75 coder auditor jobs found

Nexmc is seeking a Coder/Specialty Medical Bill Reviewer to work remotely from Schertz, Texas. In this role, you will be responsible for auditing medical bills for compliance with state fee schedules and guidelines while ensuring high accuracy in billing processes. Applicants must have a High School Diploma and AAPC Coding Certification, along with at least two years of experience in medical bill review. The position requires strong analytical skills and knowledge of medical terminology. #J-18808-Ljbffr

Medical Coding Specialist Dallas, TX 8hr shift M-F Looking for someone with outpatient or inpatient hospital coding compliance or coding auditing experience. CPC or CCS certification. Assign, sequence, validate, and edit codes for multi-specialty professional outpatient/inpatient encounters for both adults and pediatrics. Assign appropriate E/M, ICD-10-CM and/or CPT codes based on documentation and/or payer requirements. HEDIS measures CAT II code reporting for HTN, diabetes, obesity, and cervical cancer. Review NCCI and nosology edits for accurate code capture. Review LCD's and/or payor policies to appropriately resolve coding edits. Evaluate medical record for provider signature and validate provider facility credentials. Resolve and/or clarify clinical data as necessary. Review and run data reports to monitor individual productivity. Utilize current coding guidelines, Coding Clinic, CPT Assist for coding accuracy guidance.

Central Health in Austin, Texas, is seeking a Compliance Auditor responsible for conducting billing and coding audits, as well as providing training to staff. The role requires expertise in CPT, HCPCS, and ICD-10 coding principles. Qualified candidates should have at least 5 years of experience in a medical environment, with certifications as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Strong attention to detail and excellent communication skills are essential. #J-18808-Ljbffr

US Heart & Vascular is seeking a Remote Coding Compliance Auditor to perform internal medical record audits and prepare compliance reports. The role involves evaluating coding accuracy and maintaining documentation of all audits to support compliance regulations. The ideal candidate should have at least 5 years of medical coding experience and necessary certifications, along with strong communication and analytical skills. This position is critical in ensuring adherence to coding and documentation standards. #J-18808-Ljbffr

Overview Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many...

Data Quality Auditor Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Job Responsibilities/Duties: Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). IP, OP Coding: Reviews medical records for the determination of accurate assignment of all documented ICD-10-CM codes for diagnoses and procedures. Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition....

Job Description Job Description Job Summary: Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.   Job Responsibilities/Duties: · Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or...

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Position is responsible for leading multiple reviews / audits of healthcare coding, billing, documentation, operations, and related risk areas to support compliance with regulatory standards, internal policies and procedures, and other guidelines. Typically reports to Director, Corporate Compliance. Job Description Location : Memorial Hermann, Memorial City Status :...

Compliance Auditor, Billing and Coding Compliance The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and...

Job Description We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Think you've got what it takes? Job Duties & Responsibilities • Assess the treatment plan, clinical information, and medical necessity of all requested services • Utilizes established criteria to appropriately review billed services within established timeframe required. • Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. •...

Medical Compliance Auditor We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Job Duties & Responsibilities Assess the treatment plan, clinical information, and medical necessity of all requested services Utilizes established criteria to appropriately review billed services within established timeframe required. Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. Refers case failing medical...

Medical Coding Supervisor Provides day‑to‑day supervision and support to the coding team responsible for outpatient, in‑patient, and clinic‑based services across Texas Tech Physician clinics. This role ensures coding accuracy, compliance with regulatory requirements, and timely encounter completion to support revenue cycle integrity and organizational goals. The supervisor serves as a working leader who performs coding and/or auditing functions while supervising team members, monitoring productivity and their quality performance. This position works collaboratively with the Coding Manager, Compliance, and Revenue Cycle teams to implement policies, resolve coding‑related issues, and promote consistent application of coding standards across multiple specialties and oversees a staff. Major / Essential Functions Supervise daily operations and employees on your team of the centralized ambulatory coding team, ensuring timely and accurate coding of outpatient encounters. Monitor staff...

Position Description Provides day-to-day supervision and support to the coding team responsible for outpatient, in-patient, and clinic-based services across Texas Tech Physician clinics. This role ensures coding accuracy, compliance with regulatory requirements, and timely encounter completion to support revenue cycle integrity and organizational goals. The supervisor serves as a working leader who performs coding and/or auditing functions while supervising team members, monitoring productivity and their quality performance. This position works collaboratively with the Coding Manager, Compliance, and Revenue Cycle teams to implement policies, resolve coding-related issues, and promote consistent application of coding standards across multiple specialties and oversees a staff. Major/Essential Functions Supervise daily operations and employees on your team of the centralized ambulatory coding team, ensuring timely and accurate coding of outpatient encounters. Monitor...

Job Summary (Par time-Potential for Fulltime) The Certified ER Medical Coding Auditor is responsible for auditing emergency department medical records to ensure accurate coding, compliance, and optimal reimbursement. This role also includes training and mentoring offshore coding teams to maintain high-quality standards and consistency across operations.  Key Responsibilities Audit ER charts for accurate assignment of  ICD-10-CM, CPT, and HCPCS codes Validate  E/M level selection  for emergency department visits Ensure compliance with payer guidelines and regulatory standards (CMS, HIPAA) Identify  under coding, over coding, and documentation deficiencies  Prepare detailed audit reports with corrective recommendations Provide education and feedback to coders and providers Train and mentor offshore coding teams  on ER coding guidelines and audit findings Conduct regular  quality review sessions and calibration meetings  with offshore staff Develop and update...

Job Summary: Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Job Responsibilities/Duties: • Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to...

We are hiring a part-time Medical Coder to assign procedure and diagnosis codes for insurance billing, review claims data, research and correspond with insurance companies in an effort to obtain accurate reimbursement for healthcare claims. Responsibilities Utilize specialized medical classification software to assign procedure and diagnosis codes for insurance billing. Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission. Conduct medical records research and correspond with insurance companies and healthcare professionals to resolve issues resulting from denied claims. Adhere to coding policies and procedures consistent with the industry standard guidelines for CPT, ICD-9 and ICD-10. Answer coding questions. Review clinical documentation to ensure it meets level of CPT codes and ICD-10 codes. Perform related duties, as requested. Uphold the Organization's...

Overview Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Benefits for Full and Part-time Employees We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay 100% of the DENTAL monthly premiums for Employee Only coverage. We provide an...

Job Opportunity At Memorial Hermann At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Description Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Minimum Qualifications Education: High school...

HIM/Medical Records Coding Specialist Opportunity West Oaks Hospital has provided psychiatric care to the Houston area and surrounding communities for over four decades. Our 176-bed acute care facility is fully accredited and includes a 16-bed residential treatment center for adult chemical dependency. We offer a broad range of behavioral health programs for children, adolescents, and adults. Treatment is offered at multiple levels of care including inpatient, partial hospitalization, and intensive outpatient. We are available 24 hours a day, seven days a week to assist you and answer your questions about treatment options and insurance coverage. The hospital is easily accessible off the Southwest Freeway near the Galleria. West Oaks Hospital is seeking a dynamic and talented HIM/Medical Records Coding Specialist to join our team of compassionate, dedicated professionals. The HIM/Medical Records Coding Specialist will be responsible for assigning diagnostic and procedures codes...

Clinical Coding Specialist At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Minimum Qualifications Education: High school diploma or GED, required...

Become a part of our caring community The Evaluation & Management Auditor (Medical Coding Auditor) is responsible for the accurate and compliant review of Evaluation and Management services, including complex professional inpatient encounters, minor procedures, emergency room services, consultation services, and annual wellness visits. The ideal candidate will have a strong background in professional fee coding and auditing, expertise in industry‑standard encoders, and familiarity with multiple coding resources. This role ensures correct documentation, coding, and billing in accordance with regulatory guidelines, payer policies, and Humana’s internal standards. WORK STYLE Remote / Work at home WORK HOURS Associates will work on EST, regardless of where the associate resides. All associates must start between 6 AM‑9 AM EST, Monday‑Friday as a dedicated schedule. Work hours can vary occasionally and/or depending on business needs. Responsibilities Conduct comprehensive...

Inpatient Coder (Remote) Full-time Work From Home Must have CCS, RHIA, or RHIT certification Job Summary As 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 Qualifications Assign, 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-PCS Maintain or exceed established accuracy standards Maintain or exceed established productivity standards Utilize the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGs Undergraduate (Associate's or Bachelor's)...

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for 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...

Do you speak fluent CPT with a side of sass? Can you handle prickly provider chats with poise, streamline processes, and make overpayment trends tremble? Then you, my friend, are exactly who we need.Here's the vibe :We're not your average coding operations.We're the ones in the trenches, turning chaos into clarity, and making results art form.You'll be the spark behind smarter recoveries, cleaner audits, better support, and conversations that get results.What you'll need :Resilience and clarity when the provider gets spicyIntuition for what's missing-or what shouldn't be therePattern-spotting skills that'd make a data scientist jealousConfidence that comes with knowing your business operations, consistent follow through and execution of prioritiesCoding audit know-how to review findings with convictionWhat you can expect :Room to shine and show your strategic flairShare your insights with the team to move us forwardChallenges that keep you sharp and impact that feels...