39 certified coder auditing jobs found

MUST RESIDE IN FLORIDA AND HAVE CODING AND AUDITING EXPERIENCE. Deposition as well as Testimony experience is preferred. We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support including deposition and testimony services when needed. The ideal candidate must have strong Florida-based coding experience and a thorough understanding of medical necessity, documentation compliance, and payer audit defense. Responsibilities: Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS) Conduct utilization reviews to determine medical necessity and documentation compliance Review and prepare demand packages and audit response materials Analyze records for payer disputes and recoupments Prepare written audit findings and defensible reports Provide expert support for depositions and testimony as needed Review E/M services under 2021+ guidelines Interpret CMS,...

Remote Surgical Coding Specialist Use your surgical coding expertise to support accurate billing, compliance, and strong revenue cycle performance in a fully remote environment. Work Style: Remote Location Requirement: Must reside in an approved state (FL, GA, MO, PA, SC, NC, TN, or TX) FTE: PRN (Approximately 8 hours per week) Reviews and analyzes medical records to assign accurate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation, resolve coding discrepancies, and ensure the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards, including ICD, CPT, and HCPCS, and supports the billing process by providing precise coding for claims submission. Participates in auditing activities, supports staff training on coding procedures, and monitors productivity and quality metrics to drive continuous improvement....

Medical Coding Specialist Turn accurate coding into cleaner claims, reliable data, and stronger reimbursement. Work Style: Remote Location Requirement: Must reside in an authorized state (FL, GA, MO, PA, SC, NC, TN, or TX) FTE: Full-Time (1.0 FTE) Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensuring the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission. Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance. Key Responsibilities Reviews and analyzes medical records to...

University of Florida is seeking a Clinical Coder III for the Student Health Care Center in Gainesville. The role focuses on accurate, compliant coding to maximize reimbursement, education of providers on coding requirements, and collaboration with the Compliance Office on auditing. The position requires CPC/AAPC or CCS-P credentials, five years of professional medical coding experience across multiple specialties, and knowledge of CPT, ICD-10, CPT codes, and payer guidelines. #J-18808-Ljbffr

Physician Billing Coder Specializing In Anesthesia We are seeking an experienced Physician Billing Coder specializing in Anesthesia to support accurate coding, charge capture, and reimbursement for professional anesthesia services. Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensures the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission. Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance. Job Responsibilities: Reviews and analyzes medical records to assign appropriate...

Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. Responsible for the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Graduate of a Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Graduate of a Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience. 2. Certification in ONE of the following: Registered Health Information...

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 Coding Analyst will perform medical claim reviews for waste and error to ensure compliance with coding practices through a comprehensive record review for medical and institutional providers. The Analyst must have the ability to determine correct coding and appropriate documentation during the review of medical records. The Analyst must also ensure state; federal and company requirements are met. Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record...

Risk Adjustment Nurse/Coder AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! Status: Full-time permanent position (40 hours) Standard working hours: 8am to 4:30pm EST, M-F Location: This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical...

Billing Compliance AnalystJob Summary Serves as a resource to the NCHS Billing Compliance Program and is responsible for monitoring Billing Compliance activities to ensure compliance with federal, state and local regulations, and NCHS policies. Job Specific Duties Analyzes Billing Compliance review outcomes and proactively identifies trends and high-risk areas. Develops Billing Compliance audit activity and trends reports. Develops appropriate recommendations for Corrective and Preventative Action (CAPAs). Utilizes innovative ideas and tools to enhance the operational effectiveness. Monitors, analyzes, and reports the effectiveness of Billing Compliance risk-based training. Presents findings and feedback in a helpful manner to appropriate parties and provides pertinent education and/or guidance to improve billing/coding procedures. Documents education provided to applicable parties and maintains records of training sessions in the case management system as part of the Corrective...

Become a part of our caring community Code Edit Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The Medical Coding Coordinator performs advanced administrative, operational, and customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. Where you Come In The Medical Coding Coordinator 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. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and...

Coding Auditor Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Job Description Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines. Responsibilities Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements....

Medical Coding Specialist Turn accurate coding into cleaner claims, reliable data, and stronger reimbursement. Work Style: Remote Location Requirement: Must reside in an authorized state (FL, GA, MO, PA, SC, NC, TN, or TX) FTE: Full-Time (1.0 FTE) Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensuring the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission. Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance. Key Responsibilities Reviews and analyzes medical records to...

Clinical Coder III - Student Health Care Center Job no: 541662 Work type: Staff Full-Time Location: Main Campus (Gainesville, FL) Categories: Health Care Administration/Support Department: 35010204 - SH-INSURANCE OFFICE Classification Title: Clinical Coder III Classification Minimum Requirements: High school diploma or equivalent and five years of experience in professional medical coding, with experience in two or three clinical specialties. Appropriate college coursework or vocational/technical training may substitute at an equivalent rate for the required experience. Certified Professional Coder (CPC)/ American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS-P) required. Job Description: The Opportunity The Student Health Care Center (SHCC) at the University of Florida is seeking a Clinical Coder III. Reporting to the Coding and Reimbursement Supervisor, this position serves as a senior member of the SHCC Coding team and...

Medical Coding Specialist Turn accurate coding into cleaner claims, reliable data, and stronger reimbursement. Work Style: Remote Location Requirement: Must reside in an authorized state (FL, GA, MO, PA, SC, NC, TN, or TX) FTE: Full-Time (1.0 FTE) Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensuring the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission. Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance. Key Responsibilities Reviews and analyzes medical records to...

Company Overview :Upward Health is an in-home, multidisciplinary medical group providing 24 / 7 whole-person care.Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help.Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients.We are able to treat a wide range of needs - everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals - because we know that health requires care for the whole person.It's no wonder 98% of patients report being fully satisfied with Upward Health!Job Title & Role Description :The Certified Medical Coder is responsible for analyzing provider documentation to accurately select ICD-10 and CPT / HCPCS codes, ensuring compliance with coding guidelines, third-party reimbursement policies, and accreditation standards.This role...

Overview Certified Medical Coder required (AHIMA, AAPC, or PMI). Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud Investigative...

Overview Turn accurate coding into cleaner claims, reliable data, and stronger reimbursement. Work Style: Remote Location Requirement: Must reside in an authorized state (FL, GA, MO, PA, SC, NC, TN, or TX) FTE: Full-Time (1.0 FTE) Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensuring the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission. Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance. Responsibilities Key Responsibilities • Reviews and analyzes...

Medical Coding SpecialistTurn accurate coding into cleaner claims, reliable data, and stronger reimbursement.Work Style: Remote Location Requirement: Must reside in an authorized state (FL, GA, MO, PA, SC, NC, TN, or TX) FTE: Full-Time (1.0 FTE)Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies.Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensuring the integrity of coded data for billing and reporting purposes.Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission.Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance.Key Responsibilities• Reviews and analyzes medical records to assign appropriate...

Physician Coding Education SpecialistPerforms, develops, and implements coding related efficiency processes to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Education Specialist is responsible for analyzing physician coding trends and providing educations that will contribute to effective productivities.Responsibilities Essential Functions:Responsible for internal auditing and analyzing professional coding for all service lines.Guide and educate coding team members by addressing errors, performance issues, and trends identified through reporting.Takes an active role in developing and presenting educational programs to physicians, physician extenders, and physician offices.Effectively communicates best practice physician coding related feedback with physicians, non-physician providers, physician office staff, administration, practice managers, and team members of...

POSITION SUMMARY This role plays a vital part in maintaining the integrity of our revenue cycle by verifying documentation accuracy and reducing denial occurrences through auditing and accurate coding. The employee will have strong analytical skills, a deep understanding of medical terminology and coding standards, and a commitment to ensuring billing accuracy and compliance with regulatory guidelines. ESSENTIAL DUTIES AND RESPONSIBILITIES Review and assign appropriate CPT, ICD-10-CM, and HCPCS codes based on physician charges, accessing hospital portals to verify that all billing codes accurately reflect documented patient services and procedures. Ensure that patient record documentation meets coding and compliance requirements. Collaborate with the Denials Department to identify and analyze recurring patterns of omissions, errors, or documentation discrepancies. Communicate findings to Administration to elicit corrective actions and reduce future issues....

Job Summary The Risk Adjustment Coder III is responsible for the accurate and timely assignment of medical diagnosis codes in accordance with established risk adjustment models, coding guidelines, and organizational standards. This role performs high-volume, production-based coding and chart review activities, following defined policies and procedures to ensure compliance and data accuracy. This position applies advanced coding knowledge but operates within established guidelines, with work subject to quality review and audit. Duties & Responsibilities Essential Duties & Responsibilities Medical Coding and Documentation Assign ICD-10-CM diagnosis codes based on medical records, clinical documentation, and encounter data in accordance with established coding guidelines. Perform detailed chart reviews to ensure accurate capture of diagnoses, including HCC codes, following risk adjustment requirements. Identify and correct coding discrepancies based on documented evidence...

UF Health in Gainesville seeks an experienced Physician Billing Coder specializing in Anesthesia to ensure accurate coding, charge capture, and reimbursement for professional anesthesia services. You will review medical records, resolve coding discrepancies, and collaborate with providers to clarify documentation while maintaining ICD-10-CM, CPT, and HCPCS standards; CPC certification is required. The role emphasizes auditing data quality, supporting claims submission, training staff, and #J-18808-Ljbffr

Medical Coding Specialist We are seeking a detail-oriented and experienced Medical Coding Specialist to support accurate risk adjustment coding and documentation initiatives. In this role, you will analyze coding and documentation trends, perform retrospective chart reviews and audits, assign ICD-10-CM diagnosis codes, and collaborate with providers and operational teams to improve coding accuracy and risk capture. The ideal candidate is highly analytical, self-directed, and committed to maintaining the highest standards of coding quality and compliance. Key Responsibilities Ensure accurate ICD-10-CM and CPT coding with zero errors. Validate diagnosis and treatment documentation, query providers for clarification. Stay current on coding guideline updates and communicate changes, trends, and payer issues to leadership. Use auditing tools to monitor accuracy, identify trends, and drive corrective action. Meet productivity benchmarks and maintain active professional coding...

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 Coding Analyst will perform medical claim reviews for waste and error to ensure compliance with coding practices through a comprehensive record review for medical and institutional providers. The Analyst must have the ability to determine correct coding and appropriate documentation during the review of medical records. The Analyst must also ensure state; federal and company requirements are met. Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation....