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From Home R1 Rcm Medical Coding Jobs in Pennsylvania

St. Luke's Health Network, Inc.

The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS diagnoses ...

UHS

Manager - Coding (REMOTE)

Wayne, PA · On-site +1

Contributes to the development of medical coding and documentation plans and materials and works ... Independence Shared Services is not accepting unsolicited assistance from search firms for this ...

WellSpan Health

Coder II

York, PA · On-site

... from medical documentation and reports for quality assessment, audit, and billing purposes ... Presents training and feedback concerning medical coding, compliance, and reimbursement to ...

Geisinger Health

Medical Coder

Danville, PA · On-site +1

$21.50 - $28.50/hr

Work from home (Pennsylvania) Shift: Days (United States of America) Scheduled Weekly Hours: 40 ... The coding process reviews and analyzes health records to identify relevant diagnoses and ...

Nourish

RCM Associate

Philadelphia, PA · Remote

About the role Reporting directly to our Senior Manager of Revenue Cycle Operations, the RCM ... We'd love to hear from you if: * You have 2+ years of experience in a revenue cycle, medical ...

UHS

Manager - Coding (REMOTE)

Wayne, PA · Remote

Contributes to the development of medical coding and documentation plans and materials and works ... Independence Shared Services is not accepting unsolicited assistance from search firms for this ...

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From Home R1 Rcm Medical Coding information

What is a From Home R1 RCM Medical Coding job?

A From Home R1 RCM Medical Coding job involves working remotely for R1 RCM, a revenue cycle management company, to review and assign standardized medical codes to diagnoses and procedures in patient records. Medical coders use systems like ICD-10, CPT, and HCPCS to ensure healthcare providers receive proper reimbursement from insurance companies. Working from home allows for flexible work hours while still maintaining accuracy and compliance with healthcare regulations. This role typically requires specialized training in medical coding and may require certification.

What is the difference between From Home R1 Rcm Medical Coding vs R1 Rcm Medical Billing?

AspectFrom Home R1 Rcm Medical CodingR1 Rcm Medical Billing
CertificationsCPMA, CPC, CCSCPC, CPC-H, CCS
Work EnvironmentRemote, home-basedRemote or office-based
Industry UsageHealthcare, insurance claimsHealthcare, billing and collections
Job FocusAssigning medical codes for diagnoses and proceduresProcessing patient bills and insurance claims

From Home R1 Rcm Medical Coding primarily involves assigning accurate medical codes for diagnoses and procedures, often working remotely. R1 Rcm Medical Billing focuses on managing patient billing, submitting claims, and collections. While both roles are essential in healthcare revenue cycle management, coding emphasizes documentation accuracy, whereas billing centers on financial transactions.

What are the key skills and qualifications needed to thrive as a Work-from-Home R1 RCM Medical Coder, and why are they important?

To thrive as a Work-from-Home R1 RCM Medical Coder, you need a solid understanding of medical terminology, anatomy, ICD-10/CPT/HCPCS coding systems, and typically a certification such as CPC or CCS. Familiarity with medical billing software, electronic health records (EHR), and compliance tools is essential. Strong attention to detail, time management, and effective communication skills set top performers apart in this role. These competencies ensure accurate claims processing, minimize errors, and support timely reimbursements for healthcare providers.

What are some common challenges faced by remote R1 RCM medical coders, and how can they be addressed?

Remote R1 RCM medical coders often encounter challenges such as maintaining consistent communication with team members, managing time effectively without in-person supervision, and staying updated with frequent changes in coding regulations. Utilizing collaboration tools, participating in regular virtual check-ins, and dedicating time for ongoing learning can help address these issues. Additionally, establishing a dedicated workspace and setting a structured daily routine can significantly improve productivity and work-life balance.
What are the most commonly searched types of R1 Rcm Medical Coding jobs in Pennsylvania? The most popular types of R1 Rcm Medical Coding jobs in Pennsylvania are:
What are popular job titles related to From Home R1 Rcm Medical Coding jobs in Pennsylvania? For From Home R1 Rcm Medical Coding jobs in Pennsylvania, the most frequently searched job titles are:
What job categories do people searching From Home R1 Rcm Medical Coding jobs in Pennsylvania look for? The top searched job categories for From Home R1 Rcm Medical Coding jobs in Pennsylvania are:
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From Home R1 Rcm Medical Coding jobs near you
Coding Appeals Specialist

Coding Appeals Specialist

St. Luke's University Health Network

Allentown, PA • On-site

Part-time

Posted 22 days ago

St. Luke's University Health Network rating

7.1

Company rating: 7.1 out of 10

Based on 261 frontline employees who took The Breakroom Quiz

372nd of 870 rated healthcare providers

Job description

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 Coding Appeals Specialist analyzes patient medical records, claims data and coding on all diagnosis and procedure codes to assure properly assigned MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS diagnoses and/or procedures support the services/treatment rendered.
JOB DUTIES AND RESPONSIBILITIES:
  • Conduct retrospective medical record reviews for diagnosis and procedure code assignment and MS-DRG accuracy.
  • Identify and provide feedback, including identification of trends, to the Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that affect proper documentation and coding of documented medical care for appropriate reimbursement.
  • Work with the physician liaison in review of patient medical records identified by RAC/MIC/CGI/QIO and other outside auditors in retrospective reviews for DRG and coding-related issues. May participate in review of other medical necessity issues as needed.
  • Develop and apply appeal arguments to defend the coding of and by the coding professionals and be able to refute the coding determination made by the outside payor including but not limited to CMS, Aetna, IBC, Omniclaim, QIP, Gateway Health, etc.
  • Draft appeal letters, including the coding argument, to support network coding.
  • Identify clinical documentation improvement issues and through excellent communication with physicians, nurses, coding and other members of the health care team and work independently to resolve such issues.
  • Participate as needed in Administrative Law Judge (ALJ) hearings.
  • Spends approximately 20% of their time weekly coding/abstracting patient medical records according to ICD-10-CM/PCS, UHDDS and CMS guidelines. Utilizes the 3M Encoder to verify and assign ICD-10-CM/PCS diagnosis and procedure codes, and MS-DRG assignment.
  • Performs data entry of coded patient medical records into EPIC, maintaining a 95% coding accuracy rate as measured through quality reviews.
  • Queries physicians when code assignments are not clear and consistent, or when documentation in the record is inadequate, ambiguous, or unclear for coding assignment.

PHYSICAL/SENSORY DEMANDS:
Sitting, standing and light lifting. Repetitive arm/finger use retrieving/viewing computerized patient medical record and abstracting of patient information. Corrected vision and hearing to within normal range. Hearing as it relates to normal conversation. Works inside with adequate lighting, comfortable temperature and ventilation.
EDUCATION:
RHIA, RHIT and/or CCS with knowledge of ICD-9-CM and ICD-10-CM/PCS diagnosis/procedure coding and MS-DRG assignment. Minimum of 5 years coding experience in an acute care, teaching hospital, inpatient setting required.
TRAINING, KNOWLEDGE AND EXPERIENCE:
Minimum 5 years demonstrated inpatient and/or outpatient coding experience in acute care, teaching setting. Knowledge of anatomy and physiology, pathophysiology, and medical terminology required. Working knowledge of ICD-10-CM/PCS and ability to understand complex disease processes strongly preferred. Possesses extensive knowledge of reimbursement systems; extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding and, as needed, medical necessity. Previous experience with electronic patient medical record/EPIC and 3M encoding system preferred.
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.

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