33 coder auditor jobs found

Description **Medical Mutual employees must submit their applications through MySource. Note: While this role is currently remote, we are prioritizing candidates within commuting distance of our Rossford, Dublin, or Brooklyn offices to accommodate a potential future shift to a hybrid schedule. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Job Summary: Supervises staff, operations, and activities of the Risk Adjustment Retrieval and Coding Quality Department. Acts as a primary liaison between provider groups, medical coding, and chart retrieval teams to communicate appropriate documentation for Risk Adjustment coding....

Description **Medical Mutual employees must submit their applications through MySource. Note: While this role is currently remote, we are prioritizing candidates within commuting distance of our Rossford, Dublin, or Brooklyn offices to accommodate a potential future shift to a hybrid schedule. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Job Summary: Supervises staff, operations, and activities of the Risk Adjustment Retrieval and Coding Quality Department. Acts as a primary liaison between provider groups, medical coding, and chart retrieval teams to communicate appropriate documentation for Risk Adjustment coding....

Description **Medical Mutual employees must submit their applications through MySource. Note: While this role is currently remote, we are prioritizing candidates within commuting distance of our Rossford, Dublin, or Brooklyn offices to accommodate a potential future shift to a hybrid schedule. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Job Summary: Supervises staff, operations, and activities of the Risk Adjustment Retrieval and Coding Quality Department. Acts as a primary liaison between provider groups, medical coding, and chart retrieval teams to communicate appropriate documentation for Risk Adjustment coding....

Medical Coding and Billing Compliance Auditor The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy and documentation integrity and ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in Physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have an extensive background and knowledge of CPT coding, ICD10CM coding, E&M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access Medicare Physician Fee Schedule...

Description **Medical Mutual employees must submit their applications through MySource. Note: While this role is currently remote, we are prioritizing candidates within commuting distance of our Rossford, Dublin, or Brooklyn offices to accommodate a potential future shift to a hybrid schedule. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Job Summary: Supervises staff, operations, and activities of the Risk Adjustment Retrieval and Coding Quality Department. Acts as a primary liaison between provider groups, medical coding, and chart retrieval teams to communicate appropriate documentation for Risk Adjustment coding....

Medical Coding and Billing Compliance Auditor, Remote page is loaded## Medical Coding and Billing Compliance Auditor, Remotelocations: Personalized Health Partnerstime type: Full timeposted on: Posted Yesterdayjob requisition id: R-0000114860**Job Address:**10123 Alliance Road, Suite 320Blue Ash, OH 45242# **Medical Coding and Billing Compliance Auditor****Location:** Remote **Department:** Coding Compliance **Reports To:** Director of Coding **Employment Type:** Full-time Exempt# **About the Role**The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy and documentation integrity and ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office...

Medical Coding and Billing Compliance Auditor Location: Remote Division: Coding Compliance About the Role: The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have extensive knowledge of CPT coding, ICD-10-CM coding, E/M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access...

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual, family, and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5‑Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Position Summary Performs chart retrieval, medical record review, HCC identification and data quality oversight for risk mitigation and revenue recovery for both Medicare and ACA services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for coding questions/issues. Determines...

A leading healthcare data platform is seeking an experienced inpatient coder to join their remote team. The ideal candidate should have at least 3 years of inpatient coding experience, knowledge of medical terminology, and relevant certifications. This role involves coding patient records accurately and collaborating with the team to enhance documentation processes. Competitive pay ranges from $32 to $42 per hour. #J-18808-Ljbffr

HIM Coder-Level I Job Category: Business Office Requisition Number: HIMCO003051 Posted: March 27, 2026 Full-Time Remote Portsmouth, OH 45662, USA Job Details Description Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process. Department: Health Information Management Shift/schedule: Full Time (40 hrs/wk), Remote General Summary: Works under the supervision of the Health Information Reimbursement Manager. The primary job function of the HIM Coder Level I are to assign correct, ICD-10 and CPT codes to established diagnoses and procedures to outpatient (emergency room, same-day surgery, interventional radiology, observation and/or Urgent Care Center) and/or limited inpatient records. In some instances, may audit OP and /or IP records for charging accuracy. May be asked to add or delete charges for optimal reimbursement as well as compliance following coding and governmental guidelines. The level one coder...

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process." Department: Health Information Management Shift/schedule: Full Time (40 hrs/wk), Remote GENERAL SUMMARY Works under the supervision of the Health Information Reimbursement Manager. The primary job function of the HIM Coder Level I are to assign correct, ICD-10 and CPT codes to established diagnoses and procedures to outpatient (emergency room, same-day surgery, interventional radiology, observation and/or Urgent Care Center) and/or limited inpatient records. In some instances, may audit OP and /or IP records for charging accuracy. May be asked to add or delete charges for optimal reimbursement as well as compliance following coding and governmental guidelines. The level one coder has mastered a maximum of 2 work types. Performs other duties as assigned. QUALIFICATIONS Education: High School Diploma or successful completion of an...

PURPOSE OF THIS POSITION This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES Duty 1: Maintains a thorough understanding and education of federal and state regulations and payer...

Medical Claims Specialist This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. Job Duties/Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As a Professional Fee Coder III, you will be responsible for monitoring, reviewing, and accurately applying coding principles to clinical documentation received from ambulatory areas to support reimbursement, research, and regulatory compliance. In this role, you will assign appropriate diagnosis codes, CPT codes, and modifiers based on the medical record while ensuring adherence to federal coding guidelines. You will also identify and resolve billing discrepancies to ensure timely and accurate claim submission. This position supports Cleveland Clinic's mission and vision by helping submit clean claims for the services...

Essential Duties and Responsibilities: - Abstract and code clinical data. - Audit medical records to ensure compliance with the organization's coding procedures and standards. - Accurately enter coded data in a system and validate data entered. - Research correct coding practices, clearly document and share findings with others. - Review denials and recommend billing corrections. - Train staff members on the coding process. Minimum Requirements - High School diploma or equivalent with 0 - 2 years of experience. - Additional clinical licensure may be required based on project. - Must be a Certified Medical Coder, Certified Professional Coder, or a Certified Coding Specialist. - Knowledge of Medical Billing and Coding Systems such as CPT and HCPCS is essential. - Ability to work a schedule between the hours of 8:00am - 5:00pm EST Monday - Friday required. Additional Skills and Experience: - Familiarity with retrospective payment reimbursement highly preferred....

Anderson Hills Pediatrics' Expectations of all Employees: Adhere to all Anderson Hills Pediatrics' Policies and Procedures Conduct self in a manner that represents Anderson Hills Pediatrics' core values at all times Maintain a positive and respectful attitude with all work-related contacts Consistently reports to work prepared to perform the duties of the position Meets productivity standards and performs duties as workload necessitates Primary Function : Assists the Billing Manager with the claims submission and revenue cycle of the practice. Major Duties and Responsibilities : • Adherence to current HIPAA regulations and federal/state laws for patient protected health information (PHI) and/or medical records; adherence to all AHP policies/procedures as they pertain to patient PHI and the medical record; maintain strict confidentiality of all patient information • Update patient demographic information including insurance coverage; make changes/corrections as...

Job Description At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering. As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors. UC Health is committed to providing an inclusive, equitable and diverse place of employment. Using established policies and procedures; the Non-certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Non-certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series,...

Non-certified Coder At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering. As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors. UC Health is committed to providing an inclusive, equitable and diverse place of employment. Using established policies and procedures; the Non-certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Non-certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series,...

The Outpatient Surgery/IVR Medical Coder is responsible for assigning ICD-10-CM and/or CPT/HCPCS codes as appropriate and abstracts pertinent information from patient records. Essential Duties and Responsibilities: Assigns ICD-10-CM and/or CPT/HCPCS codes, as appropriate and abstracts pertinent information from OPS/OBS patient records Ensures optimal reimbursement of all cases in compliance with CMS policies and procedures and official coding guidelines Implements medical center’s physician query process when code assignments are not straightforward or documentation in the medical record is inadequate, ambiguous or unclear for coding purposes Keeps abreast of coding guidelines and reimbursement reporting requirements Brings identified concerns to the Professional Recruiter who will direct as needed Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association Adheres to Official Coding guidelines, CMS policies and regulations...

Job Description At UC Health, we’re proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering. As the region’s adult academic health system, we strive for innovation and provide world‑class care for not only our community, but patients from all over the world. Join our team and you’ll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors. UC Health is committed to providing an inclusive, equitable and diverse place of employment. Using established policies and procedures, the Non‑certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Non‑certified Coder may code all types of inpatient, observation and outpatient cases (including clinics, ancillary services, ambulatory surgery, series, and...

Job Description: Title: Medical Billing Specialist Job Code: 64305OH Division: Senior Living Corporate Status: Non-Exempt Reports to: Lead Medical Billing Specialist Revision date: April 2019 Supervises: n/a PURPOSE According to prescribed policies and procedures of the organization including all applicable state, federal and accreditation regulations and under the general supervision of the Lead Medical Billing Specialist assumes responsibility for performing all general accounting, billings, and bookkeeping functions for the Senior Living Division's Facilities. ESSENTIAL FUNCTIONS Manage accounts receivable for medical billing for the Senior Living Division including, but not limited to: Part A and B Medicare, Medicaid, Home Health, Hospice, Part B, Outpatient, Managed Care, Insurance, and Co-Insurance Billing. Communicates with different insurance carriers for timely payment of our services. Prepares and files insurance claims. Performs...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in 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 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...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Senior auditor responsible for clinical or physician compliance topics. Assigned the most complex clinical/documentation/coding/billing reviews. Provides guidance to other auditors within AHN on audit approach and analysis. Responsible for creating and overseeing orientation of auditors. Leads all hospital or physician audits/investigations, auditing support and responses related to external audit activity. ESSENTIAL RESPONSIBILITIES: Establishes and implements orientation for all members of the AHN audit compliance team. Evaluates the progress of team members including review of reports and audit activities. Works with senior management responsible for AHN-wide case management/physician programs to develop processes that meet Medicare and 3rd party payor requirements. Provides guidance to staff auditors on audit topics and reports. (20%) Conducts educational sessions for...