12 coding documentation compliance auditor jobs found in Phoenix

Risk Adjustment Coding AuditorOverview We are seeking a detail-oriented Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement. The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models. Key Responsibilities Perform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy. Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses. Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting. Evaluate...

Contract to Hire Job # 25233 Coding Auditor/Educator Acclivity Healthcare - Your personable, proven partner! Since 1999, Acclivity Healthcare has served the specialized recruiting and staffing needs of leading healthcare employers nationwide. Our clients range from independent physician practices to national healthcare systems and insurance providers. We are proud of our 18,000+ successful placements with quality-oriented organizations that recognize the value of better talent. Compensation and Schedule for the Coding Auditor/Educator Coding Auditor/Educator – Full-time, work-from-home, $28-$35 per hour, Monday to Friday, 7:00am to 3:30pm within Arizona time zone during training. Join a a remote team dedicated to employee growth! Required Qualifications of the Coding Auditor/Educator 3+ years of recent E/M coding experience required 2+ years of recent auditing and provider education experience required Surgical coding experience preferred...

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified 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 goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following: Review inpatient medical records and claims to ensure accurate coding and reimbursement Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes Audit coding quality and...

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral health, transportation and other provider records, ensuring correct coding and documentation and adherence to regulatory standards. You will audit across Medicaid lines, identify FWA patterns, educate providers, and support regulator submissions while maintaining compliance with policies. Strong analytical skills and collaboration are essential. #J-18808-Ljbffr

Coding Quality Education Specialist Job Category: Administrative Support Requisition Number: HEALT003286 Full-Time On-site 2700 N. Central Phoenix, AZ 85004, USA Description Essential Functions: Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty upon translating audit findings Follows up and clarifies any information that is not clear with the rendering provider Collaborates with IT and EHR teams to improve charge automation and optimize workflows Conducts ad-hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and...

Serco Inc. is seeking Medical Coding Auditing Specialists to support the Defense Health Agency's DHA Medical Coding Program Branch. The role involves auditing medical documentation and coding to ensure compliance with official policies and standards across DHA markets, with duties spanning routine, targeted, and surveillance audits. Candidates must possess extensive coding experience, including ICD-CM/PCS, CPT, HCPCS, and DRG concepts, and demonstrate knowledge of revenue cycle management. #J-18808-Ljbffr

Baylor Scott & White Health in Phoenix is seeking a Coding Auditor 1 to perform coding quality audits using ICD-10-CM/PCS, HCPCS, CPT and related references to support accurate classification and reimbursement. You will collaborate with Clinical Documentation Specialists, provide constructive feedback, and help ensure compliant documentation across internal teams and third-party vendors. A strong knowledge of coding rules and HIPAA is essential. #J-18808-Ljbffr

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...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note:...

Company Intro At American Vision Partners (AVP) , we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 120 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers. At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing...

Job Description Job Description Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opportunities Position Summary The Medical Biller is responsible for managing the full revenue cycle for a small, fast‑paced family practice. This role ensures accurate claim submission, timely payment posting, denial management, and patient billing. The ideal candidate is detail‑oriented, reliable, and able to work independently while maintaining strict compliance with payer rules and practice policies. Key Responsibilities Claims & Billing • Prepare, review, and submit clean claims to insurance carriers (electronic and paper). • Verify coding accuracy and ensure all required documentation is present before submission. • Correct and resubmit rejected or denied claims promptly. • Maintain up‑to‑date knowledge of CPT, ICD‑10, and payer‑specific billing guidelines. Payment Posting & Reconciliation • Post insurance and patient payments accurately into the...

Job Description Job Description Overview This position aids in properly capturing charges and correctly billing for services performed. The Medical Billing Specialist minimizes department rework, reprocessing of multiple claims from misaligned coding, and tracks and trends repeated missed opportunities for compliant charging and proactively finds and/or provides input regarding tools to streamline and/or improve charging processes. Responsibilities MAIN: Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges. Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems. Perform root cause analyses, when warranted by continuous...