19 audit compliance coder jobs found

Medical Coding and Billing Compliance Auditor Location: Remote Division: Coding Compliance About the Role: The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have extensive knowledge of CPT coding, ICD-10-CM coding, E/M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access...

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...

Job Description Interpret clinical documentation/records from patient records to ensure all diagnoses and procedures are documented and coded accurately. Ensure highest level of reimbursement practice efficiencies and compliance related to coding procedures. Provide feedback and support to physicians. Responsibilities Responsible for translating healthcare providers' diagnostic and procedural documentation into coded form, applying regulatory and organizational guidelines. Review patient reports and extract data necessary to apply appropriate ICD and CPT codes for billing, internal and external reporting, research and regulatory compliance. Utilize technical coding principals and reimbursement rule expertise to assign appropriate ICD diagnosis and CPT procedures as appropriate, with understanding of E/M coding elements. Collaborates with direct supervisor and or team lead prior to communication with assigned healthcare providers to ensure documentation and coding...

SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 hours / Days Hybrid or Remote Join a mission‑driven health plan where precision and expertise protect both members and resources—we’re seeking a certified coder who can identify discrepancies others miss, analyze coding patterns with accuracy, and turn complex clinical data into clear, actionable insights; if you bring deep knowledge of coding standards, a sharp analytical mindset, and a passion for ensuring integrity in healthcare claims, this is your opportunity to make a meaningful impact and strengthen the quality of care delivery. Summary Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met. Makes recommendations to Medical Directors, Compliance, Internal...

# Hospice Medical CoderOffice: Marysville, OH Work: Marysville, OhioHospice Medical CoderA Great Opportunity/ PRNAt ViaQuest Hospice we take a holistic approach, offering services to treat the physical, emotional and mental needs of our patients and their loved ones. Apply today and make a difference in the lives of the patients we serve!Responsibilities may include:* Review admission, recertification, and discharge documentation for coding accuracy, completeness, and compliance.* Assign ICD-10-CM diagnosis codes in accordance with CMS, LCDs, Conditions of Participation (CoPs), and ACHC standards.* Sequence diagnoses appropriately to support hospice eligibility and coverage determinations.* Collaborate with physicians, clinicians, and interdisciplinary team members to clarify documentation and resolve coding questions.* Ensure coding documentation supports accurate claims submission, Medicare billing requirements, and reimbursement.* Submit coding documentation within established...

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process. Department: Health Information Management Shift/schedule: Full Time (40 hrs/wk), Remote GENERAL SUMMARY Works under the supervision of the Health Information Reimbursement Manager. The primary job function of the HIM Coder Level I is to assign correct ICD-10 and CPT codes to established diagnoses and procedures for outpatient (emergency room, same-day surgery, interventional radiology, observation and/or Urgent Care Center) and/or limited inpatient records. In some instances, may audit OP and/or IP records for charging accuracy. May be asked to add or delete charges for optimal reimbursement as well as compliance following coding and governmental guidelines. The level one coder has mastered a maximum of 2 work types. Performs other duties as assigned. QUALIFICATIONS Education: High School Diploma or successful completion of an equivalent High School Exam...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Coder Full Time, Wooster Community Hospital, Wooster, OH, US Main Function The Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT and DRG codes as needed to all patient charts/accounts. Assists the revenue cycle team by performing audits to detect, assess and resolve reimbursement and revenue compliance concerns. Involved in the charge capture process. Responsibility Report to the System Director of Revenue Cycle. Must Have Requirements Previous coding experience / knowledge. Ability to follow written and verbal directions. Knowledge of state and federal coding regulations. Knowledge of Anatomy, Physiology, Disease Processes, and Medical Terminology. RHIT/RHIA/CCS or CCA eligible. If not credentialed at time of hire, applicant must become credentialed in one of the four areas within 12 months...

Anderson Hills Pediatrics' Expectations of all Employees Adhere to all Anderson Hills Pediatrics' Policies and Procedures Conduct self in a manner that represents Anderson Hills Pediatrics' core values at all times Maintain a positive and respectful attitude with all work-related contacts Consistently reports to work prepared to perform the duties of the position Meets productivity standards and performs duties as workload necessitates Primary Function Assists the Billing Manager with the claims submission and revenue cycle of the practice. Major Duties and Responsibilities Adherence to current HIPAA regulations and federal/state laws for patient protected health information (PHI) and/or medical records; adherence to all AHP policies/procedures as they pertain to patient PHI and the medical record; maintain strict confidentiality of all patient information Update patient demographic information including insurance coverage; make changes/corrections as needed;...

WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION Coder MAIN FUNCTION: The Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT and DRG codes as needed to all patient charts/accounts. Assists the revenue cycle team by performing audits to detect, assess and resolve re-imbursement and revenue compliance concerns. Involved in the charge capture process. RESPONSIBLE TO: System Director of Revenue Cycle MUST HAVE REQUIREMENTS: Previous coding experience / knowledge. Ability to follow written and verbal directions. Knowledge of state and federal coding regulations. Knowledge of Anatomy, Physiology, Disease Processes, and Medical Terminology. RHIT/RHIA/CCS/ or CCA eligible. If not credentialed at time of hire, then applicant must become credentialed in one of the four areas within 12 months of hire to remain employed. Ability to operate computer on a daily basis and perform basic office procedures. No written disciplinary action within the last...

PURPOSE OF THIS POSITION This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization’s operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES Duty 1: Maintains a thorough understanding and education of federal and state regulations and payer specific policies...

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:...

CVS Health is seeking a skilled medical records auditor to perform chart reviews and abstract ICD codes for CMS risk adjustment. You will ensure accuracy and compliance with state and federal regulations while supporting coding decisions with evidence from records. Responsibilities include applying guidelines, identifying active vs historical conditions, meeting tight deadlines, and conducting self-audits to maintain quality within our healthcare operations. Strong CPC/CCS-P credentials required. #J-18808-Ljbffr

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...

Responsibilities Conducts regular audits of clinical documentation and coding to identify areas for improvement and ensure compliance with federal, state, and payer regulations Makes recommendations based on interpretations of identified coding patterns Implements compliant and accurate coding solutions Identifies patterns of incorrect coding Identifies training needs and develops educational materials Partners with providers to analyze and resolve complex coding inquiries Helps Coders stay informed on changes in coding regulations Works independently to assess coding accuracy Requirements Bachelor’s degree or equivalent combination of related experience and education Certification of CPC, CCA, CCS, CCS-P, or similar designation At least 3 years of experience related to coding for physician services #J-18808-Ljbffr

Overview Looking to join our dynamic team at Ohio State University Physicians where excellence meets compassion? Who We Are With over 100 cutting‑edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth. Our culture At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community. Our Benefits We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing...

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...

Purpose of This Position This position is responsible for all medical claims including pre‑billing and follow‑up activities for delayed claims, ensuring that claims are clean and paid promptly by insurers without requiring further intervention. The staff member performs all pre‑claim submission activities, verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. The individual follows departmental productivity and quality‑control measures that support the organization’s operational goals, promotes revenue integrity, and ensures timely and accurate billing and payer follow‑up activities and collection of accounts. Job Duties / Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer‑specific policies and requirements to promote compliant claims submission practices. Adheres to HIPAA related privacy, security and transaction & code set...

The Ohio State University Physicians, Inc. is seeking a coding/billing professional in Columbus, OH to ensure accurate CPT, HCPCS, and ICD-10-CM coding for physician services. The role supports billing processes, payer compliance, and ongoing staff education. Responsibilities include audits of denials, documentation improvement, and interactions with providers to resolve coding questions, ensuring regulatory adherence and efficient reimbursement. #J-18808-Ljbffr

Medical Claims Specialist This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. Job Duties/Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer specific policies...