St. Luke's Health Network, Inc.
Allentown, Pennsylvania
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Network Coordinator, Coding Audit & Education performs internal, concurrent, prospective and retrospective coding audit activities. Reviews/validates coded medical records of Professional Coding (PC) staff to determine data quality and accuracy of coding, billing and documentation related to ICD-10, PCS, DRGs.CPT, APC's, and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. JOB DUTIES AND RESPONSIBILITIES: Coding audits of Professional Coding staff in accordance with regulatory requirements, official coding guidelines, and Network audit standards. Reviews and validates coded medical records to assess coding accuracy, documentation integrity, compliance risk, and reimbursement impact related to ICD-10-CM/PCS, CPT/HCPCS, DRG/APC assignment, modifiers, and applicable payment methodologies. Analyzes audit results to identify trends, patterns, and areas of risk or opportunity, including recurring errors, documentation gaps, and compliance vulnerabilities across the hospital system. Develops audit summaries, reports, and tracking tools to communicate findings, monitor improvement over time, and support leadership review and decision-making. Provides targeted, audit-driven education and training to Professional Coding staff, including one-on-one feedback and department-level education based on validated audit findings. Collaborates with Coding Management and Compliance to recommend corrective actions, process improvements, and risk mitigation strategies based on audit outcomes. Supports onboarding and ongoing education of coding staff by contributing audit-based insights, educational materials, and coding guidance aligned with official standards and Network expectations. Participates in external audit activities, including preparation, review, validation of findings, and assistance with response development, in collaboration with Coding Management and Compliance. Promotes accurate, compliant documentation and coding practices through consistent application of coding principles, official guidelines, and regulatory requirements. PHYSICAL AND SENSORY REQUIREMENTS: Sitting up to 7 hours per day, 3 hours at a time. Repetitive arm/finger use for retrieving/viewing computerized patient medical records and abstracting information. Extended periods of vision use for reviewing computerized patient records, abstracting of patient information, approximately 7 hours per day, hours at a time. Hearing as it relates to normal conversation. Seeing as it relates to general vision, peripheral vision and visual monotony. Occasionally may be required to use upper extremities to lift up to 10 lbs.; stoop, bend, or reach to retrieve resource materials and/or paper records in accordance with downtime policy; or use wheel cart. EDUCATION: Must maintain and be credentialed in at least ONE of the following AHIMA and/or AAPC recognized Professional Coding Certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Auditor (CPMA); Certified Professional Coder (CPC); Certified); Certified Coding Specialist (CCS); In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems. Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS/CPT Official Guidelines, Outpatient Prospective Payment System and Coding Clinic References. Current working knowledge of encoder/grouper. Strong analytical and communication skills. TRAINING AND EXPERIENCE: 5 years of coding experience required. Experience in auditing education techniques and methods preferred, but not required. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's St. Luke's University Health Network is an Equal Opportunity Employer.
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Network Coordinator, Coding Audit & Education performs internal, concurrent, prospective and retrospective coding audit activities. Reviews/validates coded medical records of Professional Coding (PC) staff to determine data quality and accuracy of coding, billing and documentation related to ICD-10, PCS, DRGs.CPT, APC's, and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. JOB DUTIES AND RESPONSIBILITIES: Coding audits of Professional Coding staff in accordance with regulatory requirements, official coding guidelines, and Network audit standards. Reviews and validates coded medical records to assess coding accuracy, documentation integrity, compliance risk, and reimbursement impact related to ICD-10-CM/PCS, CPT/HCPCS, DRG/APC assignment, modifiers, and applicable payment methodologies. Analyzes audit results to identify trends, patterns, and areas of risk or opportunity, including recurring errors, documentation gaps, and compliance vulnerabilities across the hospital system. Develops audit summaries, reports, and tracking tools to communicate findings, monitor improvement over time, and support leadership review and decision-making. Provides targeted, audit-driven education and training to Professional Coding staff, including one-on-one feedback and department-level education based on validated audit findings. Collaborates with Coding Management and Compliance to recommend corrective actions, process improvements, and risk mitigation strategies based on audit outcomes. Supports onboarding and ongoing education of coding staff by contributing audit-based insights, educational materials, and coding guidance aligned with official standards and Network expectations. Participates in external audit activities, including preparation, review, validation of findings, and assistance with response development, in collaboration with Coding Management and Compliance. Promotes accurate, compliant documentation and coding practices through consistent application of coding principles, official guidelines, and regulatory requirements. PHYSICAL AND SENSORY REQUIREMENTS: Sitting up to 7 hours per day, 3 hours at a time. Repetitive arm/finger use for retrieving/viewing computerized patient medical records and abstracting information. Extended periods of vision use for reviewing computerized patient records, abstracting of patient information, approximately 7 hours per day, hours at a time. Hearing as it relates to normal conversation. Seeing as it relates to general vision, peripheral vision and visual monotony. Occasionally may be required to use upper extremities to lift up to 10 lbs.; stoop, bend, or reach to retrieve resource materials and/or paper records in accordance with downtime policy; or use wheel cart. EDUCATION: Must maintain and be credentialed in at least ONE of the following AHIMA and/or AAPC recognized Professional Coding Certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Auditor (CPMA); Certified Professional Coder (CPC); Certified); Certified Coding Specialist (CCS); In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems. Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS/CPT Official Guidelines, Outpatient Prospective Payment System and Coding Clinic References. Current working knowledge of encoder/grouper. Strong analytical and communication skills. TRAINING AND EXPERIENCE: 5 years of coding experience required. Experience in auditing education techniques and methods preferred, but not required. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's St. Luke's University Health Network is an Equal Opportunity Employer.
OU Medicine, Inc.
Position Title: Professional Coding Specialist III Department: Revenue Integrity Job Description: Ask your recruiter about our competitive wages and total rewards package! Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Join a forward-thinking team where your expertise drives quality patient care! We are looking for a detail-oriented Professional Medical Coder to help streamline our charge review coding workflow for Adult and Pediatric Evaluation and Management services and Minor Procedures, resolve denials and work with leadership to put processes in place to reduce denials. Enjoy flexible remote / hybrid options, continuous career development, and competitive compensation in a supportive environment. General Description Senior subject matter expert responsible for the most complex pro fee coding portfolios and serving as a functional team lead through mentoring, training, and escalation support. Ensures compliant coding, high audit defensibility, and stable production across multi setting pro fee services in an academic, multi specialty and research enterprise. Essential Job Duties Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position. Code and resolve the most complex, high risk professional encounters including specialty specific procedures, high dollar services, complex modifier scenarios, and telehealth exceptions. Serve as an escalation resource for coding disputes, payer policy conflicts, and documentation challenges; provide definitive guidance consistent with coding standards. Support training and mentoring of Coding Specialists I-II; assist with onboarding, competency development, job aid creation, and informal in service education. Ability to teach and coach peers; translate guidelines into practical, consistent coding decisions and training artifacts. Contribute to coding quality management through audits and trend analysis; recommend process improvements and targeted education based on findings. High autonomy, prioritization skills, and risk ownership for audit sensitive services and complex claims. Partner with clinical leadership and compliance to support documentation improvement and mitigate coding/audit risk; support consistent query practices. Expert coding knowledge across assigned specialties and settings; advanced modifier and payer policy interpretation; strong documentation standard expertise. Strong analytical and communication skills to influence documentation improvement and reduce downstream denials. General Job Duties Performs other duties as assigned Minimum Requirements Education: High School diploma or GED required. Experience: At least 5 years of experience of physician/provider coding required. Certification/License/Registration: CPC or CCS-P required - Additional specialty credential required such as CPMA, CEMC, CRC or other specialty credentials (e.g. COPC, CEDC, CGIC, CIRCC or other) Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.
Position Title: Professional Coding Specialist III Department: Revenue Integrity Job Description: Ask your recruiter about our competitive wages and total rewards package! Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Join a forward-thinking team where your expertise drives quality patient care! We are looking for a detail-oriented Professional Medical Coder to help streamline our charge review coding workflow for Adult and Pediatric Evaluation and Management services and Minor Procedures, resolve denials and work with leadership to put processes in place to reduce denials. Enjoy flexible remote / hybrid options, continuous career development, and competitive compensation in a supportive environment. General Description Senior subject matter expert responsible for the most complex pro fee coding portfolios and serving as a functional team lead through mentoring, training, and escalation support. Ensures compliant coding, high audit defensibility, and stable production across multi setting pro fee services in an academic, multi specialty and research enterprise. Essential Job Duties Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position. Code and resolve the most complex, high risk professional encounters including specialty specific procedures, high dollar services, complex modifier scenarios, and telehealth exceptions. Serve as an escalation resource for coding disputes, payer policy conflicts, and documentation challenges; provide definitive guidance consistent with coding standards. Support training and mentoring of Coding Specialists I-II; assist with onboarding, competency development, job aid creation, and informal in service education. Ability to teach and coach peers; translate guidelines into practical, consistent coding decisions and training artifacts. Contribute to coding quality management through audits and trend analysis; recommend process improvements and targeted education based on findings. High autonomy, prioritization skills, and risk ownership for audit sensitive services and complex claims. Partner with clinical leadership and compliance to support documentation improvement and mitigate coding/audit risk; support consistent query practices. Expert coding knowledge across assigned specialties and settings; advanced modifier and payer policy interpretation; strong documentation standard expertise. Strong analytical and communication skills to influence documentation improvement and reduce downstream denials. General Job Duties Performs other duties as assigned Minimum Requirements Education: High School diploma or GED required. Experience: At least 5 years of experience of physician/provider coding required. Certification/License/Registration: CPC or CCS-P required - Additional specialty credential required such as CPMA, CEMC, CRC or other specialty credentials (e.g. COPC, CEDC, CGIC, CIRCC or other) Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.
OU Medicine, Inc.
Position Title: Professional Coding Specialist II Department: Revenue Integrity Job Description: Ask your recruiter about our competitive wages and total rewards package! Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Join a forward-thinking team where your expertise drives quality patient care! We are looking for a detail-oriented Professional Medical Coder to help streamline our charge review coding workflow for Adult and Pediatric Evaluation and Management services and Minor Procedures, resolve denials and work with leadership to put processes in place to reduce denials. Enjoy flexible remote / hybrid options, continuous career development, and competitive compensation in a supportive environment. General Description Independently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, wRVU integrity, and audit defensibility in an academic and research enterprise. Essential Job Duties Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position. Code complex professional encounters and procedures; ensure correct sequencing, modifiers, E/M level selection, and documentation alignment. Advanced expertise in ICD 10 CM, CPT , HCPCS, and modifiers; strong E/M coding proficiency and payer policy interpretation. Resolve coding-related edits and denials by identifying root cause, coordinating documentation clarification, and supporting rebilling actions as applicable. Apply payer medical policies, NCCI concepts, global service considerations, and telehealth coding rules as relevant to pro fee claims. Provide real time guidance to peers on standard coding scenarios; promote consistency through best practice sharing. Participate in internal quality review programs and implement education/corrective actions based on findings. Proficiency in Epic professional coding work queues and encoder tools; ability to efficiently review documentation in the EHR across settings. Analytical problem solving for denial/edits prevention; ability to identify documentation improvement opportunities and support compliant query workflows Working knowledge of risk adjustment concepts and HCC validation where applicable to supported populations. General Job Duties Performs other duties as assigned Education: High School diploma or GED required. Experience: At least 3 years of experience physician/provider coding required. Certification/License/Registration: CPC or CCS-P required Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.
Position Title: Professional Coding Specialist II Department: Revenue Integrity Job Description: Ask your recruiter about our competitive wages and total rewards package! Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Join a forward-thinking team where your expertise drives quality patient care! We are looking for a detail-oriented Professional Medical Coder to help streamline our charge review coding workflow for Adult and Pediatric Evaluation and Management services and Minor Procedures, resolve denials and work with leadership to put processes in place to reduce denials. Enjoy flexible remote / hybrid options, continuous career development, and competitive compensation in a supportive environment. General Description Independently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, wRVU integrity, and audit defensibility in an academic and research enterprise. Essential Job Duties Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position. Code complex professional encounters and procedures; ensure correct sequencing, modifiers, E/M level selection, and documentation alignment. Advanced expertise in ICD 10 CM, CPT , HCPCS, and modifiers; strong E/M coding proficiency and payer policy interpretation. Resolve coding-related edits and denials by identifying root cause, coordinating documentation clarification, and supporting rebilling actions as applicable. Apply payer medical policies, NCCI concepts, global service considerations, and telehealth coding rules as relevant to pro fee claims. Provide real time guidance to peers on standard coding scenarios; promote consistency through best practice sharing. Participate in internal quality review programs and implement education/corrective actions based on findings. Proficiency in Epic professional coding work queues and encoder tools; ability to efficiently review documentation in the EHR across settings. Analytical problem solving for denial/edits prevention; ability to identify documentation improvement opportunities and support compliant query workflows Working knowledge of risk adjustment concepts and HCC validation where applicable to supported populations. General Job Duties Performs other duties as assigned Education: High School diploma or GED required. Experience: At least 3 years of experience physician/provider coding required. Certification/License/Registration: CPC or CCS-P required Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.