26 coding auditor and educator jobs found

POSITION DESCRIPTION :The Compliance Auditor / Educator serves as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services.Provides professional expertise and education in CPT, ICD and HCC coding.The Compliance Auditor / Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations.This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution.Performs medical record integrity audits and conducts one-on-one meetings with Providers for corrective educational guidance.ESSENTIAL JOB FUNCTIONS :Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies...

Currently recruiting an REMOTE Medical Coding Auditor to provide support to Active Duty heroes, their families, and retirees.The full-time position is Monday-Friday, 8 hours shifts between 7:30am and 4:30pm.DUTIES OF THE MEDICAL CODING AUDITOR:Verifies the accuracy of the diagnosis, procedure, supply codes, modifiers, and sequencing for the professional and institutional (facility) components of inpatient, ambulatory, and outpatient encounters.Provides second-level review of coding assignment to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices.Examines records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.When assigned to perform Data Quality Management Control (DQMC) audits, provides each assigned MTF with coding audit accuracy data...

At Virtua Health we exist for one reason to better serve you.That means being here for you in all the moments that matter striving each day to connect you to the care you need.Whether thats wellness and prevention experienced specialists life-changing care or something in-between we are your partner in health devoted to building a healthier community.If you live or work in South Jersey exceptional care is all around.Our medical and surgical experts are among the best in the country.We assembled more than 14000 colleagues including over 2850 skilled and compassionate doctors physician assistants and nurse practitioners equipped with the latest technologies treatments and techniques to provide exceptional care close to home.A Magnet-recognized health system ranked by U.S.News and World Report weve received multiple awards for quality safety and outstanding work environment.In addition to five hospitals seven emergency departments seven urgent care centers and more than 280 other...

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

Job DescriptionJob DescriptionMedical Records Coder / Certified - Full Time (PARTIAL REMOTE / IN OFFICE FOR MTGS)POSITION SUMMARY :Codes medical records using diagnostic coding.Ensures accurate submission of all coding data for reimbursement purposes.Ensures Regulatory Compliance and follows all Federal regulations for all payment systems.POSITION REQUIREMENTS :Minimum EducationHigh School Diploma or equivalentCertificate Required :One of the following Coding Certifications :CCS-Certified Coding SpecialistCPC-Certified Professional CoderCPC-H-Certified Professional Coder-HospitalCOC-Certified Outpatient CoderCIC-Certified Inpatient CoderCMC-Certified Medical CoderMinimum Work ExperienceAbility to read and communicate in English; Bilingual preferredGood communication and multi-tasking skillsMinimum of 2 years' experience with ICD-10 and CPT / HCPCS coding in an acute facility and / or physician's office preferredKnowledge of computer applications for codingKnowledge of medical...

Department / Unit :Health Information ManagementWork Shift :Day (United States of America)Salary Range :$60,367.47 - $90,551.20This position is Fully RemoteProfessional Coding Auditor will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding / charging / denials follow-up.Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes.Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines.Provide education, instruction and training to providers and coding staff.Act as an expert for the HCC / Risk adjustment coding.This position is remote but does require onsite education to providers as needed.Essential Duties and ResponsibilitiesReview, analyze, and validate CPT and ICD-10 diagnosis codes and...

Job DescriptionJob DescriptionMUST ATTEND ORIENTATION IN PERSON IN ARCATA, CALIFORNIASUMMARY :The primary function of this position is to review ICD, CPT and HCPCS coding for data and reimbursement.The coding function is a primary source for data and information used in health care today, and promotes quality client care, captures accurate reporting numbers and optimizes reimbursement.The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.Other duties may be assigned.Level IPerforms comprehensive review of the health record, evaluates the record for documentation, consistency, accuracy and correlation of recorded data.Ensures the final diagnosis as stated by the provider is valid, complete and accurately reflects the care and treatment rendered.Consults with provider when conflicting or ambiguous documentation is...

Job DescriptionJob DescriptionSUMMARYThe Certified Risk Adjustment Coder is responsible for accurately abstracting provider services into ICD-10 codes from medical documentation.This role adheres to the coding ethics of organizations such as the American Academy of Procedural Coders (AAPC), American Health Information Management Association (AHIMA), and the National Alliance of Medical Auditing Specialists (NAMAS), as well as payer guidelines.The coder conducts concurrent, prospective, and retrospective reviews of medical record documentation to ensure the accurate and complete capture of the clinical picture, severity of illness, and complexity of patients.Additional duties include provider communication and education to support the closure of both risk adjustment and quality care gaps, as well as providing ongoing feedback to physicians regarding coding guidelines and requirements.ESSENTIAL JOB FUNCTIONSPerform coding quality audits of medical records to ensure ICD-10 codes are...

About UsAt Cooper University Health Care , our commitment to providing extraordinary health care begins with our team.Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.We have a commitment to our employees to provide competitive rates and compensation programs.Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement.We also provide attractive working conditions and opportunities for career growth through professional development.Discover why Cooper University Health Care is the employer of choice in South Jersey.Short DescriptionThe auditor reviews professional fee billing, coding and documentation.Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses.Customers include employed providers, senior leadership,...

OverviewNAH reserves the right to make hiring decisions based on applicants state of residence if outside the state of Arizona.NAH currently hires for remote positions in the following states :AlabamaArizonaFloridaGeorgiaIdahoIndianaKansasMichiganMissouriNorth CarolinaOhioOklahomaPennsylvaniaSouth CarolinaTennesseeTexasVirginiaThe Coder 3 electronically records stores and reports on reams of data.Responsible for coding the following service types based on department and assignments.Facility HIM :Inpatient outpatient emergency room and outpatient clinical.Ambulatory :Coding and auditing professional inpatient outpatient emergency and clinic.Coders will need to apply a broad knowledge of procedure coding diagnosis coding medical terminology and anatomy / physiology.Hospital Coder Proficiency :ICD-10 PCS / DRG / CPT / HCPCS / ICD-10 CM.Professional Coder Proficiency :CPT / HCPCS / ICD-10 / CM.ResponsibilitiesCommunicationWorks in collaboration with physicians in tracking un-coded...

Company Overview :Upward Health is an in-home, multidisciplinary medical group providing 24 / 7 whole-person care.Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help.Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients.We are able to treat a wide range of needs - everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals - because we know that health requires care for the whole person.It's no wonder 98% of patients report being fully satisfied with Upward Health!Job Title & Role Description :The Certified Medical Coder is responsible for analyzing provider documentation to accurately select ICD-10 and CPT / HCPCS codes, ensuring compliance with coding guidelines, third-party reimbursement policies, and accreditation standards.This role...

OverviewTalent Sourcing Specialist at Memorial Healthcare SystemSummaryReviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.ResponsibilitiesReviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.Create electronic physicians queries within allowed scope for hospital outpatient coder.Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM)...

All the benefits and perks you need for you and your family :Benefits from Day One Career Development Whole Person Wellbeing Resources Mental Health Resources and SupportOur promise to you :Joining AdventHealth is about being part of something bigger.Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit.AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ.Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team.All while understanding thattogetherwe are even better.Shift:Monday- Friday Full time 8am-5pmJob Location:RemoteThe role you will contribute :Responsible for reviewing accounts for accuracy using the charge capture audit system in compliance with local, federal, and state guidelines, as well as managed care reimbursement practices.This position uses clinical knowledge and...

Job DescriptionDepartment / Unit :Health Information ManagementWork Shift :Day (United States of America)Salary Range :$60,367.47 - $90,551.20Professional Coding Auditor will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding / charging / denials follow-up.Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes.Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines.Provide education, instruction and training to providers and coding staff.This position is remote but does require onsite education to providers as needed.This position has remote opportunityThis position requires a CPC Certification - Upon HireTwo years or more prior experience in professional fee coding - requiredEssential...

Location :RemoteSalary :$85,000depending on experienceSkills :Auditing, Inpatient Coding, DRG Validation, Quality ReviewAbout the Company / Opportunity :Are you passionate about upholding quality standards in health information management and coding practices? Our client, an industry leader in the hospitals and health care sector, provides nationwide revenue cycle services to a vast network of hospitals and physician practices.This remote opportunity allows you to leverage your expertise in coding quality review, ensuring compliance with national guidelines and maintaining data integrity.Join a mission-driven organization focused on supporting patient outcomes and enhancing health care delivery through excellence in coding quality.Responsibilities :Lead, coordinate, and perform all functions of quality review for inpatient and outpatient coding across multiple facilities.Conduct routine, pre-bill, policy-driven, and incentive plan-driven coding quality audits to ensure compliance...

Crossroads Treatment Centers is an equal opportunity employer.We celebrate diversity and are committed to creating an inclusive environment for all employees.Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder.Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery.This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery.We are committed to bringing critical services to communities across the U.S.to improve access to treatment for over 26,500 patients.Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and...

Join CommunityThe Innovative Healthcare Collaborative of Indiana (IHCI) is a joint venture between Community Health Network and Deaconess Health system.Its goal is to support our sponsors and partners in their strategic evolution to positively impact and improve the healthcare delivery system.Make a DifferenceReporting to the Clinical Documentation Integrity Manager this role performs patient chart reviews to ensure the appropriateness andcompleteness of diagnostic coding with evidence based on CMS HCC standards.The Risk Adjustment Coder is responsible for :Timely accurate and complete review of patient charts following patient encounters utilizing a variety of technical platforms to completeworkflowsValidating diagnosis codes representing patient conditions along with necessary MEAT documentationEnsuring coding is consistent with guidelines from regulatory entitiesConducting audits to meet compliance with ACA standardsCreating post-visit queries with follow upCollaborating with...

A leading healthcare system based in souther Florida is now seeking an experienced Remote Medical Coding Auditor to join their award-winning healthcare organization!Regarded as a leading healthcare provider in the vibrant region of South Florida, this renowned hospital system encompasses a network of expansive facilities known for delivering outstanding medical services and excellent patient care.The organization boasts a comprehensive range of healthcare services, including state-of-the-art emergency care, advanced surgical procedures, and specialized medical practices across various fields.Recognized for its commitment to excellence, the network has achieved numerous awards for quality, safety, and patient satisfaction, reflecting its dedication to healthcare innovation and community wellness.The Remote Medical Coding Auditor is responsible for leading the continuous improvement of the inpatient coding staff.Responsibilities include leading complex coding audits, assess coding...

Summary :Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.Responsibilities :Reviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.Create electronic physicians queries within allowed scope for hospital outpatient coder.Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM) coding policies and procedures.Conducts, audits and / or...

OverviewThis position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff.This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD-10 codes on an annual basis.ResponsibilitiesEssential Duties :Conduct prospective and retrospective chart reviews (i.e.baseline, routine periodic, monitoring, and focused) comparing medical and / or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer / title / grant coding requirements.Identify coding discrepancies and formulate suggestions for improvement.Communicate audit results / findings to providers and / or ancillary staff and share improvement ideas.Work with the Office of the CMO and provider leadership to identify and assist providers with coding.Report findings and recommendations to Compliance...

Job DescriptionJob DescriptionJob Summary / PurposeThe Senior Clinical Coding Auditor & Trainer will conduct audits of inpatient coding processes for Fidelis Care and assist in development of training and audit tools.Location :The Senior 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.Pay Range :$68,700.00 - $123,700.00 per yearResponsibilities :Develop and maintain complex audit processes and audit tools related to inpatient codingDevelop and conduct clinical education courses for existing and new employeesAudit established guidelines for medical necessityAnalyze training needs and identify, select, or develop appropriate training programs including training aids and materialsAudit staff in accordance with established auditing processes, work with staff to identify and resolve errors, and present findings and...

Job TypePart-timeDescriptionRequired :3-5 years of experience in acute care facility (hospital) medical coding auditing or complianceLocation :RemoteJob Summary :The Medical Coding Auditor is responsible for reviewing medical records to ensure accurate coding and compliance with regulatory requirements.This role ensures continuous quality improvement in coding practices while maintaining compliance with healthcare laws and organizational policies.Occasional travel may be required for audits or meetings.Key Responsibilities :Conduct reviews and audits of medical records for coding accuracy (ICD-10-CM, CPT, HCPCS) and documentation compliance.Ensure compliance with federal, state, and payer-specific regulations, including CMS guidelines.Identify and address coding discrepancies and recommend corrective actions.Prepare detailed audit reports with findings and provide feedback on documentation and coding practices.Collaborate with relevant departments to resolve audit findings and...

The Opportunity Are you an experienced Inpatient RN ready to step away from the bedside without losing your clinical edge As part of the Centene/Fidelis Care team you will ensure the clinical accuracy of care for 28 million members.This is a high-level auditing and education role designed for nurses who love the puzzle of clinical documentation and the reward of teaching others.Key OutcomesDrive Accuracy:Develop and lead complex inpatient coding audits to ensure medical necessity and documentation excellence.Educate Teams:Design training programs that translate complex clinical data into actionable knowledge for staff.Remote Flexibility:Work primarily from home with only two scheduled trips to New York per year.Qualifications :Requirements (Strictly Enforced)Active RN License:Must be currently licensed.Acute Care Foundation:You must have direct nursing experience in an Inpatient Hospital setting.(Candidates with only outpatient or clinic experience will not be considered for this...

Job DescriptionJob DescriptionMedical Coding Compliance SpecialistCompensation :Up to $85,000 annually, determined by your experience and qualifications.Job Location :Remote (US)Job Highlights :Work-Life Balance :Monday to Friday schedule for a fulfilling personal and professional life.Competitive Compensation :Be rewarded with a generous salary and benefits package.Career Growth Opportunities :Unlock your potential and advance in your career with our support.Supportive Work Environment :Join a team that values and appreciates your contributions.Comprehensive Training :Enhance your skills and knowledge through our extensive training programs.Compliance and Peace of Mind :Work with confidence knowing that we prioritize compliance with employment laws and regulations.Paid Time Off and Holidays :Enjoy well-deserved time off to relax and recharge.Life Insurance Coverage :Protect your loved ones with our employer-paid life insurance policy.Collaborative Team Environment :Thrive in a...