11 Cms Guidelines Jobs

As a Medical Records Auditor, you will play a crucial role in ensuring the accuracy of coding and documentation within patient medical records. Your responsibilities will include conducting audits of both inpatient and outpatient records to verify proper documentation and billing practices. It will be essential for you to uphold compliance with healthcare regulations such as HIPAA, Medicare/Medicaid, and CMS guidelines. Your role will involve identifying any errors in coding, billing, or documentation and providing constructive feedback to the relevant departments. You will be expected to prepare detailed audit reports that outline findings, trends, and recommendations for corrective action. Collaboration with coding, billing, clinical, and compliance teams will be necessary to address audit findings effectively. In addition, you will monitor the implementation of corrective actions and perform follow-up audits as required. Your support in identifying education opportunities for clinical and billing staff will contribute to ongoing training initiatives within the organization. This is a full-time position that offers Provident Fund benefits. The work location for this role is in person. If you are passionate about ensuring coding accuracy and documentation compliance in the healthcare industry, we encourage you to apply for this opportunity. Your expertise as a Medical Records Auditor will be instrumental in maintaining quality standards and regulatory compliance within our organization.,

As the Director of Clinical BPO Solutions and Delivery in Bangalore, with over 12 years of experience, your key responsibilities will include designing and customizing comprehensive Clinical BPO solutions in CM, UM, and RPM to meet client-specific requirements. You will oversee the delivery of Clinical BPO services, ensuring adherence to client Service Level Agreements (SLAs), regulatory compliance, and operational excellence. Your role will involve ensuring smooth end-to-end service delivery by identifying opportunities for process improvements, resource optimization, and cost-efficiency. You will lead client-facing engagements, including solution presentations and ongoing relationship management to enhance client satisfaction and retention. Building and leading cross-functional teams will be crucial, ensuring alignment between solution design and operational delivery. Additionally, you will oversee the P&L and financial performance of the service delivery, including budgeting, cost management, and profitability. It will be essential to ensure that all operational activities comply with healthcare regulations such as HIPAA and CMS guidelines while managing risks associated with Clinical BPO service delivery. Integrating emerging technologies like AI and automation to enhance Clinical BPO solutions and streamline delivery processes will be part of your responsibilities. Implementing continuous improvement initiatives using data-driven insights and operational feedback to enhance efficiency and quality of service delivery will also be key. Monitoring and reporting on key performance indicators (KPIs) will be crucial to ensure solution success and operational efficiency. Collaborating closely with internal departments such as IT, sales, legal, and HR will be necessary to ensure cohesive service delivery and alignment with company capabilities. To excel in this role, you should hold a Bachelor's degree in Life Sciences, Healthcare Administration, Business, or a related field. A Master's degree in Business Administration (MBA) or Healthcare is a plus. Strong knowledge of healthcare processes, regulatory standards, and best practices is essential. A proven track record in managing BPO operations, meeting SLAs, and optimizing delivery processes for clinical services is required. Experience in designing and presenting clinical BPO solutions tailored to client needs, bridging business and technical requirements, and the ability to assess operational data to make data-driven decisions for improved service delivery are also necessary. Proficiency in healthcare software solutions, CRM tools, and data analytics platforms is expected.,

As an SME in Denial Management with 2-3 years of experience, you will be a part of Zapare Technologies Pvt. Ltd., a leading provider of Revenue Cycle Management (RCM) solutions for the US Healthcare industry. Your role will involve analyzing, managing, and resolving denied insurance claims to enhance collections and optimize revenue cycles for clients. Your main responsibilities will include developing and maintaining denial logs to identify trends, working with denial reason codes to take appropriate actions, and ensuring compliance with HIPAA, CMS guidelines, and coding standards. You will also manage the appeals process by understanding appeal processes and SOPs, preparing and submitting appeals with accurate documentation, and monitoring deadlines for timely submissions. The ideal candidate will possess a strong understanding of the US healthcare billing cycle, hands-on experience with EMR/EHR systems, in-depth knowledge of billing regulations, coding standards, and compliance frameworks. If you are passionate about healthcare revenue management and proficient in resolving complex denials, we encourage you to apply and be a part of the Zapare team. #Hiring #DenialManagement #RCM #HealthcareJobs #MedicalBilling #RevenueCycleManagement #ZapareTechnologies #CareerOpportunity,

Job Description: As an integral part of our team, you will be responsible for conducting audits of patient medical records to verify coding accuracy and documentation compliance. You will meticulously review both inpatient and outpatient records to ensure that services are correctly documented and billed. Your keen attention to detail will be crucial in ensuring compliance with healthcare regulations such as HIPAA, Medicare/Medicaid, and CMS guidelines. Your role will involve identifying errors in coding, billing, and documentation, and providing valuable feedback to the relevant departments. You will prepare comprehensive audit reports that outline findings, trends, and recommendations for necessary corrective actions. Collaboration with coding, billing, clinical, and compliance teams will be essential in addressing audit findings effectively. Additionally, you will be tasked with monitoring the implementation of corrective actions and conducting follow-up audits as required. Your contribution to supporting training initiatives by identifying educational opportunities for clinical and billing staff will be highly valued. This is a full-time position that offers Provident Fund benefits. The work location for this role is in person. If you are a dynamic individual with a background in Life Sciences and a passion for ensuring accuracy and compliance in healthcare documentation, we encourage you to apply for this exciting opportunity.,

The ideal candidate for this position should be a Life Science Graduate with a strong attention to detail and proficiency in conducting audits of patient medical records. As a Medical Record Auditor, you will be responsible for ensuring coding accuracy and documentation compliance in both inpatient and outpatient settings. Your primary duties will include reviewing medical records, identifying errors in coding and billing, and preparing detailed audit reports with recommendations for corrective action. In addition, you will play a crucial role in ensuring compliance with healthcare regulations such as HIPAA, Medicare/Medicaid, and CMS guidelines. Collaboration with coding, billing, clinical, and compliance teams will be essential to address audit findings and monitor the implementation of corrective actions. You will also support training initiatives by identifying education opportunities for clinical and billing staff. This is a full-time position that offers Provident Fund benefits. The work location for this role is in person. If you are a dedicated professional with a keen eye for detail and a passion for maintaining the highest standards of coding and documentation in healthcare, we encourage you to apply for this exciting opportunity.,

Designation: SME - Denial Management Experience: 2-3 years Skills desired: Detailed knowledge of US healthcare billing cycle Experience working with different EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc. Denial analysis and management - Review and analyze denied insurance claims to identify cause of denials such as coding issues, preauthorization, payer-specific policies - Develop and track denial log to monitor patterns and trends in denied claims - Experience talking with payers to obtain clarification with denials and initiate timely appeals when appropriate Expertise in working with denial reason codes (CARC, RARC) and identifying root causes of denials. Strong understanding of billing regulations, CPT, ICD-10, HCPCS codes, and compliance standards (HIPAA, CMS guidelines). Appeals - - Understand 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP - Prepare, submit, and follow up on appeals ensuring all necessary documentation is included - Revie Review assigned denials and EOBs for appeal filing information. Gather any missing information - Review case history, payer history, and state requirements to determine appeal strategy - Obtain patient and/or physician consent and medical records when required by the insurance plan or state - Gather and fill out all special appeal or review forms - Create appeal letters, attach the materials referenced in the letter, and mail them Maintain a record of all appeals and responses to track appeal outcomes and recovery rates Monitor payer response timelines to ensure appeal filing deadlines are met Track insurance company and state requirements and denial trend changes

As a Senior Business Analyst specializing in Revenue Operations and US Healthcare Software Solutions, you will play a crucial role in driving efficiency and compliance within healthcare organizations. Your expertise in US healthcare operations and software will be instrumental in optimizing revenue cycle management, regulatory adherence, and data standards. Your responsibilities will include performing complex data analysis, modeling, and gap analysis to generate insights that support decision-making. By utilizing tools like SQL, Excel, Tableau, VBA, Python, and Access, you will automate reporting processes and develop reports that highlight key business drivers. Collaborating with senior stakeholders in medical institutions, you will gather and document business requirements, ensuring that product enhancements align with operational efficiency, regulatory standards, and user experience. Your ability to identify transformative opportunities in revenue operations and healthcare software systems will drive strategic improvements within the organization. To excel in this role, you should possess a Bachelor's degree in Business, Healthcare, or a related field, with a preference for a Master's degree. With 8-15 years of experience in US healthcare, you should have a proven track record of working closely with stakeholders and end-users in medical environments. Proficiency in data analysis tools, Agile methodologies, and strong communication skills are essential for success in this position. By joining our team, you will have the opportunity to make a direct impact on healthcare outcomes and revenue operations. You will be part of an innovative and collaborative team dedicated to achieving world-class performance. In our growth-oriented environment, you can expect opportunities for leadership development and career advancement, along with competitive compensation and performance-based incentives.,

Assign accurate ICD-10-CM, CPT, and HCPCS codes for surgical procedures; ensure compliance with coding guidelines; verify and abstract data from medical records in outpatient surgery and hospital settings. Required Candidate profile 2–4 years in surgical coding; proficiency in ICD-10-CM, CPT, HCPCS; knowledge of AMA, AHA, CMS guidelines; strong analytical skills; CPC or equivalent certification preferred.

We are looking for a skilled and detail-oriented Content Writer with proven experience in the Healthcare RCM (Revenue Cycle Management) domain. The ideal candidate will be responsible for creating high-quality, engaging, and informative content tailored to medical billing, coding, compliance, and healthcare operations. Roles and Responsibilities: Write and edit content specific to RCM processes including medical billing, coding, denial management, and payer policies. Create blog posts, case studies, whitepapers, email campaigns, and website content relevant to the US healthcare system. Research industry trends and ensure content accuracy and compliance with HIPAA regulations. Collaborate with SMEs, marketing, and business teams to develop strategic content. Optimize content for SEO and user engagement. Desired Candidate Profile: Minimum 2 years of content writing experience in the Healthcare RCM domain is mandatory. Strong understanding of US healthcare terminology, RCM workflow, and payer-provider communication. Excellent written communication and grammar skills. Knowledge of SEO best practices is an added advantage. Key Skills: RCM Content Writing, Healthcare Writing, Medical Billing & Coding, SEO, HIPAA, US Healthcare System, CMS Guidelines, Denial Management Share resume: Shifana.u@247mbs.com Call: +91 7708722553

About IKS Health IKS Health enables the enhanced delivery of exceptional healthcare for todays practicing clinicians, medical groups and health systems. Supporting healthcare providers through every function of the patient visit, IKS Health is a go-to resource for organizations looking to effectively scale, improve quality and achieve cost savings through integrated technology and forward-thinking solutions. Founded in 2007, we have grown a global workforce of 14,000 employees serving over 150,000 clinicians in many of the largest hospitals, health systems, and specialty groups in the United States. IKS Health revitalizes the clinician-patient relationship while empowering healthcare organizations to thrive. We take on the chores of healthcare spanning administrative, clinical, and operational burdens so that clinicians can focus on their core purpose: delivering great care. Combining pragmatic technology and dedicated experts, our solutions enable stronger, financially sustainable enterprises. By bringing joy and purpose back to medicine, were creating transformative value in healthcare and empowering clinicians to build healthier communities. Vision: Healthier Communities, Happier Clinicians, Thriving Organizations, Successful Healthcare for All. Mission: Our mission is to enable the efficient delivery of excellent care. We will deliver on this promise in a manner that makes it a joy for all to work with us becoming the trusted partner that ensures financial success for our clients and healthier populations in our communities. Position: Coding Manager Grade: 10 Reporting To: Portfolio Leader Designations Reporting To This Role: Medical Coder, Coding Specialist and Coding Specialist Auditor Department: Coding Operations Profile Description: The coding manager is responsible for managing day-to-day operations, which includes, team management, client management (client communication, meeting SLAs), meeting and exceeding productivity and quality expectations for the account. Liaison with internal functions to ensure seamless work-flow. Key Responsibilities: Responsible for the day to day planning as well as work allocation for the entire team Ensuring regular as well as on time floor and knowledge support for all the team members Develop / maintain monthly coding production and accuracy reports to track and optimize internal productivity & quality improvement activities Support the Portfolio Leader(s) in creating data for client calls eg: CDI - provider feedback / education efforts Support quality/training team in creating SOPs Ensure all coder/specialist performance data is maintained and shared as and when required Accountable for client delivery SLAs including meeting turnaround time (TAT), daily/weekly/monthly volume deliverables and Quality Partner with the recruitment team in the hiring efforts of the IKS Coding department Accountable for overall performance of the team as well as people metrics such as attrition (retention), absenteeism, schedule adherence, TOS Ensuring upskilling of team members through constant coaching and feedback, execution of individual development plans and completion of performance appraisals on time Ensuring high engagement levels in the team through various ESAT initiatives such as huddles, team meetings and EMPOWER connects Train the team on the latest updates in regards to coding and documentation. Work with training and quality team members to make sure there is ongoing training for the team based on feedback from quality Train the coders on various client specifications Responsible for understanding people's concerns and coordinating with required stakeholders for solution and escalate/highlight for any support required from PL Define career paths and development goals for every individual in the team Ensuring a Learning culture through constant training needs identification, training program coverage at all levels as per development plans for his/her account/department designed in the Career Architecture Ensuring that all programs planned for Self Development are completed Identify areas for provider education and prepare notes Responsible for all client reports including report cards, production report and quality report Responsible for all client workflows, reconciliation and closure Responsible for bringing any clarifications to client and get it resolved and guide the team based on the response Lead scheduled client calls on agenda as well document MOM Assist PL on MBR, QBRs for performance presentations and agenda items, follow up action items and closure Responsible for addressing all client concerns, issues at 1st level along with closing the loop to client Responsible for responding to all client emails in a timely manner (ideally within 24 hrs) Custodian of process SOP and own the update management and sign off from client Accountable for delivering service as per client SLA including meeting TAT, volumes and quality Responsible for driving the topliner of P&L - Volumes for transactional model and resources and productivity on FTE model Take initiatives on any revenue uplift by processing additional volumes without increasing resources/cost Primarily assist on driving all efficiency measures at team level along with PL for cost efficiency Assist PL on keeping the right mix of resources from cost perspective Qualifications: BPT, MPT, BSC Nursing, MSC Nursing, B Pharm, M Pharm, BOT, Life Science is a must AHIMA/AAPC certification is a must MBBS, BDS, BAMS, BHMS, BUMS etc would be an added advantage Role Prerequisites: Minimum of 5 years of experience in the coding domain in Multispecialty OR IPDRG OR OBGYN OR ED specialty is a MUST Currently working for a min of year at least as coding specialist or coding specialist auditor is a must Functional Competencies: Should be conversant with core coding guidelines and best practices with strong knowledge of NCCI edits, local and national policies (CMS guidelines) Good Comprehension Skills Detail Orientation Good Presentation Skills Good People Management Skills Coaching and Feedback Skills Good Knowledge of Microsoft Excel / G-suite is a must Behavioral Competencies: Accountability Customer Service Orientation Developing Others Team Work Analytical Skills Communication

Role: Emergency Department CDI (ED CDI) Specialist Department: CDI Qualification : life science stream At least 2 yrs in clinical documentation improvement • Certifications: CPC Location: Chennai/ Hyderabad Contact : 6379093874 Sangeetha(Whats App)