9 quality coding auditor jobs found in Madison

Humana is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. This remote role requires verification of CPT/HCPCS codes, review of clinical documentation, and adherence to APC guidelines. Candidates should have post-certification experience and strong attention to detail. The position offers opportunity to conduct peer reviews, handle multiple priorities, and support quality initiatives while maintaining HIPAA compliance. Travel may be required occasionally. #J-18808-Ljbffr

Humana, a Fortune 100 Company, seeks an experienced and Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will contribute to cost reduction by ensuring accurate payments and DRG assignments. The role involves extracting clinical information, assigning ICD-10-CM/PCS codes, auditing quality, and collaborating across teams to improve accuracy. Remote work with occasional travel may be required. #J-18808-Ljbffr

Become a part of our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed....

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...

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...

Coder Boone Memorial Health is seeking a detail-oriented and motivated Coder (HIM Coder) to join our Health Information Management team. In this role, you will play a critical part in ensuring accurate coding, regulatory compliance, and timely reimbursement for outpatient services. If you have a passion for medical coding, enjoy working independently, and take pride in accuracy and attention to detail, we encourage you to apply. Essential Functions Review medical record documentation and accurately assign diagnosis and procedure codes using ICD-10-CM, CPT, and HCPCS guidelines. Abstract patient information into electronic medical record systems while ensuring data accuracy and integrity. Apply CMS regulations, payer-specific guidelines, and coding compliance standards to support ethical and accurate reimbursement. Resolve coding-related claim edits and assist with denial management. Collaborate with providers, billing staff, and ancillary departments to answer...

Job Details Job Location: BMH Forester Building - Revenue Cycle - Madison, WV 25130 Position Type: Per Diem Overview Boone Memorial Hospital is seeking a detail-oriented and motivated Coder (HIM Coder) to join our Health Information Management team. In this role, you will play a critical part in ensuring accurate coding, regulatory compliance, and timely reimbursement for outpatient services. Essential Functions Review medical record documentation and accurately assign diagnosis and procedure codes using ICD-10-CM, CPT, and HCPCS guidelines. Abstract patient information into electronic medical record systems while ensuring data accuracy and integrity. Apply CMS regulations, payer-specific guidelines, and coding compliance standards to support ethical and accurate reimbursement. Resolve coding-related claim edits and assist with denial management. Collaborate with providers, billing staff, and ancillary departments to answer coding questions and improve documentation quality....

Position Overview Looking to be part of a team that provides extraordinary healthcare from the heart? You Belong Here. 100% Remote position with option to work onsite. Wisconsin or Illinois residency required. Title Medical Coding Specialist – Outpatient Position Specs FTE: 1.0 (40 hours per week) Schedule: Monday to Friday, five (5) 8-hour shifts between hours of 6am and 5pm Holiday Rotation: None Weekend Rotation: None On Call Requirements: None Position Summary Reviews medical reports and physician documentation for clinic and hospital outpatient services in order to apply diagnostic and procedural codes to individual patient health information for claims processing, data retrieval and analysis. This role will primarily focus on Emergency Department and Urgent Care coding but will also assist in other areas. Technical Responsibilities Assigns codes for ambulatory outpatient services using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT)...