthcare support team. This is a remote, independent contractor opportunity involving medical claim processing, coding, and administrative support for healthcare providers. We’re hiring both experienced professionals and motivated individuals looking to enter the field. If you’re detail-oriented, organized, and eager to work from home, this could be the right opportunity for you. ???? Responsibilities • Process and submit medical claims accurately and on time, • Assign appropriate ICD-10, CPT, and HCPCS codes, • Review documentation for coding compliance, • Follow up on denied or unpaid claims as needed, • Communicate with providers, payers, or clients when necessary, • Maintain HIPAA compliance and data security standards ???? Qualifications ✅ Preferred: • Experience with medical billing, coding, or claim processing, • Familiarity with EHR or billing software, • Strong attention to detail and accuracy, • Basic understanding of insurance guidelines and terminology, • Certifications such as CPC or CBCS are a plus ???? Entry-Level Applicants: If you do not have experience, that’s okay. We will consider highly motivated candidates who demonstrate strong interest in the field. Additional details regarding onboarding and training will be discussed during the interview process. ???? Position Details • Location: 100% Remote, • Schedule: Flexible – hours vary based on client/project needs, • Compensation: Varies depending on experience and client placement, • Type: Independent Contractor (1099) ???? To Apply Submit your resume and a short message about your experience or interest in medical billing. Selected applicants will be invited to attend an interview session to learn more about current opportunities and next steps. ???? Rooted Talent Solutions is an equal opportunity contractor network. We welcome applicants of all backgrounds and are committed to fostering a supportive, remote-first work environment.

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.

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.