37 certified coding auditor jobs found

Valley Health System in Blacksburg seeks a seasoned clinical documentation auditor to conduct reviews of billed services for VMG enterprise accuracy. This role supports audit responses and improves coding quality across departments. The candidate will assist in payor and governmental audits, respond to denials and inquiries, and research new coding guidelines to enhance reimbursement processes and corporate compliance. #J-18808-Ljbffr

Coding Educator/AuditorInsight Global is seeking a Coding Educator/Auditor for a healthcare system in Virginia. The educator will provide consulting services to physicians, residents, allied health professionals and billing staff to support patient care documentation, coding and billing practices according to federal, state and local regulatory compliance standards.• Creates and delivers presentations to clinical faculty and billing staff.• Develops training programs and delivers training and education sessions for physicians, allied health professionals, residents, and coding and billing staff to support compliance with third party documentation and billing regulatory standards, including but not limited to classroom training, web-based training and one-on-one provider observation and training sessions.• Participates on clinical department Billing Quality Councils as a member of the respective councils and acts as the primary resource providing technical and regulatory expertise...

The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and educations associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remains in compliance with all federal healthcare program rules, regulations, administrative requirements and guidance. MINIMUM QUALIFICATIONS EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ; Associate’s Degree AND Five (5) years experience in multi-specialty coding, E&M coding, procedural/surgical coding. Current certification in one of the following: Certified Professional Coder (CPC)through the American Academy of Professional Coders (AAPC) Registered Health...

Summary About the Position: The positions fall under the Defense Health Agency (DHA) Atlantic Network at the Naval Medical Center Portsmouth, Patient Administration Department (PAD) providing guidance and functional expertise to improve coding accuracy, and functioning primarily as a medical auditor/trainer. (See duties below) . This is a Direct Hire Solicitation Learn more about this agency Duties Help Analyze patient medical records to identify inaccurately coded services in accordance with federal coding regulations and guidelines. Assign specific codes to medical records, sequencing and determining codes to accurately reflect the resources and procedures used in the care of the patients. Ensure compliance with regulatory and third-party insurance requirements in utilizing the ICD-10-CM, and CPT coding books. Perform limited utilization review of outpatient and inpatient records to assure the diagnosis responsible for the length of stay is...

Job Posting About the Position: The positions fall under the Defense Health Agency (DHA) Atlantic Network at the Naval Medical Center Portsmouth, Patient Administration Department (PAD) providing guidance and functional expertise to improve coding accuracy, and functioning primarily as a medical auditor/trainer. (See duties below).

About the Position: The positions fall under the Defense Health Agency (DHA) Atlantic Network at the Naval Medical Center Portsmouth, Patient Administration Department (PAD) providing guidance and functional expertise to improve coding accuracy, and functioning primarily as a medical auditor/trainer. (See duties below). This is a Direct Hire Solicitation Who May Apply: US Citizens In order to qualify, you must meet the experience requirements described below. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about...

Remote Chicago - 550 Van Buren Michigan-Grayling Pennsylvania-Trappe Boro Pennsylvania-East Lampeter Twp Pennsylvania-Skippack Twp Pennsylvania-Bethel Twp (Armstrong) Pennsylvania-North Bethlehem Twp Pennsylvania-South Park Twp Pennsylvania-West Norriton Twp Pennsylvania-West Mifflin Boro Pennsylvania-Wilkinsburg Boro Pennsylvania-Cogan House Twp (Lycoming) Kentucky-Wolfe County Pennsylvania-Reading (Berks) Pennsylvania-Bensalem Twp Pennsylvania-Lower Salford Twp Ohio-Mentor Michigan-Lansing Pennsylvania-Clarks Green Boro Ohio-Lima Pennsylvania-Bethlehem Twp Pennsylvania-West Cornwall Twp (Lebanon) Pennsylvania-Edgeworth Boro Ohio-Rocky River Kentucky-Murray Pennsylvania-Kennedy Twp Pennsylvania-Moon Twp Ohio-Bay Village Ohio-Lakewood Ohio-Ashville Kentucky-Lakeside Park Pennsylvania-Lower Paxton Twp Ohio-Oxford Ohio-Bedford Pennsylvania-Ross Twp Pennsylvania-Newtown Twp Pennsylvania-Washington Twp...

Compliance Coding Auditor Performs a number of functions including those of physician education, internal auditing, coder education, management of AR queries/problems, and liaison with external auditors for corporate audits. The internal audit program assures optimal ethical reimbursement for Sentara's patients, and also assures that the coding practices fall within established compliance guidelines. Both ICD and CPT coding methodologies are used in the internal audit activity. The Auditor must exhibit competence in Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Conditionals Categories (HCC) and other federal payer policies, and is expected to achieve mastery in the MPFS payment methodology, including the impact on Relative Value Unit (RVU) value related to Non-Physician Practitioner (NPP) services, Provider Based Billing (PBB) locations, and all other complex coding protocols within one year. All queries arising from the audit process are...

The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and educations associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remains in compliance with all federal healthcare program rules, regulations, administrative requirements and guidance. MINIMUM QUALIFICATIONS EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ; Associate’s Degree AND Five (5) years experience in multi-specialty coding, E&M coding, procedural/surgical coding. Current certification in one of the following: Certified Professional Coder (CPC)through the American Academy of Professional Coders (AAPC) Registered Health...

If you are an experienced medical coder who thrives in a complex academic medicine environment, this is an opportunity to make a meaningful impact behind the scenes of world-class patient care. Your expertise will help support accurate reimbursement, documentation integrity, regulatory compliance, and the financial health of a nationally recognized academic health system. As a Coding Quality Specialist 3 , you will leverage advanced coding expertise in cardiology services, cardiac, thoracic and vascular surgical procedures, catheter-based procedures, diagnostic testing, and evaluation & management services . This remote role offers the opportunity to work with highly specialized physician services while partnering with providers and operational teams to ensure coding accuracy, compliance, and excellence across the revenue cycle. The Role In this highly specialized coding position, you will perform professional fee coding and quality review functions for complex...

Responsibilities Atlantic Region CBO: The Atlantic Region Central Billing Office (“ARCBO”) or (“CBO”) provides business office services including billing, collections, cash posting, pre-access management, variance, and customer service to our affiliated Universal Health Services hospitals. https://jobs.uhs.com/atlantic-region-cbo The Atlantic Region CBO is seeking a dynamic and talented Inpatient Coder for our Appeals department. The primary responsibility of the DRG Coder is to analyze third party coding audits of paid claims, draft detailed appeal letters, evaluate clinical level of care and review denial trends. Key Responsibilities include: Perform DRG (Diagnosis Related Group) validation reviews in response to audits from third party payers. Review audit findings letters from third party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical / coding rationale. Analyze medical records to obtain supporting clinical documentation...

Medical Coding Professional 2The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and deficiencies.The...

City/StateVirginia Beach, VAWork ShiftFirst (Days)Overview:Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!Hours: Monday - Friday, dayshift.This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week or must be able to do site visits. The role also includes travel as needed to support business objectives and team collaboration.OverviewPerforms 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 Condition Categories...

This position may be filled prior to the posted deadline. Koniag Advisory Business Solutions, LLC a Koniag Government Services company, is seeking a Medical Records Technician Coder III to support KABS and our government customer. The position is remote. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. Benefits include medical, dental, and vision insurance, 401(k) retirement plan, paid time off, paid parental leave, life and disability insurance, flexible spending accounts, commuter benefits and tuition reimbursement. Koniag Advisory Business Solutions (KABS) is seeking an experienced Medical Records Technician – Coder III to support the Indian Health Service (IHS) Haskell Indian Health Center. This is a fully remote position responsible for accurate and timely coding of outpatient and ambulatory patient encounters and supporting the facility's efforts to reduce its existing coding backlog and...

POSITION SUMMARY Conducts reviews and provides recommended corrections of billed services as it relates to clinical documentation for the VMG enterprise. Assists in the reviews and responses to payor and governmental audits of billed services. Assists the CBO in replying to payor denials and patient inquiries as it relates to services billed. Reviews and research new coding guidelines and codes. Assists the staff of the VHS corporate compliance. EDUCATION CPC (AAPC) required. Degree in Heath Services Management, Business or another related field preferred. Extensive knowledge of ICD-9-CM/ICD-10 CM and CPT coding principles and guidelines required. Extensive knowledge of reimbursement systems required. EXPERIENCE Eight to ten years’ experience (college degree can be substituted for years of experience) and expertise in ICD-9 CM/ICD-10 CM Coding. SPECIAL SKILLS Medical Terminology, ICD-9 CM/ICD-10 CM and CPT-4 Coding, Ability to relate to people and work closely with physicians and...

Job TitleNewport News, Virginia$23.00 - $29.90/Hourly Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs.This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA.OverviewEnsures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations.What You Will DoOrganizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits for documentation...

Required Skills & Experience Must Haves:\n•\t5+ years of medical coding experience\n•\tCoder III level experience\n•\tPathology coding experience\n•\tExperience processing both PB and HB charges\n•\tEpic experience required\n•\tStrong knowledge of CPT, ICD-10, HCPCS, and pathology coding guidelines\n•\tExperience coding anatomic pathology specimens\n• \tIf their resume states "labs" that is not the same thing. Coding experience would include surgical specimens such as Bone Marrows, hysterectomies, organ resections\nCpc Job Description The Pathology Coder III is responsible for reviewing pathology documentation and assigning accurate ICD-10, CPT, and HCPCS codes for pathology and laboratory services. This individual will support both professional and hospital billing functions by ensuring coding accuracy, compliance, and appropriate charge capture. The ideal candidate has extensive pathology coding experience and a strong understanding of coding regulations, reimbursement...

Pathology Coder IIIRequired Skills & Experience Must Haves:5+ years of medical coding experienceCoder III level experiencePathology coding experienceExperience processing both PB and HB chargesEpic experience requiredStrong knowledge of CPT, ICD-10, HCPCS, and pathology coding guidelinesExperience coding anatomic pathology specimensCoding experience would include surgical specimens such as Bone Marrows, hysterectomies, organ resectionsJob Description:The Pathology Coder III is responsible for reviewing pathology documentation and assigning accurate ICD-10, CPT, and HCPCS codes for pathology and laboratory services. This individual will support both professional and hospital billing functions by ensuring coding accuracy, compliance, and appropriate charge capture. The ideal candidate has extensive pathology coding experience and a strong understanding of coding regulations, reimbursement methodologies, and documentation requirements.Note: UVA Health is seeking an experienced...

Pathology Coder III Required Skills & Experience Must Haves: 5+ years of medical coding experience Coder III level experience Pathology coding experience Experience processing both PB and HB charges Epic experience required Strong knowledge of CPT, ICD-10, HCPCS, and pathology coding guidelines Experience coding anatomic pathology specimens Coding experience would include surgical specimens such as Bone Marrows, hysterectomies, organ resections Job Description: The Pathology Coder III is responsible for reviewing pathology documentation and assigning accurate ICD-10, CPT, and HCPCS codes for pathology and laboratory services. This individual will support both professional and hospital billing functions by ensuring coding accuracy, compliance, and appropriate charge capture. The ideal candidate has extensive pathology coding experience and a strong understanding of coding regulations, reimbursement methodologies, and documentation requirements. Note: UVA Health is...

Inpatient Coder (Remote)Full-time • Work From HomeMust have CCS, RHIA, or RHIT certificationJob SummaryAs a Coding Integrity Specialist III WORK FROM HOME, you will review and evaluate hospital inpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM and ICD-10-PCS codes. A CIS III performs coding and/or code/DRG validation across multiple entities by applying all appropriate coding guidelines and criteria for code selections.Job QualificationsAssign, sequence, validate, and/or edit codes/DRGs and abstracted data (e.g., physician, discharge disposition, query tracking) for inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCSMaintain or exceed established accuracy standardsMaintain or exceed established productivity standardsUtilize the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGsUndergraduate (Associate's or Bachelor's) degree in HIM/HIT...

Universal Health Services is seeking an Inpatient Coder for the Appeals department within the Atlantic Region CBO to analyze third party coding audits, draft appeal letters, and review denial trends. The role requires DRG validation, review of audit findings, and analysis of medical records to justify coding decisions; responsibilities include drafting detailed appeal letters to prevent payment downgrades and supporting the appeals team. #J-18808-Ljbffr

Coding Specialist (Part-Time)At Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.The Coder Reviewer position is responsible for supporting and conducting reviews and determinations for independent dispute resolutions at both the Federal and State levels. Subject matter expert in clinical...

Certified CoderAt Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.The Certified Coder performs coding-focused medical review of Medicare Part A/B and DMEPOS claims for the program. Certified coders apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local...

Chesapeake Regional Medical Group is seeking a Senior Coding Specialist to perform coding tasks across physician practices, including obtaining pathology and operative reports, assigning ICD and CPT codes, and ensuring accurate transmissions within the system. The role requires experience in hospital/medical office settings, CPC certification (or within one year), and strong computer skills. You will participate in audits, education, and go-live support across multiple locations. #J-18808-Ljbffr