29 coder auditor professional jobs found

Title: Risk Adjustment Coding Auditor Location: Remote Job Type: Contract (6 months) Compensation: $35.00 – $38.00 per hour Industry: Health Insurance About the Role Our firm is partnering with a leading nonprofit health insurance organization that serves members across commercial, Medicare, and Medicaid health plans. We are seeking an experienced Risk Adjustment Coding Auditor to help ensure the accuracy, integrity, and compliance of clinical coding and documentation used in risk adjustment programs. In this role, you will support accurate reimbursement and regulatory compliance by conducting detailed coding audits, identifying documentation gaps, and providing expert guidance on risk adjustment coding practices. This position is ideal for a coding professional with strong HCC auditing experience who is passionate about data accuracy, compliance, and continuous improvement. Job Description As a Risk Adjustment Coding Auditor, you will evaluate coded clinical data to ensure...

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 (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. 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...

Experienced Associate, Healthcare ForensicsThe Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients.Job Duties:Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance mattersContributes to forensic engagements related to medical coding and...

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 (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. 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...

The Coding Auditor/Educator - Multi-specialty will assure consistent quality coding and training in evaluation and management, office procedures, and surgical coding through ongoing internal audits, training and education while adhering to official coding guidelines, in support of federal, state, local, and department requirements. FT role requires supporting the coding department during core business hours, 7:30 AM - 5:00 PM in the Central Time Zone. This role is 100% remote. Revo Health is a professional services company that partners with multiple healthcare groups to deliver exceptional patient care. This position will be employed by Revo Health, working closely with Infinite Health Collaborative (i-Health) and its operating divisions. Essential Job Functions: Training and development of current and newly hired remote and on-site coding team members. Perform quality assurance reviews to assess comprehension of training efforts. Training and continued development...

Inpatient Coding SpecialistFind your purpose as an Inpatient Coding Specialist at CentraCare. This position is responsible for analyzing and auditing documentation to ensure it meets requirements for assignment of codes from the appropriate classification system. Professional will work closely with provider and clinical documentation integrity staff to consistently and accurately translate medical record documentation and educate as necessary. Assists with performing quality audits, denial management, data collection, monitoring, and reporting documentation patterns and trends. This role will help guarantee that CentraCare is reimbursed for the services provided. Safeguards patient privacy and confidentiality.Schedule: Full-time 80 hours every 2 weeks Mon-Fri Days Fully RemotePay and Benefits: Starting pay is 25.70 per hour exact wage determined by years of related experience. Pay range: 25.70-38.57 per hour Full time benefits: medical, dental, PTO, retirement, employee discounts...

Anticipated End Date: 2026-10-20 Position Title Inpatient DRG Validator (Acute Care) Job Description The Inpatient DRG Validator (Acute Care) is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending physician’s statement sent in by acute care hospitals on submitted DRG. Anticipated Job Posting End Date: 08/17/2026 Virtual: This role enables associates to work virtually full-time, with the exception of 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...

Job Description Job Description Description: Riverland Community Health is a Federally Qualified Health Center in St. Paul, where patients receive community-based Family Practice medical care in addition to mental health, dentistry, social work and other integrated services. When joining RCH, you become part of a diverse, inclusive, and welcoming team who are dedicated to serving our patients and pursuing our mission to deliver excellent healthcare for all and training for the providers of tomorrow.  JOB SUMMARY: The Medical Coding Specialist / Provider Educator is responsible for the review of medical records, notes, dictation and other related documentation to ensure the accurate and timely submission of charges for professional services provided by physicians and other providers as well as diagnoses for clinic services. The Medical Coding Specialist / Provider Educator is also responsible for conducting coding audits, providing education and communication of process...

Get started on an exciting career in health information management. We’re with you every step of the way. Starts out onsite, then transitions to REMOTE 4 days/week. Job Summary: Required Services provide single path medical coding services and related medical records functions. Single path coding combines facility coding and professional coding and allows one coder to code facility and professional codes for the same patient utilizing a single coding platform. perform technically complex professional services coding for medical conditions and assign the correct International Classification of Diseases, ICD-10-CM, Procedure Coding System (PCS) Current Procedural Terminology (CPT), Health Care Financing Administration Common Procedure Coding System (HCPCS), and Evaluation and Management (E&M) codes for diagnosis, acuity of care and procedures for a wide range of medical specialties to include coding of complicated cases identified as difficult to classify such as treatment of...

Required Skills & Experience • Certified coder (CPC, CCS, CRC, CCA, or equivalent certification) • Strong ICD-10-CM coding experience and medical record review background • Knowledge of Risk Adjustment and HCC coding methodologies • Experience reviewing physician documentation and assigning accurate diagnosis codes • Strong understanding of medical terminology, anatomy, physiology, and disease processes • Ability to interpret complex clinical documentation with high accuracy and productivity • Familiarity with CMS guidelines and Medicare Advantage requirements Nice to Have Skills & Experience • Medicare Advantage Risk Adjustment experience • Experience working with CMS-HCC models • CRC (Certified Risk Adjustment Coder) certification • Experience with EMRs and coding software platforms • Background in a health plan, physician practice, hospital, or revenue cycle environment • Audit and quality assurance experience Job Description Insight Global is seeking Medical Coders...

Coding Specialist Minnesota Urology is looking for a dedicated Coding Specialist to join our team! Monday- Friday No Weekends, Holidays, or Evenings Eligible for Hybrid Work Options after minimum of 90 days in office POSITION TITLE: Coding Specialist DEPARTMENT: Business Services REPORTS TO: Business Services Manager PRIMARY OBJECTIVE: To accurately link ICD-10, CPT and HCPCS codes to daily charges, ensure ICD-10, CPT and HCPCS codes are updated and reviewed regularly for accuracy, monitor physician and physician extender coding practices, and ensure that all charges are accounted for and entered in a timely manner. RESPONSIBILITIES: Monitors daily flow of office, hospital, and laboratory charges to ensure accuracy and timeliness of entry. Verifies and audits provider documentation. Provides feedback and education to providers as needed to ensure documentation and compliance standards are met. Links ICD-10 codes to CPT and HCPCS codes correctly and completely prior...

Senior Medical Coder Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Medical Coder performs concurrent review of FFS coding rules, ensuring all CPT and E/M codes are accurately coded and billed for maximum reimbursement and minimal denials. This position will support coding functions within charge review, claim edits, and denials and play a critical role in maintaining coding accuracy and supporting revenue cycle integrity....

Improve the lives of others while Caring. Connecting. Growing together. Job Description - Senior Medical Coder (2379427) Senior Medical Coder - 2379427 Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Medical Coder performs concurrent review of FFS coding rules, ensuring all CPT and E/M codes are accurately coded and billed for maximum reimbursement and minimal denials. This position will support coding functions within charge...

Coding Subject Matter ExpertOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.Responsible for providing oversight to Optum360 coding services, directly overseeing facility-based and/or HIM (Health Information Management) Center operations leadership of Optum 360 Coding Departments within the assigned Region. The SME will lead key initiatives within the organization related to Quality metrics, workflow improvement, and audits, etc. to meet or exceed metrics, drive efficient coding services, and deliver performance excellence through standardization of processes...

Salary Range $22.38 - $31.80 Hourly Position Type Full Time Category Coding Description Remote work is available for candidates in Minnesota, North Dakota or South Dakota, only. The Outpatient Coder exhibits professional and proficient communication, with patients, co-workers, medical staff and administrative staff. Meet or exceed the expected accuracy rate of 95% and demonstrate efficient skills when coding outpatient charges for billing. Be knowledgeable of outpatient coding guidelines, ICD-10 diagnosis application and resources available within and outside the clinic to obtain optimum accuracy for account billing while sustaining coding charts per hour rate expectations based on outpatient specialty areas. Other coding tasks as assigned by supervisor. Responsibilities include but are not limited to: Audit charge tickets for accurate and required CPT, ICD-10, and HCPCS codes, according to third party requirements. Communicate with medical staff to acquire...

Lake Region Healthcare is seeking an Outpatient Coder to join our Health Information Management Department. This role offers remote work options for candidates in Minnesota, North Dakota or South Dakota, with day shifts (80 hours biweekly) and an hourly wage range of $22.38–$31.80. The ideal candidate will audit CPT, ICD-10 and HCPCS codes, communicate with clinical staff, and interpret documentation to ensure accurate coding while maintaining per-hour productivity targets. #J-18808-Ljbffr

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...

Minnesota Urology P.A. is seeking a dedicated Coding Specialist to join our Business Services team. The role focuses on linking ICD-10, CPT and HCPCS codes to daily charges, ensuring coding accuracy and timely entry across office, hospital, and lab settings. The position supports providers through coding guidance, audits, and education while maintaining confidentiality and compliance. A hybrid work option is available after 90 days in the office, with a Monday–Friday schedule and no evenings, #J-18808-Ljbffr

Join OptumOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Review provider documentation and medical records to assign appropriate diagnosis and procedure codesAbstract and code professional fee services for non-invasive cardiology procedures, including but not limited to:Stress testing (exercise and pharmacologic)Stress...

City/State Norfolk, VA Work Shift Multiple shifts available Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote! Status Full-time, permanent position (40 hours) Work hours 8am to 5pm EST, M-F Location This position is remote for candidates that live in the following states: VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year. Job Responsibilities Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits. Contribute to the review of reimbursement systems relating to health insurance...

Minnesota Urology is looking for a dedicated Coding Specialist to join our team! Monday- Friday No Weekends, Holidays, or Evenings Eligible for Hybrid Work Options after minimum of 90 days in office POSITION TITLE: Coding Specialist DEPARTMENT : Business Services REPORTS TO : Business Services Manager PRIMARY OBJECTIVE: To accurately link ICD-10, CPT and HCPCS codes to daily charges, ensure ICD-10, CPT and HCPCS codes are updated and reviewed regularly for accuracy, monitor physician and physician extender coding practices, and ensure that all charges are accounted for and entered in a timely manner. RESPONSIBILITIES: Monitors daily flow of office, hospital, and laboratory charges to ensure accuracy and timeliness of entry. Verifies and audits provider documentation. Provides feedback and education to providers as needed to ensure documentation and compliance standards are met. Links ICD-10 codes to CPT and HCPCS codes correctly and completely prior to processing for billing,...

Minnesota Urology in Bloomington, MN is seeking a Coding Specialist to accurately link ICD-10, CPT and HCPCS codes to charges and ensure coding accuracy. This role monitors billing entries, audits provider documentation, and provides feedback to clinicians to maintain compliance. The Coding Specialist will use NextGen, UroChart, and Microsoft Office to enter and review codes, and will participate in external meetings for professional development. #J-18808-Ljbffr

Coding Specialist Minnesota Urology is looking for a dedicated Coding Specialist to join our team! Monday- Friday No Weekends, Holidays, or Evenings Eligible for Hybrid Work Options after minimum of 90 days in office POSITION TITLE: Coding Specialist DEPARTMENT: Business Services REPORTS TO: Business Services Manager PRIMARY OBJECTIVE: To accurately link ICD-10, CPT and HCPCS codes to daily charges, ensure ICD-10, CPT and HCPCS codes are updated and reviewed regularly for accuracy, monitor physician and physician extender coding practices, and ensure that all charges are accounted for and entered in a timely manner. RESPONSIBILITIES: Monitors daily flow of office, hospital, and laboratory charges to ensure accuracy and timeliness of entry. Verifies and audits provider documentation. Provides feedback and education to providers as needed to ensure documentation and compliance standards are met. Links ICD-10 codes to CPT and HCPCS codes correctly and...

Inpatient Coding Specialist Find your purpose as an Inpatient Coding Specialist at CentraCare. This position is responsible for analyzing and auditing documentation to ensure it meets requirements for assignment of codes from the appropriate classification system. Professional will work closely with provider and clinical documentation integrity staff to consistently and accurately translate medical record documentation and educate as necessary. Assists with performing quality audits, denial management, data collection, monitoring, and reporting documentation patterns and trends. This role will help guarantee that CentraCare is reimbursed for the services provided. Safeguards patient privacy and confidentiality. Schedule: Full-time 80 hours every 2 weeks Mon-Fri Days Fully Remote Pay and Benefits: Starting pay is 25.70 per hour exact wage determined by years of related experience. Pay range: 25.70-38.57 per hour Full time benefits: medical, dental, PTO, retirement, employee...