105 coder auditor professional jobs found

Description The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Summary Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD-10-CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. Monitors professional fee vendor‑coding services to...

Medical Coder Educator - USFTGP Revenue Cycle Operations Serves as the coding reviewer and documentation educator for USFTGP Revenue Cycle Operations. Collaborate extensively with compliance; utilizing approved coding industry tools and approved internal documentation. This position is responsible for providing coding literacy and awareness using adult methodologies to revenue cycle, coding professionals, department managers, medical staff and others, ensuring proficiency is accurate and within compliant coding practices for billing. Analyze and report review findings indicating documentation gaps reimbursement and data internation, inpatient, outpatient and professional service coded. Report to compliance focused areas of improvements, recommendations and actions taken to improve medical staff knowledge and coding accuracy. Conduct individual and group coding and documentation support instructions as assigned and acts as an internal coding expert resource. Qualifications...

Coding Specialist Location: Miramar, Florida 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 Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data. Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing). May assign and sequence basic CPT...

Job Description Job Description Location: Miami, FL (On-site preferred; Hybrid/Remote may be considered) Employment Type: Part-Time (25–35 hours per week) About the Position We are seeking an experienced Senior Medical Coding Auditor (CPC) to join our growing multi-specialty medical practice specializing in Primary Care and Gynecology . The ideal candidate will be responsible for reviewing clinical documentation before claims are submitted to ensure accurate coding, appropriate E/M level selection, documentation compliance, and optimal reimbursement while maintaining full regulatory compliance. This position works closely with providers, clinical staff, and the billing department to improve documentation quality, reduce claim denials, maximize appropriate reimbursement, and ensure coding accuracy. Primary Responsibilities Review approximately 300 provider notes per week for coding accuracy and documentation compliance prior to claim submission. Validate...

Medical Coding SpecialistAt 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.Location:Miramar, FloridaSummary:Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.Responsibilities:Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category),...

Coding Auditor The Coding Auditor reviews/audits patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment, as applicable, according to established guidelines. This position issues the coding "report card" quarterly to all coders. This position provides coding training and education. This position may audit accounts for ER Charging accuracy and perform RAC and other third party audit appeals. Responsibilities Reviews patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment according to established guidelines and scores appropriately, if applicable. Works with CDIS on DRG assignment and educates on missed Query opportunities. Works with staff on coding guidelines and correct code assignment Informs manager of any activities which do not meet federal or state coding and billing requirements Appeals RAC DRG review charts. Receives requests from business office on issues relating to coding and responds...

Ascension is seeking a qualified HIM Coder Auditor to join the HIM Coding Documentation team. This full-time, remote role conducts audits of professional-fee coding records across ambulatory specialties, focusing on CPT, HCPCS, ICD-10-CM, modifiers, and E/M services. You will analyze findings, prepare clear reports for practice managers and leadership, and design educational programs to address documentation gaps and evolving standards. #J-18808-Ljbffr

Job Description - Sr Compliance Auditor (301657) Job Description Sr Compliance Auditor - 301657 Description Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider‑coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties Conduct audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise...

A healthcare services organization is seeking a Medical Record Audit / Coding Auditor to oversee the development of a clinical coding audit program. The role involves conducting compliance reviews, training coding associates, and ensuring adherence to coding regulations. Candidates must have at least five years of experience in physician coding and be a certified professional coder. This job offers an opportunity to impact billing accuracy and training processes within the organization. #J-18808-Ljbffr

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Patient Safety DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in...

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...

Location: Miami, FL (On-site preferred; Hybrid/Remote may be considered) Employment Type: Part-Time (25–35 hours per week) About the Position We are seeking an experienced Senior Medical Coding Auditor (CPC) to join our growing multi-specialty medical practice specializing in Primary Care and Gynecology. The ideal candidate will be responsible for reviewing clinical documentation before claims are submitted to ensure accurate coding, appropriate E/M level selection, documentation compliance, and optimal reimbursement while maintaining full regulatory compliance. This position works closely with providers, clinical staff, and the billing department to improve documentation quality, reduce claim denials, maximize appropriate reimbursement, and ensure coding accuracy. Primary Responsibilities Review approximately 300 provider notes per week for coding accuracy and documentation compliance prior to claim submission. Validate appropriate Evaluation & Management (E/M)...

Job Description The Coding Auditor reviews/audits patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment, as applicable, according to established guidelines. This position issues the coding "report card" quarterly to all coders. This position provides coding training and education. This position may audit accounts for ER Charging accuracy and perform RAC and other third party audit appeals. Responsibilities Reviews patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment according to established guidelines and scores appropriately, if applicable. Works with CDIS on DRG assignment and educates on missed Query opportunities. Works with staff on coding guidelines and correct code assignment Informs manager of any activities which do not meet federal or state coding and billing requirements Appeals RAC DRG review charts. Receives requests from business office on issues relating to coding and...

Job Description Job Description Description: POSITION SUMMARY: Reporting to the VP of Compliance, the Compliance Auditor is responsible for ongoing analysis and review of coding accuracy, medical necessity documentation, and regulatory compliance in patient records. ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES: Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity, supporting documentation and other operational functions. Conducts ad hoc reviews and audits based on high risk, problem prone, or otherwise specified areas. Maintains tools, reports, data, metrics, benchmarking, tracking, and trending patient and compliance data. Participates in various committees to address risks and opportunities for improvement, to report on compliance data, and collaborate in process improvement initiatives. Provide reports to management on compliance metrics and audit findings as requested. Requirements: EDUCATION AND QUALIFICATIONS: RN or...

PRIMARY FUNCTION The Professional Fee Coding Auditor is responsible for conducting comprehensive coding audits (prospective and retrospective), ensuring documentation and coding compliance, identifying revenue integrity opportunities, and providing feedback to providers and clinical staff. This role serves as a key partner to physicians, advanced practice providers, operational leaders, and revenue cycle teams to promote accurate coding, documentation integrity, regulatory compliance, and reimbursement optimization. This role ensures compliance with applicable coding guidelines and/or payer requirements as well as regulatory standards while supporting revenue cycle integrity through education and process improvement. In addition to audit and education responsibilities, this position maintains coding proficiency by performing production coding activities as needed to support business operations, staffing coverage, backlogs, special projects, and organizational priorities....

Abstracts clinical information from a variety of medical records, charts and documents and assigns appropriate ICD-10 and/or CPT-4 codes to patient records according to established procedures. Works with coding databases and confirms DRG assignments. Responsibilities: Codes data from patient records utilizing coding systems to ensure optimal reimbursement of the office visits and hospital surgery for all surgeons and mid-levels of the practice. Translates diagnostic and procedural information using the International Classification of Diseases codes and sequences these codes in a manner which legitimately optimizes office and hospital reimbursement through the use of proper coding and modifiers. Skilled in accurate assignment and auditing of ICD-10-CM, CPT, HCPCS, and E/M services for inpatient, outpatient and office-based encounters. Abstracts data from patients’ medical records in order to compile accurate and timely statistical data. Reviews and analyzes all patient types to...

Description Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties * Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. * Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. * Monitors professional fee...

Overview Certified Medical Coder required (AHIMA, AAPC, or PMI). Hybrid-Sunrise, Florida 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 Investigative...

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...

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 activities. Work with...

NACBA is seeking a Senior Billing Compliance Auditor located in Miami, Florida. This role involves conducting audits of NCPS professional fee encounters, ensuring compliance with federal and state coding and documentation requirements. The ideal candidate will have at least 7-10 years of experience in coding and compliance, along with a Certified Professional Coder designation. Responsibilities include preparing audit trends, collaborating with administrators, and maintaining compliance standards. #J-18808-Ljbffr

Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider‑coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring/auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Key Responsibilities Conduct audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serve as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Florida AHCA / Medicaid, and CMS regulatory requirements. Monitor professional fee vendor‑coding...

Job Description The Coding Auditor reviews/audits patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment, as applicable, according to established guidelines. This position issues the coding "report card" quarterly to all coders. This position provides coding training and education. This position may audit accounts for ER Charging accuracy and perform RAC and other third party audit appeals. Responsibilities Reviews patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment according to established guidelines and scores appropriately, if applicable. Works with CDIS on DRG assignment and educates on missed Query opportunities. Works with staff on coding guidelines and correct code assignment. Informs manager of any activities which do not meet federal or state coding and billing requirements. Appeals RAC DRG review charts. Receives requests from business office on issues relating to coding and responds...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note:...