79 coder auditor professional jobs found

Job Description Job Description Hybrid-Sunrise, Florida Position Summary: The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities: Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud...

Physician Coding Auditor The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective...

Summary Position is located in the Health Information Management (HIM) section at the Business Office at the Bay Pines VA Healthcare System (BPVAHCS). MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi­specialty clinics, and specialty centers. Responsibilities Duties and task of the Medical Records Technician (Coder) - Auditor include, but are not limited to the following: Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection. Reviews assigned codes from the current version of several coding systems to include current versions of the International Classification of Diseases (ICD), Current Procedural Terminology...

Overview Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families...

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. 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 procedures meet clinical criteria and correct coding guidelines Utilize encoders and various coding resources Perform CPT Procedure reviews Maintain strict patient and...

About the Job Position Highlights: Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors. The Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or hospital documentation, coding and billing, and federal and state regulations and guidelines. The Compliance Auditor communicates audit results to physicians, physician leadership, senior management, management, and staff and provides physician and coder education. The Compliance Auditor will act as a liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs and will serve as an...

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements. Responsibilities: Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify...

Position Highlights: Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors. The Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or hospital documentation, coding and billing, and federal and state regulations and guidelines. The Compliance Auditor communicates audit results to physicians, physician leadership, senior management, management, and staff and provides physician and coder education. The Compliance Auditor will act as a liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs and will serve as an institutional subject matter...

Job Description This entry-level position is responsible for auditing outpatient and ambulatory services claims to federally funded healthcare payors across the Baptist Physician Enterprise (BPE) organization. The position audits and provides feedback as needed and attends BPE department meetings as needed to respond to compliance related coding and billing questions and provide feedback on audit findings and necessary remediation/corrective action requirements. The position analyzes coded records for compliance with federal, state and third-party insurer rules and regulations and note trends. The position educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements; and maximize reimbursement. This role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the...

Position Summary Department : Patient Accounting- Physicians Status: Full Time Shift: Remote Location: Orlando, FL Title: Physician Coding Auditor Summary: The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding. Forbes has named Orlando Health as one of America's Best-In-State Employers. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not...

Job Summary Are you dedicated to advancing compliance in healthcare? Join our dynamic team as a Lead Compliance Auditor. Your expertise will be vital in protecting our health plans from regulatory and contractual discrepancies. Your role will significantly contribute to the detection and management of compliance risks, ensuring the integrity and safety of Molina Healthcare. Essential Job Duties Lead and conduct thorough pre-delegation and annual audits to guarantee adherence to all regulatory and accreditation standards. Examine delegate policies, procedures, and case files meticulously, ensuring high-quality service delivery. Work closely with delegate leadership to evaluate risks and create effective solutions together. Leverage your analytical skills to identify systemic issues and collaborate with other departments to mitigate risks. Analyze audit outcomes, determine root causes, and develop comprehensive corrective action plans (CAPs). Prepare and manage...

Department Patient Accounting- Physicians Status Full Time Shift Remote Location Orlando, FL Title Physician Coding Auditor Summary The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding. "Orlando Health Is Your Best Place to Work" is not just something we say, it’s our promise to you. Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective populations in our community. So, no matter who you are, what you believe or how you express yourself, you are welcome here. ORLANDO HEALTH...

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 10,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work for in the Nation, a Digital Health Most Wired Organization and continually named one of the Tampa Bay Time's Top Workplaces. A National Cancer Institute (NCI)-designated Comprehensive Cancer Center since 2001. Summary Position Highlights: Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors. The Compliance Auditor evaluates the adequacy and...

About the job Medical Record Audit / Coding Auditor OUR CLIENT is a contracting and data management services organization dedicated to primary care physicians throughout Florida IN THIS ROLE YOU are responsible to assist in the development, undertaking and maintenance of a long term comprehensive, clinical coding audit program for inpatient and outpatient activity. To develop and Implement policies to support the clinical coding audit function Receive, review and communicate findings on patient billing coding related complaints. Identify training needs through the audit program of work and liaise with the clinical coding training manager and audit manager to provide the necessary training identified Conduct routine, risk based, proactive or reactive compliance reviews of procedural and diagnosis coding/billing and medical record documentation performed by clinical service providers Prepare reports as required relative to these monitoring and review...

Overview Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families...

A healthcare organization is seeking a Physician Coding Auditor to perform coding audits, ensuring compliance and efficiency. The role involves analyzing physician and coder charges, monitoring audit results, and collaborating with education teams. Candidates must have a high school diploma, coding certification, and at least 5 years of professional coding experience. Strong communication and organizational skills are essential. The position is remote, allowing flexibility in work location. #J-18808-Ljbffr

Overview Department : Patient Accounting- Physicians Status : Full Time Shift : Remote Location : Orlando, FL Title : Physician Coding Auditor Summary : The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the governing compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for surgical, procedural and E/M based coding. Responsibilities Responsible for internal auditing and analyzing professional coding for all service lines. Monitor the audit results closely to identify any potential coding inaccuracy. Provide the Educators the needed support in identifying coding errors. Provide results or trends with Education Team for physician education. Review medical records to ensure coding accuracy. Identify and communicate physician documentation and coding opportunities for improvement. Provide feedback to...

Job Title: Medical Clinic Biller/Coder Location: Northwest Florida Community Hospital - Chipley, FL Position Type: Full-Time Position Summary: Northwest Florida Community Hospital is seeking a detail-oriented and experienced Medical Clinic Biller/Coder to join our team. This position is responsible for accurate coding, billing, and claims processing for clinic services to ensure timely reimbursement and compliance with federal regulations and payer requirements. The ideal candidate will have strong knowledge of medical terminology, coding systems, and insurance billing procedures. Responsible for all activities in the Clinic accounts receivable function. Manages billing and collection activities such as sending follow-up inquiries, negotiating with past due accounts, and referring accounts to collection agencies. Codes and sequences all diagnoses and procedures using established ICD-10-CM coding rules for each patient encounter; coding will be subject to accuracy and...

Overview FTE: .20 Shift Hours: VARIABLE Work Location: Remote - Authorized remote work states - FL, GA, MO, PA, NC, SC, TN and TX Position Summary: Under general supervision, the Coder reviews, analyzes, and assigns final diagnoses and procedures based on provider documentation, adhering to all compliance policies and guidelines. The Coder accurately codes office and hospital procedures to ensure proper reimbursement. This position also provides physician education to ensure proper completion of Electronic Health Records and accurate assignment of ICD-10, CDM, HCPCS, and CPT codes , delivered verbally, physically, and in written form. Responsibilities Review clinical documentation and code to the highest level of specificity for accurate charge capture. Interact with providers to provide feedback and education using verbal, written, and in-person communication. Assign and sequence appropriate codes and modifiers using current procedure, diagnosis, and HCPCS coding for...

Job Posting Overview FTE: PRN - 8 hours per week Experience in surgical coding is strongly preferred. This position offers flexibility with remote work and is authorized within approved states only (FL, GA, MO, PA, SC, NC, TN, or TX). Reviews and analyzes medical records to assign accurate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation, resolve coding discrepancies, and ensure the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards, including ICD, CPT, and HCPCS, and supports the billing process by providing precise coding for claims submission. Participates in auditing activities, supports staff training on coding procedures, and monitors productivity and quality metrics to drive continuous improvement. Key Responsibilities Reviews and analyzes medical records to assign accurate diagnostic...

Job Description Job Description Description: Position Overview The Professional Billing Coder – Cardiothoracic / Special Surgical is responsible for accurate and compliant coding of physician professional services for complex surgical procedures. This role supports timely claim submission, regulatory compliance, and revenue integrity within a hospital-based professional billing environment. Requirements: Key Responsibilities • Assign accurate CPT, HCPCS, and ICD-10-CM codes for cardiothoracic and other special surgical services • Review operative reports, clinic notes, and supporting documentation to ensure complete and compliant coding • Apply appropriate modifiers, bundling rules, and NCCI edits • Ensure compliance with CMS, AMA, and payer-specific billing guidelines • Identify documentation gaps and communicate clarification needs as appropriate • Meet established productivity and quality standards • Participate in internal quality reviews and audits as required...

Job Description Job Description Description: Position Overview The Professional Billing Coder – Vascular Surgery is responsible for accurate coding of professional services related to vascular procedures. This role supports compliant billing practices and contributes to revenue integrity and audit readiness. Requirements: Key Responsibilities • Assign accurate CPT, HCPCS, and ICD-10-CM codes for vascular surgery procedures • Review operative and procedural documentation for coding accuracy and completeness • Apply appropriate modifiers and NCCI edits • Ensure adherence to CMS, AMA, and payer guidelines • Maintain accuracy and productivity standards in a high-volume environment • Support internal audits and quality improvement initiatives Required Qualifications • Minimum 2+ years of professional billing coding experience • Proven experience with vascular surgery coding • Strong knowledge of CPT, ICD-10-CM, modifiers, and NCCI edits • CPC or equivalent certification...

Overview Position Summary: This role is responsible for reviewing, analyzing, and assigning final diagnoses and procedures as documented by the practicing provider, following all compliance policies and guidelines. The position ensures accurate coding of office and hospital procedures to guarantee proper reimbursement. Responsibilities Review clinical documentation and code to the highest level of specificity for accurate charge capture. Interact with providers to provide feedback and education using verbal, written, and hands-on communication methods. Assign and sequence appropriate codes and modifiers using current procedure, diagnosis, and HCPCS codes for billed services. Accurately follow coding guidelines and legal requirements to ensure compliance with Federal and State regulations. Communicate with physicians, business group personnel, clinical staff, and other relevant parties regarding coding-related questions. Manage coding-related edit work queues efficiently....