30 certified coding auditor jobs found

Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role involves assigning ICD-10-CM, ICD-10-PCS, and DRG codes and ensuring accurate payments. Remote position with occasional travel to Humana offices, 40 hours per week, pay range $71,100-$97,800 with bonus eligibility. Requires 4+ years in MS-DRG coding auditing and RHIA/RHIT/CCS certification. #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...

CVS Health in New Hampshire is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation across medical, behavioral, transportation and other healthcare services. The role requires CPC certification, 3+ years of coding or auditing, and strong knowledge of CPT/HCPCS/ICD-10, CMS 1500/UB04, plus proficiency with Excel and Word. #J-18808-Ljbffr

Coding & Compliance Auditor The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. This is a hybrid position: 2 days onsite; 3 days remote option. Compensation Pay Range: $73,000.00 - $104,400.00 Job Responsibilities Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC's, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation...

Job Requirements If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number R-22463 Facility LOC0006 - 780 Main Street 780 Main Street Weymouth, MA 02190 Department Name SHS Compliance Status Full time Budgeted Hours 40 Shift Day (United States of America) Hybrid Position 2 days onsite; 3 days remote option. Description The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Compensation Pay Range $73,000.00 - $104,400.00 Job Responsibilities Establishes, implements, and maintains a formalized review process for coding...

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:...

Department Description:The Critical Care Auditor/ Coder position will be working directly with the Department of Anesthesia, Critical Care and Pain Medicine and will have the opportunity to work remotely following an initial onsite training period. The incumbent will be required from time-to-time to attend billing onsite staff meetings and meetings with the physicians they support. AFS, LLC is located in Needham Heights, Massachusetts. Job Location:Virtual Job Summary:Performs professional certified coding and provides administrative and project support to the department. Analyzes surgical-medical documentation, provides the individual surgeon/physician with the application of appropriate ICD-10/CPT/HCPCS descriptor codes including the appropriate use of modifiers to ensure compliance for reimbursement. Essential Responsibilities:Analyzes evaluation and management, including critical care, procedures and other notes and documents to determine the scope and complexity of the...

Surgical Coding Manager Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Location: Remote - Nationwide You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Oversees surgical coding team of 8 coders. Facilities and monitors workflows. Assigns work daily and projects as needed Responsible for procedure and diagnostic coding of professional charges. Works...

Medical Coder The entry level Medical Coder is responsible for documentation improvement and integrity and serves as a liaison between clinical care providers, finance, and billers. This role is also an information and educational resource, providing proactive and retrospective review of health center visits as they relate to ICD-10-CM diagnosis coding and reimbursement. The entry level Medical Coder will audit medical records to ensure completeness, accuracy and compliance with Medicaid coding and supporting documentation guidelines. Key Responsibilities: Evaluates medical record documentation for completion to ensure accuracy and compliance to meet Medicaid and ICD-10-CM standards. Compares past and present medical history of each participant to maintain complete and accurate ICD-10 codes for appropriate reimbursement. Reviews medical records prospectively to ensure that the care of the patient is recorded in language that payers can interpret which accurately and...

Senior Medical Coding Analyst 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. 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 meetsand exceedsour 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...

Outpatient Coder When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Description: Under the general supervision of the Outpatient (OP) Coding Manager and OP Coding Supervisor, the OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. Essential Duties & Responsibilities including but not limited to: Hospital Coding: Review the complete...

Outpatient Coder When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Description Under the general supervision of the Outpatient Coding Manager and OP Coding Supervisor, the OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. Essential Duties & Responsibilities including but not limited to: Review the complete electronic and scanned...

Optum is seeking an experienced medical coder to lead a surgical coding team of eight, ensuring accurate CPT/HCPCS/ICD-10 coding and revenue maximization. You will collaborate with physicians and staff to resolve payer issues and maintain compliance across departments. Key duties include supervising workflows, supporting audits, and communicating policy updates. A CPC/CCS certification or eligibility with 3+ years of coding experience is preferred, along with Epic proficiency. #J-18808-Ljbffr

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account. Exemption Status: Non-Exempt Hiring Range: $0.00 - $0.00 Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations . Schedule Details: Monday through Friday Scheduled Hours: 7a-3:30p Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 99940 - 5470 ED Coding and Revenue Capture This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a...

Facility Op Coder When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Description: Under the general supervision of the Facility Outpatient (OP) Coding Manager and OP Coding Supervisor, the Facility OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The facility OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. Essential Duties & Responsibilities including but not limited to: Review...

Job Description Job Description Title: Certified Risk Coder Reports to: Manager, Risk Coding Classification: Individual Contributor Location: Boston (Remote) Job description revision number and date: 2.0, 01.06.2025 Organization Summary: Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. Job Summary: The Certified Risk Coder will be a part of an emerging...

Westboroughbehavioral is seeking a Medical Office Coder to join their team in Westborough, Massachusetts. This per diem position requires the coder to accurately assign medical codes for billing purposes, perform audits, and ensure compliance with coding regulations. Applicants should have a High School degree and an Associate's Degree or Certificate in Medical Coding/CPC, alongside at least one year of coding experience, preferably in psychiatric services. The role offers benefits like 401K, medical, dental, and vision coverage. #J-18808-Ljbffr

UMass Memorial Health is seeking an Outpatient Coder II to interpret clinical documentation and assign ICD-CM and CPT codes for outpatient encounters across the hospital system. The role focuses on accurate coding, supports reimbursement, and requires close attention to detail. Responsibilities include verifying documentation, minimizing coding backlogs, participating in audits, and maintaining a high accuracy rate while working with billing teams. #J-18808-Ljbffr

Job Information Exemption Status: Non-Exempt Hiring Range: $0.00 - $0.00 (final offer may vary based on experience, skills, qualifications, and internal equity considerations) Schedule: Monday through Friday, 7:00 a.m. – 3:30 p.m. (1 – Day Shift, 8 Hours, United States of America) Hours: 40 per week Cost Center: 99940 – 5470 ED Coding and Revenue Capture Sign‑off: This position may have a signing bonus available. A member of the Recruitment Team will confirm eligibility during the interview process. Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account. Major Responsibilities Upon review of the medical record, perform analysis on documentation, which includes review of tests/reports to determine the appropriate ICD‑CM (current edition) and/or CPT codes as well as modifiers. Based on account type, may assign ICD‑PCS codes, as defined by official coding guidelines and other recognized...

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? Exemption Status: Non-Exempt Hiring Range: $0.00 - $0.00 Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations. Schedule Details: Monday through Friday Scheduled Hours: 7a-3:30p Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 99940 - 5470 ED Coding and Revenue Capture This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are...

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...

What We’re Looking For We’re looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace! What You Will Do Assign diagnostic and procedural codes using ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes Accurately sequence and abstract medical codes from patient records, ensuring precision and adherence to documentation Oversee and audit the work of Level 1 & 2 Coders, where applicable Champion documentation improvement opportunities and coding issues, facilitating resolution with relevant stakeholders Uphold an overall 95% coding accuracy rate and a 95% accuracy rate for MS-DRG assignments Maintain a minimum production of 1 chart per hour or site-specific productivity benchmarks Foster professional...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Under the general supervision of the Facility Outpatient (OP) Coding Manager and OP Coding Supervisor, the Facility OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The facility OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. Job Description: Essential Duties & Responsibilities including but not limited to: Hospital Coding: ·...

UnitedHealth Group is seeking a skilled Medical Coder to work remotely from anywhere in the United States. You will code a variety of medical records using CPT, HCPCS, and ICD-10, prepare and transmit claims, and interface with providers and auditors to ensure accurate, compliant coding. The role requires 2+ years coding experience, CPC/ CCS-P/ CCS/ CPC-H credentials, and strong knowledge of government and payer guidelines. #J-18808-Ljbffr