23 rn coding auditor jobs found

RN, DRG Coder / Clinical Auditor Must be a Registered Nurse with experience Remote | Full-Time | Healthcare | Clinical Documentation & Coding About the Role We’re seeking a detail-oriented DRG Coder/Clinical Auditor to perform DRG validation reviews of medical records and documentation. This role ensures accurate coding and clinical support for DRG assignments, helping improve billing accuracy, reimbursement, and compliance. You’ll work independently to review records, validate coding, and communicate findings clearly and professionally. Key Responsibilities Chart Review & Validation Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions. Physician Documentation Review Confirm that physician notes and clinical indicators support assigned DRGs. Audit & Compliance Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities. Coding Expertise Apply ICD-10-CM and PCS...

A healthcare technology firm is seeking a Nurse Coder DRG Auditor to validate coding accuracy and medical necessity of inpatient claims. The role involves applying industry standards and guidelines to perform DRG validations while collaborating within a team. Successful candidates will have an active RN license, relevant coding certifications, and experience in clinical practice. A competitive salary of $85,000 to $90,000 is offered, along with a comprehensive benefits package. #J-18808-Ljbffr

1 day ago Be among the first 25 applicants This range is provided by TalentPlug LLC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $55,100.00/yr - $99,000.00/yr Direct message the job poster from TalentPlug LLC The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Position Purpose: Responsible for developing and conducting training and quality auditing programs for the Diagnosis Related Group (DRG) and Medical Record Audit Programs for Fidelis Care. The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Responsibilities: Conducts auditing of work performed by staff and present...

The University of Vermont Health Network is seeking a qualified RN Clinical Coder/Auditor for a hybrid position based in Colchester, VT. This role involves auditing clinical documentation to ensure compliance with regulatory standards and enhancing clinical outcomes through accurate coding. Candidates must possess a current Vermont RN Licensure and relevant prior experience in home health or hospice. Strong skills in ICD-10 coding, attention to detail, and project management are essential for success in this position. #J-18808-Ljbffr

Position Overview MetroPlusHealth seeks a Clinical Certified Coder to support the Special Investigations Unit in detecting, preventing, and investigating suspected fraud, waste, and abuse. The role reports to the Director of the Special Investigations Unit. Scope of Role & Responsibilities Review medical records and claims to determine accuracy and compliance with regulations. Conduct high‑risk claim audits to detect potential fraud, waste, and abuse. Collaborate with the SIU team to evaluate suspected fraudulent activities such as over‑utilization, upcoding, and non‑medically necessary services. Create detailed reports with findings, rationale, sources, and corrective action recommendations. Assist in provider calls to discuss findings and rationale. Present findings to leadership and stakeholders to facilitate FWA proceedings. Prepare documentation for audits, recoupments, compliance/legal reviews, and regulatory inquiries. Maintain thorough documentation of...

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its...

Insight Global is seeking a Remote DRG Validation Auditor for one of our clients to sit 100% remote.  This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Below are the key responsibilities for this role: Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate...

Job Description Job Summary The Clinical RN Auditor is responsible for ensuring clinical documentation meets regulatory standards and procedures. This role involves reviewing potential quality of care issues, understanding workflows, and establishing patient care plans to support technical and clinical requirements. The auditor works to improve clinical outcomes by monitoring documentation accuracy and consistency, reducing risk, evaluating data, and collaborating with the manager of clinical outcomes to provide expertise in coding classifications. Initial Onboarding Initial onboarding will take place at our offices in Colchester, VT. The position will then be a hybrid work arrangement with 1-2 days per week in our offices located in Colchester, VT. In-person meetings are also required at least quarterly. Qualifications / Job Requirements Education and Licensure Current unencumbered Vermont RN Licensure Homecare Coding Specialist- Diagnosis, or ability to obtain within one year...

The RN Auditor role focuses on ensuring clinical documentation meets regulatory standards and supports accurate coding. You will review quality of care issues, understand workflows, and help establish patient care plans to improve outcomes. Initial onboarding occurs at Colchester, VT, followed by a hybrid work arrangement with 1-2 days per week in Colchester and quarterly in-person meetings. Strong attention to detail and communication are essential. #J-18808-Ljbffr

RN Clinical Coder/Auditor - Hybrid Colchester, VT. Initial onboarding will take place at our offices in Colchester, VT. The position will then be a hybrid work arrangement with 1–2 days per week in our offices located in Colchester, VT. In-person meetings are also required at least quarterly. Job Summary The Clinical RN Auditor is responsible for ensuring clinical documentation meets regulatory standards and procedures. This role involves reviewing potential quality of care issues, understanding workflows, and establishing patient care plans to support technical and clinical requirements. The auditor works to improve clinical outcomes by monitoring documentation accuracy and consistency, reducing risk, evaluating data, and collaborating with the manager of clinical outcomes to provide expertise in coding classifications. Qualifications / Job Requirements Education and Licensure Current unencumbered Vermont RN Licensure Homecare Coding Specialist – Diagnosis, or ability to...

Description At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a...

Coder III Coder III is responsible conducting clinically based concurrent and retrospective reviews of inpatient medical records. This review is to evaluate that the clinical documentation is reflective of quality of care outcomes and reimbursement compliance for acute care services provided. The CDS will work closely with the medical staff to facilitate appropriate clinical documentation of patient care. The CDS/Coder III abstracts and codes the diagnostic and procedural information for Inpatient Services and Surgery medical records utilizing the current version of International Classifications of Diseases in accordance with regulatory agencies and hospital specific guidelines. The CDS/Coder III enters the coded data and other abstracted data from the medical record into the electronic information system. This position assumes primary responsibility for clarifying ambiguous documentation, DRG optimization with the primary role in assisting medical staff members with improving...

Our client is a fast-growing healthtech company building AI agents for health plans to streamline care navigation and optimize healthcare spending. On their behalf, we are seeking an RN-Coder Clinical Validation Reviewer to join their team in New York, NY (Flatiron District) . In this role, you will review medical records against billed claims, document clear clinical rationales, and partner directly with product teams to refine AI-supported review workflows. Key Responsibilities Review professional and facility claims against medical records to validate billed services, diagnoses, codes, and payment findings. Write clear, professional clinical and coding rationales for payment integrity and audit workflows. Identify unsupported claims and potential overpayments. Collaborate with product and operations teams to test and give feedback on AI-assisted review tools. What We’re Looking For CPC or CCS certification required (additional coding credentials a plus). Experience...

Certified Professional Coder Job Location: Hopewell, NJ Job Duration: 6 Months (possibility of extension) Payrate: $35 - $38/ hr. on w2 Job Summary: This position is responsible for leading on-site and desk audits of hospital billing and coding practices, including forms development, audit profiling, and tracking institutional audit trends. The role involves designing audit protocols, handling special projects, and performing/finalizing per diem audits, bill verification, DRG validation (utilization review audits), and credit balance reviews. The position also provides education and guidance on ICD-10-CM coding, DRG assignment, payment methodologies, and auditing practices. Key Responsibilities: Lead hospital billing and coding audits, both on-site and remote Identify and present billing discrepancies and coordinate improper claim payment referrals Analyze trends related to documentation, billing errors, and provider contract interpretation issues Compile audit...

Job Title: Certified Professional Coder Job Location: Hopewell, NJ Job Duration: 6 Months (possibility of extension) Payrate: $35 - $38/ hr. on w2 Job Summary: This position is responsible for leading on-site and desk audits of hospital billing and coding practices, including forms development, audit profiling, and tracking institutional audit trends. The role involves designing audit protocols, handling special projects, and performing/finalizing per diem audits, bill verification, DRG validation (utilization review audits), and credit balance reviews. The position also provides education and guidance on ICD-10-CM coding, DRG assignment, payment methodologies, and auditing practices. Key Responsibilities: Lead hospital billing and coding audits, both on-site and remote Identify and present billing discrepancies and coordinate improper claim payment referrals Analyze trends related to documentation, billing errors, and provider contract interpretation issues...

Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: 2. HEDIS 3. Medical Record Reviews (Accreditation) 4. And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities Abstract pertinent information from patient medical records. Assign...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient medical...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient medical...

Remote Certified CoderAltegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in:CMS HCC Risk AdjustmentHEDISMedical Record Reviews (Accreditation)And moreThese are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines).Responsibilities:Abstract pertinent information from patient medical records. Assign appropriate...

UNC Health Care in North Carolina seeks a healthcare coder to capture data from medical records for reimbursement, statistics, research and benchmarking. You will work daily with the CDI Auditors as part of the Clinical Documentation Improvement Team (CDI) and support accurate documentation. Requires RHIT/RHIA or CCS credentials, an associate degree in Health Information Technology or Nursing (LPN/RN), 3 years of healthcare coding experience, and ICD-9/ICD-10 proficiency. #J-18808-Ljbffr

Coding Specialist (Part-Time) At Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care. Primary Duties Performing audit functions for the identified encounters in a timely and accurate manner. Generating well-written deliverables and audit work papers. Outstanding verbal communication...

UNC Health Care in North Carolina seeks a healthcare coder to capture data from medical records for reimbursement, statistics, research and benchmarking. You will work daily with the CDI Auditors as part of the Clinical Documentation Improvement Team (CDI) and support accurate documentation. Requires RHIT/RHIA or CCS credentials, an associate degree in Health Information Technology or Nursing (LPN/RN), 3 years of healthcare coding experience, and ICD-9/ICD-10 proficiency. #J-18808-Ljbffr