11 coder auditor professional jobs found

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...

At South Shore Health, we come together to improve the health of our family, friends and neighbors by bringing together people, caregivers and excellence in medicine. We are seeking a Coding and Compliance Auditor to evaluate medical record documentation and coding accuracy, identify opportunities for improvement, and design and deliver coding education and training programs for clinical staff, coders and other key stakeholders. In this role, you will monitor external regulatory and internal process changes and provide support to colleagues in adhering to Federal, State and local requirements. The annual pay range for this role is $73,000.00 - $104,400.00.   Responsibilities: ·        Establish, implement, and maintain a formalized process for coding compliance and a formal review (audit) process, and conduct routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPCs, PCS and ICD-10-CM codes ·        Perform prospective...

Overview: The Documentation and Coding Consultant 1 provides training, consultation, review, and feedback to clinicians on their medical service documentation and coding to ensure KPNW receives appropriate reimbursement and conforms to applicable guidelines and regulations. This is a hybrid position that is a blend of working both remotely and in office. Must reside in the Northwest Service Region (Oregon or Washington). Major Responsibilities / Essential Functions: Consulting and Coding services Provides expert consultation to specialists or primary care clinicians as assigned on coding and documentation education and questions. Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards. Follow coding specificity guidelines using coding rules and guidelines. General coding knowledge and understanding of Risk Adjustment models and submission...

Rocky Mountain Review brings clarity and confidence to healthcare by focusing on what matters most—accuracy, accountability, and the people behind every claim.   In an industry often driven by speed and volume, Rocky Mountain Review stands for thoughtful review and sound judgment. Our approach is rooted in a simple belief: every decision should be defensible, every outcome intentional, and every client supported with consistency they can rely on.   We engage deeply across the claim lifecycle—strengthening payment integrity, supporting plan performance, and delivering insights that empower better decisions. By combining clinical expertise with meticulous review processes, we ensure that nothing is overlooked, and everything is aligned, every time.   About This Opportunity:   As a Lead Coding, Audit, and Compliance Specialist, you play a critical role in ensuring accuracy and integrity across...

THE POSITION:  Under general direction this position is responsible for providing billing and coding support within the Ambulatory Care Clinic System. The clinic areas of specialization include ENT, plastic reconstruction, neurology, and urology.  Examples Of Duties: Duties may include but are not limited to the following: Reviews electronic medical records initiated by a health care provider and ensures accuracy of diagnosis, procedure codes, and modifiers in accordance with Federal and State regulations in compliance with billing and coding guidelines. Effectively monitors assigned work queues and reviews claim errors, ensuring timely and accurate resolution of accounts.  Review, Analyze and validate medical records to ensure completeness and accuracy of code selections while identifying educational opportunities. Prepares educational materials to communicate with providers when identifying gaps in clinical documentation for the selection of appropriate...

CodaMetrix is revolutionizing Revenue Cycle Management with its AI-powered autonomous coding solution, a multi-specialty AI-platform that translates clinical information into accurate sets of medical codes. CodaMetrix’s autonomous coding drives efficiency under fee-for-service and value-based care models and supports improved patient care. We are passionate about getting physicians and healthcare providers away from the keyboard and back to clinical care. Overview Reporting to the Senior Manager, Medical Coding & Audit, as a Senior Medical Coding Analyst, this role will be a key member of the team responsible for ensuring that CodaMetrix meets—and exceeds—our customers’ coding quality expectations. They will leverage their strong background in coding, billing, and auditing across service lines to review, analyze, and enhance coding processes, both internally and externally. They will play a pivotal role in improving the quality and efficiency of coding operations by...

Billing Compliance Curriculum Development Specialist Dana-Farber Cancer Institute Boston, MA Full Time The Billing Compliance Curriculum Development Specialist is responsible for the design, development, implementation, and evaluation of enterprise-wide billing compliance education programs at Dana-Farber Cancer Institute (DFCI). This role serves as a subject-matter expert in professional and technical billing compliance, with a strong emphasis on oncology services, regulatory requirements, and risk-based education strategies. The position partners closely with Billing Compliance leadership, Revenue Cycle, HIM, Clinical Operations, and Compliance to ensure education is standardized, scalable, evidence-based, and aligned with CMS, OIG, NCCI, payer guidance, and institutional risk priorities. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united...

POSITION SUMMARY: The Medical Accounts Receivable Billing Specialist, reporting directly to the Revenue Cycle Manager, is responsible for managing and resolving insurance and patient accounts receivable, and ensuring accurate and timely billing, reimbursement, and collections. This role supports WACBD's financial health by monitoring outstanding balances, communicating with patients and payers, and maintaining meticulous documentation in accordance with organizational policies and healthcare regulations. This position requires strong analytical skills, attention to detail, and a commitment to delivering exceptional service to patients with chronic and complex medical needs. KEY RESPONSIBILITIES: Review and monitor accounts receivable aging reports to identify outstanding balances and prioritize follow-up activities. Work complex denials (coding, medical necessity, eligibility, prior auth, duplicate, bundling, coordination of benefits) and submit appeals to secure...