32 coder auditor professional jobs found

Blue Cross Blue Shield of Arizona is seeking a Quality Assurance Coder/Auditor to develop risk mitigation and provider education programs. On a regular basis, you will educate primary care providers and their staff on diagnoses, coding accuracy, and risk mitigation based on medical records and documentation. The role requires in-depth knowledge of HCC coding, Medicare guidelines, and the ability to perform QA audits and deliver corrective actions. #J-18808-Ljbffr

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims...

Quality Assurance Coder/Auditor The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at-risk code identification and risk mitigation. This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses. This analysis combined with QA findings and EDPS claims errors will drive the content and audience for provider education. The Quality Assurance Coder/Auditor will perform medical record reviews...

Become a part of our caring community The Medical Coder 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 Medical Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters, and manipulates databases. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Review medical documentation for clinical indicators to ensure correct...

Description At BLS, we pride ourselves on providing high-quality financial services with a focus on supporting our clients’ unique needs. We are currently seeking an experienced Employee Benefit Plan Accountant to join our growing team. This position offers the opportunity to work with a dynamic group of professionals in an engaging and fast-paced environment. Job Responsibilities: Assist in the preparation and review of financial statements of employee benefit plans (including defined contribution (401(k), 403(b), etc.), defined benefit, and health & welfare plans) Assist in the preparation of Form 5500 and related filings Manage the audits of employee benefit plans and coordinate with clients and their service providers Ensure compliance with ERISA regulations and other applicable laws Perform related testing procedures including reconciliation of reports, analysis of certifications and trust reports, sample selection procedures, participant data, contribution,...

Description At BLS, we pride ourselves on providing high-quality financial services with a focus on supporting our clients’ unique needs. We are currently seeking an experienced Employee Benefit Plan Accountant to join our growing team. This position offers the opportunity to work with a dynamic group of professionals in an engaging and fast-paced environment. Job Responsibilities: Assist in the preparation and review of financial statements of employee benefit plans (including defined contribution (401(k), 403(b), etc.), defined benefit, and health & welfare plans) Assist in the preparation of Form 5500 and related filings Manage the audits of employee benefit plans and coordinate with clients and their service providers Ensure compliance with ERISA regulations and other applicable laws Perform related testing procedures including reconciliation of reports, analysis of certifications and trust reports, sample selection procedures, participant data, contribution,...

Join to apply for the Professional Billing Coder II role at Onvida Health 2 days ago Be among the first 25 applicants Join to apply for the Professional Billing Coder II role at Onvida Health Get AI-powered advice on this job and more exclusive features. Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Shift: Days Pay Rate Type: Hourly Location: Remote Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates. Min = $22.62 Mid = $28.28 Max = $33.93 Summary The Professional Billing Coder II is an intermediate-level coding professional responsible for independently reviewing medical documentation and assigning accurate diagnostic and...

Research Compliance Auditor Position Highlights The Human Subjects Protection Program (HSPP) provides administrative and regulatory support to the University of Arizona Institutional Review Board (IRB). Through collaboration with the research community, the HSPP promotes ethical and compliant human research. The HSPP is seeking a Research Compliance Auditor who will primarily conduct routine audits of research protocols for adherence to federal, state and institutional policy. The Research Compliance Auditor will collaborate with the Quality Assurance officer and a varied group of auditors across multiple departments to ensure a broad cross-section of research projects are reviewed. They will identify mitigation strategies through analysis of corrective actions which increase adherence to policy, and are identified by compliance committees in the research division. The Research Compliance Auditor will assist with development of tools and resources to assist investigators regarding...

Job Title Essential Functions: Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty upon translating audit findings Follows up and clarifies any information that is not clear with the rendering provider Collaborates with IT and EHR teams to improve charge automation and optimize workflows Conducts ad-hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies Nonessential Functions: Follows policies and procedures and adheres to the...

Phoenix Children's in Phoenix, AZ is seeking a Coding Auditor and Educator under the supervision of the Manager of Professional Services. The role provides oversight on education and audits of medical records for compliance with federal coding regulations and guidelines (CPT, ICD-10, EM) to align with government and hospital billing requirements. You will audit ambulatory medical records, educate coders and providers to improve accuracy and compliance, maintain policy documents, and collaborate #J-18808-Ljbffr

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...

Position Summary: Analyzes, codes, abstracts, and compiles medical records of patients to document patient condition and treatment largely for billing purposes by performing the following duties personally. Responsible for ensuring that all critical tasks are fulfilled on a timely basis. Critical Tasks: Ensures and requires that all data and information received for coding and input from providers is fully accurate, and notifies submitters if corrections are required. Accurately abstracts and codes diagnoses, treatments and procedures from health records by using appropriate classification systems, standards, and procedures. Utilizes and maintains continually updated knowledge and understanding of Current Procedural Terminology, Healthcare Common Procedure Coding, and International Statistical Classification of Diseases. Prepares fully accurate statistical reports required by legal, accrediting, licensing and regulatory authorities as well as by payers. Assigns...

Under general supervision of the HIM Director, the Certified Inpatient Coder is responsible for reviewing inpatient medical records and accurately assigning ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, and MS-DRGs in accordance with official coding guidelines, federal regulations, and Tribal 638 facility policies. Upholds the principles of WIHCC's Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times. This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive. Essential Duties & Responsibilities: Maintains regular attendance and punctuality. Review inpatient medical records to identify all diagnoses and procedures relevant to each patient encounter. Assign ICD-10-CM and ICD-10-PCS codes according to official coding guidelines. Determine and assign the appropriate MS-DRG. Ensure coding reflects the highest level of specificity...

Job Description Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY The primary purpose of this position is to process third party claims (billing and collection) on-line to pharmacy insurance carriers for the cost of pharmaceuticals furnished to...

ED / Observation Coder (Full Time) Unlock your potential for professional development! We are hiring an ED / Observation Coder to join our Imaging Services Team! Located in northwest Arizona, Kingman has a mild climate with stunning Arizona sunsets! In the shadows of beautiful mountain ranges and nearby lakes, Kingman is an outdoor enthusiasts' paradise with abundant sunshine and is a great community to live, work and play! Position Purpose: All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI's vision to be among the kindest, highest quality health systems in the country. The ED / Observation Coder oversees assigned departments' charging through software systems. Benefits (Full Time Employees): We offer you an excellent total compensation package, including a competitive salary, comprehensive benefits, and growth opportunities: Exceptional Colleagues Join us and you'll be a part of a culture where we support...

PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center. Position Summary The Lead Medical Coder serves as a certified professional coder and assists the Medical Coding Office Manager with oversight of daily coding operations. Performs the full range of coding, assigns ICD, CPT, HCPCS, and medical inpatient codes; abstracts data from the record; performs chart analysis, research coding issues; peer reviews; and serves as a medical documentation and coding technical expert to TONHC providers. Scope of Work This position is located within Tohono O'odham Nation Health Care (TONHC). The work involves performing specialized medical record tasks and resolving problems using established processes, coding conventions, and guidelines. Performance of duties reflects directly on patient care by recording services performed on the patient. The incumbent works...

Location: Tucson Employment Type: Full-Time Schedule: Monday – Friday Position Overview The Medical Biller / Coder & Credentialing Specialist will manage key functions of the revenue cycle including coding accuracy, claims processing, payer credentialing, denial management, and provider enrollment. This role works closely with providers, leadership, and clinical teams to ensure accurate billing, compliance with payer requirements, and efficient reimbursement processes. Key Responsibilities Medical Coding Review provider documentation and assign accurate ICD-10, CPT, and HCPCS codes. Ensure coding complies with payer regulations and industry guidelines. Identify documentation gaps and communicate with providers when clarification is required. Support coding compliance and documentation improvement. Claims & Billing Prepare and submit electronic claims through the practice management system. Monitor claim status and follow up on unpaid or denied claims....

DEPT OF VETERANS SERVICES For Veterans and those who care for them. Medical Records Supervisor Job Location: Arizona State Veterans' Home – Phoenix 4141 North Silvestre Herrera Way Phoenix, Arizona 85012 Posting Details: Salary: $22.00 - $24.20 (DOE) Grade: 19 Closing Date: August 7, 2026 Job Summary: Would you like to be part of an amazing team that helps veterans thrive? At the Arizona Department of Veterans' Services (ADVS), we are committed to serving and honoring veterans, service members, and their families by ensuring that they receive the highest quality services so that they can thrive for a lifetime! Your rewards: Incomparable Benefits: Our program provides the opportunity to receive a pension and healthcare benefits for a lifetime! Meaningful Work: Your dedication will directly enhance the lives of veterans and their family members, providing them with the care and respect that they deserve. Professional Growth: You will have the opportunity to engage in...

Audits charts and revies clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medica specialty upon translating audit findings Follows up and clarifies any information that i s not clear with the rendering provider Collaborates with IT and EHR teams to improve charge automation and optimize workflows Conducts ad-hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies Nonessential Functions Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program Ensures...

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...

Surgery HIM Coder We are seeking a highly detail-oriented and experienced Surgery HIM Coder to join our Health Information Management team. This position is responsible for reviewing, analyzing, and accurately assigning ICD-10-CM, CPT, and HCPCS codes for surgical procedures based on clinical documentation in the patient medical record. The Surgery Coder ensures coding compliance with federal regulations and internal policies to optimize reimbursement and ensure data integrity. This is a remote position with a 4 day on-site work rotation, every 6-7 weeks. Essential Job Duties Review operative reports, physician documentation, and other clinical records to assign accurate and complete ICD-10-CM, CPT, and HCPCS codes. Abstract relevant information from medical records into the health information system. Ensure compliance with all coding guidelines (AAPC, AHIMA, CMS, and payer-specific). Query physicians when documentation is unclear, conflicting, or incomplete....

Specialist - Concurrent Coding / Inpatient Coder Full-time Company Description Accounting and Finance/Healthcare Job Description Specialist-Concurrent Coding/Inpatient Scottsdale Arizona 85258 Exp 2-5 Degree Associates Job Summary: The Concurrent Coding Specialist performs and facilitates concurrent inpatient coding in order to establish a working DRG. Ensures high quality documentation that is thorough, accurate and complete to ensure accurate reimbursement capture. He or she will concurrently reviews health records, identifies key clinical data elements within the record, and translate this data from verbal description of disease, injuries and procedures into numerical designations, applying ICD coding systems. Audits for documentation opportunities and queries clinical staff with CDI to fill in any gaps, clarify confusing, incomplete or conflicting information and obtain any needed additional documentation in real time. Ensures coding compliance and acts as...

Specialist - Concurrent Coding / Inpatient CoderAccounting and Finance/HealthcareJob DescriptionSpecialist-Concurrent Coding/Inpatient Scottsdale Arizona 85258Exp 2-5Degree AssociatesJob Summary:The Concurrent Coding Specialist performs and facilitates concurrent inpatient coding in order to establish a working DRG. Ensures high quality documentation that is thorough, accurate and complete to ensure accurate reimbursement capture. He or she will concurrently reviews health records, identifies key clinical data elements within the record, and translate this data from verbal description of disease, injuries and procedures into numerical designations, applying ICD coding systems. Audits for documentation opportunities and queries clinical staff with CDI to fill in any gaps, clarify confusing, incomplete or conflicting information and obtain any needed additional documentation in real time. Ensures coding compliance and acts as technical resource, resolves issues, educates and works...

About Optima Medical :Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130medical providers, who care for more than 200,000 patients statewide.Our mission is to improve the quality of life throughout Arizona by helping communities Live Better, Live Longer through personalized healthcare, with a focus on preventing the nation's top leading causes of death.We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services.We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard.This position requires an initial 60-day training period at our corporate office in Scottsdale, Arizona.Upon successful completion of training, the position will transition to a fully remote role.Job Responsibilities :Audit Medical Records...