• Coder I - Risk Adjustment, Geisinger Health Plan…

    Geisinger (Danville, PA)
    Job Summary Risk Adjustment coding is the transformation of verbal descriptions of diseases and injuries into alphanumeric designations. The coding process ... + Reviews the content of the medical record for hospital and professional inpatient and outpatient records to identify diagnosis codes. + Carefully details review of… more
    Geisinger (09/22/25)
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  • HIM Clinical Documentation Specialist

    Penn Medicine (Philadelphia, PA)
    …discussion to instruct the clinical teams in appropriate documentation as suggested by CMS coding guidelines and to ensure that the clinical chart is the true and ... and offer direction to primary care staff w regard to changes in coding practices and noted trends noted in team documentation requiring clarity and/or specification… more
    Penn Medicine (08/07/25)
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  • Per Diem Professional Fee PA/NJ Remote Coder

    St. Luke's University Health Network (Allentown, PA)
    …for validation of RVUs and CPT-4 procedure unbundling. + Maintains a 95% coding accuracy rate as measured through quality reviews. + Maintains daily productivity as ... outlined + Responsible for maintaining up-to-date knowledge of coding guidelines as they relate to physician services for hospital inpatient , observation,… more
    St. Luke's University Health Network (09/26/25)
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  • Medical Abstractionist

    Advatix, Inc. (Philadelphia, PA)
    …claim submission by departmental productivity and accuracy standards + Review of inpatient data and reconciliation of billable services, including review of system ... omissions and clinical documentation insufficiencies + Review and resolution of coding -related edits and errors that impact claim submission + Maintaining thorough… more
    Advatix, Inc. (07/15/25)
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  • Medical Director-Payment Integrity

    Humana (Harrisburg, PA)
    …level of care, and/or requested site of service should be authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is ... of decisions to internal associates. The clinical scenarios predominantly arise from inpatient or post-acute care environments. A remote possibility exists of doing… more
    Humana (09/26/25)
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  • Denials Management Specialist (RN required), Per…

    St. Luke's University Health Network (Allentown, PA)
    …patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes ... appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing… more
    St. Luke's University Health Network (08/13/25)
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  • PPS Coordinator

    Select Medical (Hummelstown, PA)
    …Medical** **PPS Coordinator (RN, PT, SLP, OT)** **Schedule:** Full-time Our Inpatient Rehabilitation Hospital is committed to providing exceptional and compassionate ... patient care **Responsibilities** + Coordinates the data collection on the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) + Ensures the… more
    Select Medical (08/19/25)
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  • CDQI Nurse Specialist - Part Time - Remote

    Datavant (Harrisburg, PA)
    …+ Conduct timely, accurate, and complete documentation reviews for selected inpatient records, addressing inadequate or conflicting documentation. + Collaborate with ... secondary diagnoses, and procedure impact on DRG. + Improve coding specificity by educating physicians and caregivers on the...throughout a patient's stay. + Follow AHA guidelines and coding clinics for accurate coding and required… more
    Datavant (09/04/25)
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  • Medical Director - Southeast Region

    Humana (Harrisburg, PA)
    …participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians ... require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient… more
    Humana (09/10/25)
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  • Referral Coordinator - Bilingual/Vietnamese

    ChenMed (Philadelphia, PA)
    …physicians/clinicians needs or outstanding items regarding to patients. + Enters all Inpatient and Outpatient elective procedures in HITS tool. + Ensures patient's ... + Knowledge of medical terminology, CPT, HCPCS and ICD coding desired + Detail-oriented with the ability to multi-task....+ Knowledge of medical terminology, CPT, HCPCS and ICD coding desired + An understanding of the company's patient… more
    ChenMed (09/06/25)
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