7 quality coding auditor jobs found in Springfield

Coder Auditor-Professionals are responsible for auditing coding assignments with providers and coders, training coding professional staff, and pro‑fee based coding which includes the assignment of ICD‑CM, CPT, HCPCS codes, E&M assignment, modifiers, and charge posting. They interact with medical staff, nursing, ancillary departments, provider offices, and outside organizations. At this time, we are only able to consider applicants who reside in the following states: Alabama, Arkansas, Arizona, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, New Mexico, Ohio, Oklahoma, South Carolina, Tennessee, Texas. Responsibilities Assists coders with coding questions. Conducts the collection and reporting of provider and coder audit results and education. Works with coders and providers to ensure appropriate documentation for clinic services. Reports results to Coding Supervisor - Professional. Demonstrates ability to code all...

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Supervise and provide leadership to the Claims Audit team, ensuring adherence to company policies, procedures, and workflows across lines of business. Manage claims production and quality to meet or...

Job Summary We are seeking an experienced and certified Medical Coder - Inpatient & Outpatient to join our Health Information Management/Revenue Cycle team.The Medical Coder is responsible for accurately reviewing and coding inpatient and outpatient hospital medical records in accordance with official coding guidelines, CMS requirements, payer regulations, and hospital policies.This position plays an essential role in ensuring coding accuracy, regulatory compliance, timely reimbursement, and the integrity of clinical and financial data.The successful candidate will demonstrate strong knowledge of hospital coding, medical terminology, anatomy and physiology, reimbursement methodologies, and regulatory requirements. Essential Duties and Responsibilities Review inpatient and outpatient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes based on assigned account type. Assign and validate appropriate MS-DRG/APR-DRG, APC, Present on Admission (POA),...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. The Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Conduct a...

Medical Coder II The Medical Coder II plays a key role in our hospital's revenue cycle by accurately coding diagnoses and procedures in accordance with established coding guidelines. This position is essential in maintaining financial accuracy and compliance with regulatory requirements. Position Highlights: Position:Medical Coder II Location:Warrenville, IL Full Time/Part Time:Full-time (40 hours per week) Hours:Monday-Friday, during normal business hours What you will do: Assign accurate diagnostic (ICD-10-CM) and procedural (CPT) codes to medical records based on clinical documentation, ensuring adherence to coding guidelines and conventions. Conduct internal audits of medical records and coding work to ensure the accuracy and consistency of code assignments. Examine clinical documentation in medical records, working with physicians and clinical staff to clarify and improve documentation as needed for accurate coding. Stay up-to-date with the latest coding guidelines,...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

QA Nurse / Coder (RN) As a QA Nurse / Coder, you will ensure the accuracy, completeness, and regulatory compliance of Home Health documentationparticularly OASIS assessments, the Home Health Plan of Care (485), and face-to-face encounter noteswhile properly sequencing diagnoses according to federal/state standards and agency policy. Core responsibilities include: Review OASIS forms and Plans of Care for appropriateness, completeness, and compliance. Assign and sequence ICD?10 codes in line with current home health coding guidelines. Ensure consistency and compliance of face-to-face encounter documentation with OASIS and care plans. Conduct additional clinical record audits and OASIS reviews as assigned. Stay current on Medicare reimbursement policies, home health regulations, and compliance requirements. Maintain relevant certifications (HCS?D, HCS?O or COS?C). Participate in quality assurance and performance-improvement efforts. Coordinate with physicians, facilities,...