13 coder quality auditor jobs found

Coder Quality Auditor The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties. Job Responsibilities: Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders'...

Program Integrity Coder- FWA Auditor Evolent partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with the...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with...

Job Description Job Description Position Summary The Certified Medical Coder and Biller is responsible for accurate medical coding, charge capture, and timely billing of services provided within a Federally Qualified Health Center (FQHC). This role ensures compliance with federal, state, and payer-specific regulations, including HRSA, CMS, Medicare, Medicaid, and managed care requirements. The position plays a key role in maintaining revenue integrity while supporting the organization’s mission to provide high-quality, affordable care to underserved populations. Responsibilities and Duties Coding Responsibilities Assign accurate CPT, HCPCS, and ICD-10-CM codes in accordance with official coding guidelines and FQHC requirements Review clinical documentation to ensure coding accuracy, completeness, and medical necessity Apply appropriate modifiers, revenue codes, and PPS/encounter billing methodologies (e.g., T1015 where applicable) Identify documentation...

*Job Title: DRG Certified Coder* Employment Type: Full-Time Location: Fully Remote *About the Role! * We are seeking a highly skilled and detail-oriented DRG Certified Coder to join our Health Information Management team. The ideal candidate will be responsible for accurately assigning ICD-10-CM/PCS codes, validating DRG assignments, and ensuring compliance with all federal coding guidelines and organizational standards. This role plays a critical part in optimizing reimbursement, supporting clinical documentation integrity, and maintaining accurate data for reporting and analytics. *Description* * Review inpatient medical records to accurately assign ICD-10-CM/PCS codes according to official coding guidelines. * Assign and validate MS-DRGs / APR-DRGs to ensure appropriate reimbursement. * Collaborate with Clinical Documentation Integrity (CDI) teams to clarify documentation and support accurate code assignment. * Ensure coding accuracy and compliance with CMS, AHA Coding...

Job Description Job Description The Staff Pad has partnered with Blue Ridge Medical Center in Blue Ridge, Georgia. Blue Ridge Medical Center is seeking an experienced Health Information Management (HIM) Coder to join our team in a fully remote capacity. This individual will be responsible for reviewing, analyzing, and assigning diagnostic and procedural codes for inpatient, outpatient, and/or emergency department medical records using ICD-10-CM, CPT, and HCPCS coding systems in accordance with official coding guidelines and facility standards. Key Responsibilities: Review and abstract clinical documentation from patient records to assign accurate codes for diagnoses and procedures Ensure compliance with federal regulations and hospital policies related to coding and billing Maintain productivity and quality standards established by the HIM department Query physicians when appropriate to ensure accurate and complete documentation Assist in resolving...

Lead Medical Coder - FT - Days - HPG Administration Hybrid HAMILTON PHYSICIAN GROUP - DALTON, GA 30722 Description Hours: 8AM - 5PM, Weekdays Job Summary Works under direct supervision of the Coding and Documentation Manager and follows written policies and procedures to perform the job duties. The coding lead will remain an active coder for the department when needed. The associate will complete required daily activity reporting as needed. The individual will maintain positive business relationships internally and externally to ensure effective and efficient coordination of services to promote individual and departmental goals. The associate ensures the accuracy and timeliness of all encounters coded, and provides support to team members on a regular basis. The individual resolves and advises medical coders on answers to routine questions and problems and refers more complex issues to higher levels. The associate assists the Coding and Documentation Manager in routine...

Job Description: The HIM Hospital Inpatient & Same Day Surgery Coding Analyst deciphers and interprets provider documentation in the health record and assigns diagnostic information using ICD-10-CM/PCS and CPT codes for a complex range of acute care services for Intermountain Health. The caregiver provides specific coding expertise in the various fields of NCCI edits, Drugs and Biologicals, Revenue Codes, Current Procedural Terminology (CPT) codes, ICD-10 & CPT codes, DRGs, anatomy and physiology, pharmacology. The analyst also performs audits, provides feedback, and advanced training to clinical teams and physicians on ICD-10 and CPT coding best practices. Essential Functions Reviews and analyzes inpatient medical records for completeness, accuracy, and compliance for Same Day Surgery, Observation and Inpatient acute services at Intermountain Health. Performs coding at an advanced level of complexity for inpatient hospitals including governmental and/or...

Inpatient Facility Coder My client is hiring for an experienced Inpatient Facility Coder to support hospital-based coding operations within a Trauma Level I teaching facility. This is a fully remote opportunity offering flexible daytime hours, with the expectation that candidates are available to work full-time (40 hours per week). Key Responsibilities: Assign accurate ICD-10-CM and ICD-10-PCS codes for inpatient facility encounters Review clinical documentation to ensure compliant and complete coding Apply inpatient coding guidelines in accordance with CMS, UHDDS, and facility standards Support DRG assignment and coding quality initiatives Collaborate with CDI, physicians, and revenue cycle teams as needed Meet established productivity and accuracy benchmarks Required Qualifications: CCS, RHIT, or RHIA certification (required) 23 years of inpatient facility coding experience Experience coding in a Trauma Level I teaching hospital Strong knowledge of inpatient...

Job Description Job Description Description: The Certified Professional Coder (CPC) – Primary Care (with Risk Code Review) is responsible for accurate and compliant coding of professional services, verification of demographic and insurance information, and timely resolution of front-end claim edits prior to submission. This role also includes reviewing encounters for accuracy of risk-related diagnosis codes to ensure proper documentation support in compliance with payer and CMS guidelines. The coder supports Southeast Medical Group’s goals for revenue integrity, compliance, and operational efficiency through close collaboration with providers, front-end staff, and billing teams. Requirements: Essential Duties and Responsibilities Coding and Charge Review Review provider documentation to assign accurate CPT, HCPCS, and ICD-10-CM codes for all primary care encounters, including preventive, chronic, and acute visits. Ensure all codes are supported by clinical documentation and...

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for 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...

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura's Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research...

Location: Fully Remote Schedule: Flexible Daytime Hours (Must Work Full-Time) Pay Rate: $35-40/hour Benefits: LaSalle Network contractors have the opportunity to enroll in benefits including medical, dental, and vision insurance. Job Description: My client is hiring for an experienced Inpatient Facility Coder to support hospital-based coding operations within a Trauma Level I teaching facility. This is a fully remote opportunity offering flexible daytime hours, with the expectation that candidates are available to work full-time (40 hours per week). Key Responsibilities: Assign accurate ICD-10-CM and ICD-10-PCS codes for inpatient facility encounters Review clinical documentation to ensure compliant and complete coding Apply inpatient coding guidelines in accordance with CMS, UHDDS, and facility standards Support DRG assignment and coding quality initiatives Collaborate with CDI, physicians, and revenue cycle teams as needed Meet...