16 certified coder auditing jobs found

Job Description Job Description Shift delivers AI agents that transform insurers' most critical work. By combining deep industry expertise and unmatched data resources, Shift provides proven results that have earned the trust of hundreds of the world's leading insurers. Our insurance-grade AI is accurate, explainable, and secure—empowering human experts to move with unmatched speed, total confidence, and a renewed focus on the people they serve.        Your browser does not support the video tag. Our culture is built on innovation, trust, and a drive to transform the insurance industry through our SaaS platform. We come from more than 50 different countries and cultures and together we are creating the future of insurance. Learn more at www.shift-technology.com   As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment...

Certified Medical Coding Specialist Shift is the leading AI platform for insurance. Shift combines generative, agentic, and predictive AI to transform underwriting, claims, and fraud and risk - driving operational efficiency, exceptional customer experiences and measurable business impact. Trusted by the world's leading insurers, Shift delivers AI when and where it matters most, at scale and with proven results. Our culture is built on innovation, trust, and a drive to transform the insurance industry through our SaaS platform. We come from more than 50 different countries and cultures and together we are creating the future of insurance. As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits,...

Randstad USA is seeking a Program Integrity Coder- FWA Auditor to verify itemized claim reviews for payment, coding, and billing guidance. The role involves working with SIU Investigators, analyzing medical records, and abstracting codes. You will maintain current coding knowledge and provide SME support while ensuring Privacy and Security standards are met. Applicants should have 1–2 years of experience in medical record auditing, and hold an active certified coder credential. #J-18808-Ljbffr

The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with the Plans’ provider agreements and the National Healthcare Billing Audit guidelines. The successful candidate must be capable of building and maintaining strong working relationships with key internal and external constituents and working effectively in a matrixed environment. Responsibilities include: Work with SIU Investigators assisting in research, discuss to make appropriate coding determinations as needed Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed Compare information submitted on the claims to determine amount and nature of billable services as needed Determines appropriateness of billing and reimbursement as needed Documents findings for each claim line in a spreadsheet as needed Summarize findings in a...

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...

Certified Medical Coding SpecialistShift is the leading AI platform for insurance. Shift combines generative, agentic, and predictive AI to transform underwriting, claims, and fraud and risk - driving operational efficiency, exceptional customer experiences and measurable business impact. Trusted by the world's leading insurers, Shift delivers AI when and where it matters most, at scale and with proven results.Our culture is built on innovation, trust, and a drive to transform the insurance industry through our SaaS platform. We come from more than 50 different countries and cultures and together we are creating the future of insurance.As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and...

Shift delivers AI agents that transform insurers' most critical work. By combining deep industry expertise and unmatched data resources, Shift provides proven results that have earned the trust of hundreds of the world's leading insurers. Our insurance-grade AI is accurate, explainable, and secure—empowering human experts to move with unmatched speed, total confidence, and a renewed focus on the people they serve. Our culture is built on innovation, trust, and a drive to transform the insurance industry through our SaaS platform. We come from more than 50 different countries and cultures and together we are creating the future of insurance. As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and...

Mass General Brigham seeks a Medical Coder to review patient records after visits and translate clinical details into ICD-10-CM/HCPCS codes for insurer reimbursement. You will confirm treatments with staff, identify missing information, and submit coding data to insurers while ensuring accuracy and timeliness. The role includes auditing and peer reviews to uphold coding standards and compliant billing practices. #J-18808-Ljbffr

US Tech Solutions is a global staff augmentation firm providing a wide-range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit our website www.ustechsolutions.com. We are constantly on the lookout for professionals to fulfill the staffing needs of our clients, sets the correct expectation and thus becomes an accelerator in the mutual growth of the individual and the organization as well. Keeping the same intent in mind, we would like you to consider the job opening with US Tech Solutions that fits your expertise and skillset. Job Description Medical Record Reviewer will primarily be responsible for completing medical record reviews (on-site, remote and/or in-house) in support of the Medicare risk adjustment retrospective initiative and Risk Adjustment Data Validation (RADV) Audits. This role will also assist with building the medical chart review program at Client’s. Duties and Responsibilities Utilize comprehensive knowledge...

Mass General Brigham Incorporated is seeking a Medical Coder to review patient records and translate information into ICD-10-CPT-HCPCS codes for insurance processing. The role involves verifying treatments with clinicians, identifying missing data, and submitting codes for reimbursement, with peer review to ensure accuracy. Responsibilities include auditing documentation, addressing coding challenges, guiding peers, and ensuring compliance with coding guidelines while working remotely from the #J-18808-Ljbffr

Are you an experienced Medical Billing Specialist interested in working for the premier, privately-owed women's health practice in the Greater Springfield, MA area? Would you like to join the billing department team of a successful Ob/Gyn group with an excellent provider group, strong management team, and amazing support staff? If you answered yes, we invite you to apply to BOGG! (Baystate Ob/Gyn Group, Inc.) Job Summary The Billing Specialist plays a crucial role in supporting efficient medical billing workflows and maintaining the financial integrity of BOGG.This position is responsible for accurately processing medical claims from start to finish within the electronic medical record (EMR) and practice management systems.Key duties include reviewing clinical documentation, ensuring accurate ICD-10 and CPT coding (specifically in Ob/Gyn), verifying payment postings, resolving claim denials, assisting patients and staff with billing inquiries, and ensuring compliance with...

Physician Medical Coder (Primary Care Coding)The Primary Care Physician Medical Coder performs coding validation and review of charges for assigned medical departments to ensure timely, accurate, and compliant submission of charges. This position assigns, sequences, validates, and/or edits codes for assigned medical departments and initiates, reviews, and/or edits physician queries when appropriate. The Coder maintains current knowledge of coding guidelines, regulatory requirements, reimbursement practices, and hospital policies to ensure accurate and compliant coding.Key ResponsibilitiesPerforms complex ICD-10 and CPT/ASA coding review and validation for assigned medical departments.Reviews and validates physician charges to ensure accurate and compliant billing.Establishes and maintains working relationships with physicians to resolve coding, documentation, and case-related questions.Participates in coding and reimbursement training programs and provides education to staff on...

Position Summary The Primary Care Physician Medical Coder performs coding validation and review of charges for assigned medical departments to ensure timely, accurate, and compliant submission of charges. This position assigns, sequences, validates, and/or edits codes for assigned medical departments and initiates, reviews, and/or edits physician queries when appropriate. The Coder maintains current knowledge of coding guidelines, regulatory requirements, reimbursement practices, and hospital policies to ensure accurate and compliant coding. Key Responsibilities Performs complex ICD-10 and CPT/ASA coding review and validation for assigned medical departments. Reviews and validates physician charges to ensure accurate and compliant billing. Establishes and maintains working relationships with physicians to resolve coding, documentation, and case-related questions. Participates in coding and reimbursement training programs and provides education to staff on accurate charge...

Position SummaryThe Physician Specialty Coder works independently to manage complex coding review, validation, and charge submission processes for assigned specialty departments. Specifically Surgical Coding. This role ensures accurate and compliant ICD-10, CPT, and/or ASA coding while partnering closely with physicians, billing teams, and operational staff to resolve coding and reimbursement issues. The position also serves as a resource for coding guidance, documentation improvement, and workflow optimization to support timely and accurate reimbursement.Key ResponsibilitiesPerform complex ICD-10, CPT, and/or ASA coding review and validation for assigned specialty departments.Partner with physicians and clinical staff to resolve coding questions and documentation issues.Review and edit physician queries in compliance with hospital policies and coding standards.Collaborate with Billing teams to ensure timely and accurate charge submission and workflow completion.Provide education...

Position Summary The Physician Specialty Coder works independently to manage complex coding review, validation, and charge submission processes for assigned specialty departments. Specifically Surgical Coding. This role ensures accurate and compliant ICD-10, CPT, and/or ASA coding while partnering closely with physicians, billing teams, and operational staff to resolve coding and reimbursement issues. The position also serves as a resource for coding guidance, documentation improvement, and workflow optimization to support timely and accurate reimbursement. Key Responsibilities Perform complex ICD-10, CPT, and/or ASA coding review and validation for assigned specialty departments. Partner with physicians and clinical staff to resolve coding questions and documentation issues. Review and edit physician queries in compliance with hospital policies and coding standards. Collaborate with Billing teams to ensure timely and accurate charge submission and workflow completion....

Physician Specialty Coder- remote | Boston Childrens HospitalPosition Summary The Physician Specialty Coder works independently to manage complex coding review, validation, and charge submission processes for assigned specialty departments. Specifically Surgical Coding. This role ensures accurate and compliant ICD-10, CPT, and/or ASA coding while partnering closely with physicians, billing teams, and operational staff to resolve coding and reimbursement issues. The position also serves as a resource for coding guidance, documentation improvement, and workflow optimization to support timely and accurate reimbursement. Key ResponsibilitiesPerform complex ICD-10, CPT, and/or ASA coding review and validation for assigned specialty departments.Partner with physicians and clinical staff to resolve coding questions and documentation issues.Review and edit physician queries in compliance with hospital policies and coding standards.Collaborate with Billing teams to ensure timely and...