15 provider coding auditor educator jobs found in Springfield

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....

Coder Auditor-Professional Job Description Coder Auditor-Professionals are responsible for auditing of coding assignment with providers and coders, training of coding professional staff, pro-fee based coding includes the assignment of Assigns ICD-CM, CPT, HCPCS codes, E&M assignment, modifiers, and charge posting. Interacts with medical staff, nursing, ancillary departments, provider offices, and outside organizations. Department: Physician coding Hours: Full-Time; 40 hours required Required: High School Diploma, CPC, CEMA within 6 months of hire, CPMA within 1 year of hire Pay: based on experience, starting at $23.87 At this time, we are only able to consider applicants who reside in the following states: Alabama, Arkansas, Arizona, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, New Mexico, Ohio, Oklahoma, South Carolina, Tennessee, Texas Responsibilities Assists coders with coding questions. Conducts the...

Description Coder OP McKenzie-Willamette Medical Center is your community medical provider, serving the Willamette Valley and its residents. Our 113-bed hospital offers inpatient, outpatient, diagnostic, medical, surgical and emergency care. We are a family of caregivers offering care to our larger family — our community. Hourly Base Rate: $18.28 - $26.37 Shift: Days Hours Per Week: 40 hours Date Posted: 02/20/2026 Job Summary: Certified Coder required. Working knowledge of basic medical terminology, ICD-10, CPT and HCPCS codes. Preferred experience in multiple specialties including: Cardiology, Cardiology diagnostic testing, Cardiothoracic Surgery, Critical Care, General Surgery, Gastroenterology, Pulmonology, Vascular Surgery and Vascular Imaging services. Ability to assign codes to diagnoses, procedures, E&M visits, and diagnostic testing. Ability to research and analyze clinical documentation as well as produce reports from a variety of sources. Ability to work...

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 experimentation....

Department: 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status: Full time Benefits Eligible: Yes Hou rs 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...

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...

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. 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. Customer Obsession: Bonus Incentives Tuition Reimbursement By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. The Senior Coding Compliance Auditor will assist with the development and execution of the Annual Compliance Workplan including the Auditing and Monitoring Workplans. They will lead & complete detailed Coding compliance audits including complex audits, implement Management Action Plans, prepare high quality audit reports, establish and maintains an...

Coder OPMcKenzie-Willamette Medical Center is your community medical provider, serving the Willamette Valley and its residents. Our 113-bed hospital offers inpatient, outpatient, diagnostic, medical, surgical and emergency care. We are a family of caregivers offering care to our larger family — our community.Position Details:Hourly Base Rate: $18.28 - $26.37Shift: DaysHours Per Week: 40 hoursJob Summary:Certified Coder required.Working knowledge of basic medical terminology, ICD-10, CPT and HCPCS codes.Preferred experience in multiple specialties including: Cardiology, Cardiology diagnostic testing, Cardiothoracic Surgery, Critical Care, General Surgery, Gastroenterology, Pulmonology, Vascular Surgery and Vascular Imaging services.Ability to assign codes to diagnoses, procedures, E&M visits, and diagnostic testing.Ability to research and analyze clinical documentation as well as produce reports from a variety of sources.Ability to work independently with minimal...

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...

Coding Auditor - Professional Department: Physician coding Hours: Full-Time (40 hours per week) Location: Remote or onsite. Must reside in one of the following states: Alabama, Arkansas, Arizona, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, New Mexico, Ohio, Oklahoma, South Carolina, Tennessee, Texas. Pay: Starts at \$23.87/hour, based on experience. Estimated compensation range \$23.87 - \$37.00. Responsibilities Assist coders with coding questions. Conduct collection and reporting of provider and coder audit results and education. Work with coders and providers to ensure appropriate documentation for clinic services. Report results to Coding Supervisor – Professional. Demonstrate ability to code all types of encounters. Maintain 95% accuracy in diagnoses and procedures coding. Ensure data quality and optimum reimbursement under federal and state payment systems. Identify and refer trend patterns of coding and...

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...

Coder – Professionals are responsible for professional coding includes the assignment of ICD-CM, CPT, and HCPCS codes, modifiers, and evaluation and management (E/M codes) provider audits. Interacts with medical staff, nursing, ancillary departments, provider offices, and outside organizations. Accepting remote workers in the following states: Alabama, Arkansas, Arizona, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, New Mexico, Ohio, Oklahoma, South Carolina, Tennessee, Texas. Department: Physician Coding Hours: Full time, 40 hours/week Shift: 1st Location: Remote or On-site. Pay: Based on experience, starting at $22.72. Compensation Estimated Compensation Range $22.72 - $35.22 Pay based on experience. Responsibilities Analyze and confirm assigned encounters for provider’s selection of EM code level utilizing EM code level selection auditing tool. Assists physicians with record documentation needs by requesting...

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...

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),...