18 compliance coding auditor jobs found in Springfield

About Ensemble Thank you for considering a career at Ensemble!Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!O.N.E Purpose:Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognise that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving...

Emory Healthcare is seeking a Remote Medical Coding Auditor to ensure accuracy, completeness, and regulatory compliance of professional coding services. You will review records, collaborate with providers and compliance staff, and support accurate reimbursement. Role emphasizes auditing, chart reviews, and ongoing education on coding standards to mitigate risks and improve documentation quality. Remote within eligible US states with strong attention to detail required. #J-18808-Ljbffr

Description: BASIC FUNCTION This position is responsible for the accurate coding of claims by providers. Under supervision, this position is responsible for researching and analyzing the itemized bills and/or medical records for facility and inpatient claims validating the coding. This position audits itemized bills and/or medical records to ensure compliance with the organization's coding procedures and standards according to the CMS Coding Guidelines and Official ICD10 Coding Guidelines and recommends coding corrections. JOB REQUIREMENTS Associate Degree OR 2 years of experience working in the health insurance industry; 2 years medical coding through medical record abstraction; National coding certification from AAPC or AHIMA to include one or more of the following:Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCS P), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT); PC experience and skills...

W3R Consulting is seeking a detail-oriented Medical Coder to accurately code provider claims, review itemized bills and medical records for facility and inpatient claims, and ensure compliance with CMS Coding Guidelines and ICD-10 guidelines. Under supervision, you will audit documents, recommend coding corrections, and maintain documentation that supports coding procedures and standards. CPC/CCS/P/RHIA/RHIT certifications are preferred, with an Associate or Bachelor degree as a potential path. #J-18808-Ljbffr

Brightli is seeking an Integrity Specialist, Market in Springfield, MO, to safeguard billing accuracy, coding integrity, and regulatory compliance across behavioral and medical health services. You'll conduct audits, identify improvement opportunities, and collaborate with leaders across departments to strengthen our compliance program. This role requires a detail-oriented professional with analytical skills, strong communication, and a commitment to ethical practices. #J-18808-Ljbffr

W3R Consulting seeks an experienced healthcare auditor to investigate complex claims and verify coding accuracy before payment. You will combine clinical coding expertise with investigative rigor to ensure medical necessity and regulatory compliance across CPT, HCPCS, ICD-10-CM/PCS coding standards. Please lead pre‑payment reviews, identify fraud or non‑compliance patterns, and prepare audit summaries to inform SIU or Compliance teams as warranted. #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...

Humana is seeking an experienced outpatient behavioral health coding auditor to join the disputes team. This remote role focuses on BH coding disputes, ensuring accuracy, timeliness, and compliance with CPT/HCPCS guidelines. You will collaborate with coding professionals across departments and communicate outcomes to providers. The ideal candidate has 3+ years in BH coding audits, CPC/CCS certification, and strong MS Office skills. #J-18808-Ljbffr

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

Description: Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical reviews of high-dollar or highly complex medical records before a claim is finalized for payment....

About the role As a Medical Coding Quality Auditor, you will play a critical role in ensuring coding accuracy, compliance, and quality across healthcare records. You will collaborate with coding professionals and physicians to support accurate clinical documentation, regulatory compliance, and operational excellence while maintaining high quality and productivity standards in a remote work environment. In this role, you will: Review medical documentation to accurately assign diagnosis and procedure codes. Communicate with physicians and other healthcare providers to obtain or clarify diagnoses and procedures through the coding query process. Assign accurate codes using electronic encoder applications in accordance with company policies, coding guidelines, and regulatory requirements. Perform peer reviews and quality audits of Health Information Management coding auditors and coders. Prepare and complete reports, audit findings, and other deliverables as requested. Monitor...

Overview Be inspired. Be valued. Belong. At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more LOCATION: Remote This position is remote; however, applicants must be physically located and authorized to work in one of the following states: Alabama, Arkansas, Florida, Georgia, Illinois, Louisiana, Michigan, New Hamsphire, North Carolina, Ohio, Pennsylavnia, South Caroline, Tennessee, Texas, Virginia, Wisconsin Description This position ensures the accuracy, completeness, and compliance of medical coding and clinical...

QA Nurse / Coder (RN)As a QA Nurse / Coder, you will ensure the accuracy, completeness, and regulatory compliance of Home Health documentation—particularly OASIS assessments, the Home Health Plan of Care (485), and face-to-face encounter notes—while properly sequencing diagnoses according to federal/state standards and agency policy.Core responsibilities include:Review OASIS forms and Plans of Care for appropriateness, completeness, and compliance.Assign and sequence ICD?10 codes in line with current home health coding guidelines.Ensure consistency and compliance of face-to-face encounter documentation with OASIS and care plans.Conduct additional clinical record audits and OASIS reviews as assigned.Stay current on Medicare reimbursement policies, home health regulations, and compliance requirements.Maintain relevant certifications (HCS?D, HCS?O or COS?C).Participate in quality assurance and performance-improvement efforts.Coordinate with physicians, facilities, and clinical staff...

Department 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status Full time Benefits Eligible Yes Hours per Week 40 Schedule Details / Additional Information Will support :A mix of inpatient community and academic coding. Includes service lines such as cardiology, neurology, and oncology.Schedule :Full-time, Monday-Friday 40hrs with a standard schedule of Monday through Friday, 8 hours per day, totaling 40 hours each week. Certification Required Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote Opportunity Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range $33.05 - $49.60 Major...

Sarah Bush Lincoln Health Center is seeking a Coder to assign ICD-CM, CPT, and HCPCS codes, modifiers, and E/M codes. The role interacts with medical staff and outside organizations on coding audits and documentation needs. It supports professional encounters across clinic, hospitalist, and other services with emphasis on accuracy and compliance. Responsibilities include auditing EM codes, educating staff, resolving denials, and maintaining data quality while contributing to optimal #J-18808-Ljbffr

Job Summary We are seeking an experienced and certified Medical Coder - Inpatient & Outpatient to join our Health Information Management/Revenue Cycle team.The Medical Coder is responsible for accurately reviewing and coding inpatient and outpatient hospital medical records in accordance with official coding guidelines, CMS requirements, payer regulations, and hospital policies.This position plays an essential role in ensuring coding accuracy, regulatory compliance, timely reimbursement, and the integrity of clinical and financial data.The successful candidate will demonstrate strong knowledge of hospital coding, medical terminology, anatomy and physiology, reimbursement methodologies, and regulatory requirements.Essential Duties and Responsibilities Review inpatient and outpatient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes based on assigned account type. Assign and validate appropriate MS-DRG/APR-DRG, APC, Present on Admission (POA),...