29 auditor jobs found

Compliance Coding Auditor Hours: Variable Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $48.140 - $62.110 - $76.080 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. What You Will Do The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit...

Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4:30PM Contract length: 4 months assignment with possible conversion Job Summary: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Day to Day: 75% Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings...

Job Description Summary Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type Regular Cost Center CC002278 SYS - Compliance Program Pay Rate Type Salary Pay Grade Health-27 Scheduled Weekly Hours 40 Work Shift Job Description The Compliance Auditor reports to the Internal Audit Coordinator and performs audits to evaluate adherence to laws, regulations and policies by reviewing records, analyzing data, and interviewing staff and stakeholders. These audits include but are not limited to services identified as high-risk via the annual risk assessment, OIG-CMS-PGBA workplan areas, ad hoc audit requests, and “for cause” coding and billing concerns. The audit scope includes a) the regulatory and industry research needed for audit planning, b) pre and post audit meetings with stakeholders, c) cohesive audit report that communicates results and includes a corrective action plan if warranted, and d) education...

Inpatient Coding Auditor (PRN) Join Our Award-Winning Team and Work with the Best! We are thrilled to share that UASI has been recognized as a Top Workplace by the Cincinnati Enquirer in 2022, 2023, and 2024! With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we've built and the long-term success of our dedicated team. We are currently seeking an experienced facility inpatient Coding Auditor to join our team on a PRN basis. The Coding Auditor will perform inpatient coding audits and review services to client sites remotely from a home office. Additional responsibilities include: Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans Perform necessary research to provide to the client to support findings. Examples of this research include...

Job Title Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary...

A regional healthcare provider is seeking a Professional Billing Quality Coding Auditor to ensure accurate coding and mentor coders. This role involves reviewing multi-specialty coding, presenting findings monthly, and facilitating training for coders. Applicants should hold a Bachelor's degree and have three years of relevant coding experience, along with the necessary CPC and CPMA certifications. Join us to transform healthcare and serve the community effectively. #J-18808-Ljbffr

Inspire health. Serve with compassion. Be the difference. Job Summary The Professional Billing Quality Coding Auditor will support the Medical Group Coding and Education department by performing routine reviews of coders to ensure accurate coding. This position will also perform specialty reviews as identified by Coding and Education leadership. Prepares a summary of findings and presents reports to leadership on a monthly basis. Will assist with training coders on identified opportunities for improvement. Will also assist in preventing coding denials when applicable. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings. Performs review of all coders within the...

A medical university is seeking a Compliance Auditor, responsible for conducting audits and ensuring adherence to regulations. The ideal candidate will have a bachelor's degree or significant experience in medical billing and coding, along with relevant credentials. Strong communication skills are essential. This full-time position offers an opportunity to work in a vibrant environment with dedicated individuals. #J-18808-Ljbffr

A healthcare auditing firm is seeking a Quality Medical Auditor to conduct validation reviews related to medical coding and compliance. The ideal candidate will have an Associate Degree in Nursing or Health Information Management and at least 3 years of experience in medical records management. Responsibilities include managing coding issues, creating analytical reports, and ensuring HIPAA compliance. This position is primarily onsite but may offer potential for remote work. #J-18808-Ljbffr

Join to apply for the Health Information Management Inpatient Coding Auditor Sr. FT, Days, - Remote role at Prisma Health . Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work queue management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Reviews and responds to inpatient denials as needed. Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Essential Functions All team members are expected to be...

Become a part of our caring community and help us put health first 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...

A regional healthcare provider based in Columbia, South Carolina, is seeking an experienced auditor. The role requires 2 years of auditing experience and knowledge of financial data analysis. Strong interpersonal and communication skills are essential. The position is in a typical office environment, with some travel between locations required. The company offers a competitive benefits package including health and dental insurance, 401k with matching, and education assistance. #J-18808-Ljbffr

Quality Medical Auditor - Coding Specialist Join to apply for the Quality Medical Auditor - Coding Specialist role at BlueCross BlueShield of South Carolina . Summary Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate...

Title: Certified Coding Specialist - Auditor Location: Novant Health Urgent Care (Columbia, SC) Status: Full-Time Part of the Novant Health family based in North Carolina, Novant Health Urgent Care (formerly Doctors Care) provides exceptional healthcare through our network of more than 50 urgent care centers and 20 physical therapy facilities across South Carolina. Our Columbia‑based headquarters delivers non‑medical management and administrative services to support these locations, and for decades we have been committed to delivering convenient, affordable healthcare experiences to families and communities throughout the Palmetto State. What We Offer Competitive wages with annual market data review Incentive Pay Program Continuing Education Reimbursement Eligible employer under the Public Service Loan Forgiveness (PSLF) Program UpToDate Subscription Generous PTO 403(b) with 100% vested match Health, dental, vision insurance Health Reimbursement Account Flexible...

Inspire health. Serve with compassion. Be the difference. Job Summary The Professional Billing Quality Coding Auditor will support the Medical Group Coding and Education department by performing routine reviews of coders to ensure accurate coding. This position will also perform specialty reviews as identified by Coding and Education leadership. Prepares a summary of findings and presents reports to leadership on a monthly basis. Will assist with training coders on identified opportunities for improvement. Will also assist in preventing coding denials when applicable. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings. Performs review of all coders within the...

A leading healthcare provider in Greenville, SC is seeking a Professional Billing Quality Coding Auditor to support the Medical Group Coding and Education department. The role involves auditing coding practices, training staff, and ensuring compliance with coding guidelines. Candidates should possess a Bachelor's degree in Business, with three years of multi-specialty coding experience, and hold certifications as a CPC and CPMA. This position offers the opportunity to influence coding accuracy and enhance training processes. #J-18808-Ljbffr

Crossroads Treatment Centers is an equal opportunity employer.We celebrate diversity and are committed to creating an inclusive environment for all employees.Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder.Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery.This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery.We are committed to bringing critical services to communities across the U.S.to improve access to treatment for over 26,500 patients.Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and...

Global Disbursing Overview The Comptroller Global Financial Services (CGFS), Global Disbursing is composed of teams in Bangkok, Charleston, and Paris. Respective staff are financial experts who engage the Department's global customers through the provision of services: payments and collections, foreign currency, banking, cashier monitoring, and reconciliation with Treasury. All activity is processed through the Regional Financial Management System/Disbursing to promote accuracy, reporting, and quality stewardship over financial resources. Disbursing & Cashier Management Overview The Cashier Management section provides oversight of all overseas cashier operations to include, regulation and fiscal law compliance; monthly reconciliation; correcting out of balance or fiscal irregularities; review of advances; appointing and revocation of cashiers and Cash Verification Officers; review and monitoring of bank accounts and currency exchanges; and performs onsite and remote...

A leading health data platform company is seeking an Inpatient Auditing Specialist to perform coding audits and provide consultancy related to coding quality. The role requires a strong focus on customer service and adherence to coding standards. Candidates should have 5+ years of inpatient coding experience and hold relevant certifications. This fully remote position offers flexible scheduling and competitive hourly pay ranging from $35 to $45. #J-18808-Ljbffr

A healthcare provider in South Carolina is seeking a qualified professional to lead coding teams, manage coding processes, and perform audits on inpatient records. The ideal candidate holds an Associate's degree or equivalent and has a minimum of 4 years' experience in inpatient coding. This role involves mentoring coders, validating DRGs, and collaborating with clinical teams, all while ensuring compliance with Medicare requirements. Join us and help transform healthcare in our community. #J-18808-Ljbffr

Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work queue management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Reviews and responds to inpatient denials as needed. Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Essential Functions Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding...

Job Description Job Description Medical Coder - CPC W2H Contract to Hire Pay rate: $36/hr Location: Columbia South Carolina Join our dynamic healthcare team as a Quality Medical Auditor and play a critical role in ensuring the accuracy and integrity of medical coding and billing processes. You will be instrumental in validating complex diagnoses, coding accuracy, and identifying opportunities for cost savings, all while supporting compliance and legal standards. This position offers a unique opportunity for career growth in healthcare auditing, coding accuracy, and data analysis. Key Responsibilities: Conduct comprehensive validation reviews of Diagnosis Related Groups (DRGs), Adaptive Predictive Coding (APC), and Never Events (medically inexcusable outcomes) across all lines of business, ensuring coding accuracy and compliance. Develop and implement robust methodologies for case selection to identify records for validation reviews efficiently. Collaborate closely...

Inpatient Coder Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal...

Medical Coder - Hematology/Oncology Clinic Duration: 12 Weeks Location: 100% Remote Job Description Review documentation of professional services in EPIC, obtain copies of chart notes, reports (i.e., admission/discharge records, patient medical records) and any other source of documentation available to ensure compliance with the Center for Medicare and Medicaid Services' (CMS) documentation of professional services and assign correct CPT, ICD-9-CM, and HCPCS codes. Utilizes ICD-9-CM, ICD-10, CPT codebook and Coding Clinic references to verify code specificity and follow ICD-9-CM Official Guidelines for Coding and Reporting and AMA Official Guidelines for CPT. Enter billing information into EPIC Resolute. Establish and maintain procedures and other controls necessary in carrying out all insurance billing activity. Monitor activity for compliance with federal and/or state laws regarding correct coding set forth by CMS and Oregon Medical Assistance program (OMAP)....