30 coder auditor professional jobs found

Location: Tulsa, Oklahoma, United StatesCompany: CommUnityCarePosted: 2026-10-24Location: Tulsa, Oklahoma, United StatesCompany: CommUnityCarePosted: 2026-10-06Risk Adjustment Auditor The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. Key responsibilities include performing bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. Ensuring documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. Identifying unsupported diagnoses, over coding, under-coding, and documentation gaps....

Location: Tulsa, Oklahoma, United StatesCompany: CommunityCare, Inc.Posted: 2026-10-24JOB SUMMARY:The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.KEY RESPONSIBILITIES:Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.Provide detailed audit findings and recommendations to coding teams, providers, and leadership.Monitor...

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...

Location: Tulsa, Oklahoma, United StatesCompany: CommUnityCarePosted: Job ID: 6283Req ID: 1133Location: Tulsa, OK, USAPosted: Job Family: CommercialPay Type: SalaryJOB SUMMARY:The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.KEY RESPONSIBILITIES:• Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.• Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.• Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.• Provide detailed audit...

SIU ICD10 Professional Coder - Healthcare Fraud, Waste and Abuse Department - Hybrid 2 days in office SIU ICD10 Professional Coder - Healthcare Fraud, Waste and Abuse Department - Hybrid 2 days in office Location US-MA-Worcester Job ID 8406 # Positions 1 Category Professionals Location US-MA-Worcester Job ID 8406 # Positions 1 Category Professionals Overview About us: Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability,...

JOB SUMMARY: This position is responsible for reviewing a patient's medical records after a Clinic visit and translating the information into codes that insurers use to process claims for patients. Duties include confirming treatments with medical staff, identifying missing information, and submitting information to insurers for reimbursement. RESPONSIBILITIES (ESSENTIAL FUNCTIONS): Accurately assigns and sequences codes (ICD-10-CM, CPT, HCPCS/modifiers as necessary) for each patient encounter, following proper coding guidelines and legal requirements to ensure compliance with federal and state regulations. Ensures professional/physician billing CPT codes/ICD-10 codes are assigned correctly and sequenced appropriately as per government and insurance regulations. Queries providers or other Clinic team members when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Assigns and enters...

Job Description Join our team as a day shift, full time, Coding Auditor and Educator at INTEGRIS Health in Oklahoma City, OK. Get to Know Your Team INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives. Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more. Take the first step toward growing your career by joining us. Responsibilities The Coding Auditor and Educator leads coding quality assurance and education efforts to drive coding accuracy, regulatory compliance, and continuous improvement across coding operations. Performs comprehensive coding audits to assess accuracy, compliance, and performance trends. Analyzes audit findings to identify root causes and develops targeted...

Department: 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Will support : A mix of inpatient community and academic coding. Includes service lines such as cardiology, neurology, and oncology. Schedule : Full-time, Monday-Friday 40hrs with a standard schedule of Monday through Friday, 8 hours per day, totaling 40 hours each week. Certification required : Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range: $33.05 - $49.60 Major...

Job DetailsJob Location: Home Office - Oklahoma City, OK 73134Position Type: Full TimeEducation Level: CertificationTravel Percentage: OccasionalJob Shift: DayJob Category: Health Information Management (HIM)JOB PURPOSE: This position is for an Outpatient Coder with Emergency Dept and Ambulatory Surgery coding experience. The coder will code Surgery, Emergency department, and Ancillary records. Emergency Dept coding includes injection & infusion coding as well as the assignment of the E&M Professional fee. Coder will demonstrate competency by meeting productivity standards and achieving an accuracy rate of 95% on all chart types coded. Will abstract and code every account compliantly, accurately, and completely, to ensure accurate and timely reimbursement and reporting. Verifies, reviews, analyzes, and abstracts medical information; researches missing clinical information; assigns accurate codes; appropriately queries physicians when required; elevates documentation issues...

Job Purpose The Lead Coder will code all patient types as needed; inpatient, swing bed, same‑day surgery, ancillary, ambulatory and provider‑based clinics, and will mentor, train, and assist coding staff, including newly hired staff. They must review documentation to assign appropriate CPT/HCPCS and ICD‑10‑CM‑PCS diagnosis codes and procedures for hospital and physician (professional) services for inpatient and outpatient records based on knowledge of coding systems. Essential Functions Ensures that coding compliance initiatives are met with all record types. Conducts regular internal coding audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures and education as needed. Assists with productivity reporting and reducing DNFC. Coding complex outpatient or inpatient accounts utilizing encoder software and references in the assignment of ICD‑10‑CM/PCS, CPT/HCPCS codes, DRG, POA assignments, APC assignment...

ED/OP CoderFully Remote • Home Office - Oklahoma City, OK 73134OverviewPosition Type Full Time Job Shift Day Education Level Certification Travel Percentage Occasional Category Health Information Management (HIM)DescriptionJOB PURPOSE: This position is for an Outpatient Coder with Emergency Dept and Ambulatory Surgery coding experience. The coder will code Surgery, Emergency department, and Ancillary records. Emergency Dept coding includes injection & infusion coding as well as the assignment of the E&M Professional fee. Coder will demonstrate competency by meeting productivity standards and achieving an accuracy rate of 95% on all chart types coded.Will abstract and code every account compliantly, accurately, and completely, to ensure accurate and timely reimbursement and reporting. Verifies, reviews, analyzes, and abstracts medical information; researches missing clinical information; assigns accurate codes; appropriately queries physicians when required; elevates...

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 If you are located outside of the state of Texas -- you must be located in KANSAS, OKLAHOMA, TENNESSEE, LOUISIANA, GEORGIA, SOUTH CAROLINA, NORTH CAROLINA, or be willing to relocate to one of the eligible states (including Texas). Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity...

Remote Medical Coder Edmond, Oklahoma, United States Position Details Reports to: Billing & Patient Services Supervisor Location: Remote Must currently reside in Oklahoma Schedule: MondayThursday: 8:00 a.m.5:00 p.m. CST Friday: 8:00 a.m.12:00 p.m. CST Why the role is open: Growing patient volume and expanded clinical programs Are you detail-oriented, analytical, and passionate about getting coding right the first time? We're seeking an experienced Medical Coder to join a respected and growing healthcare organization. This is a fully remote opportunity for candidates currently residing in Oklahoma and is ideal for someone who thrives on accuracy, works well independently, and understands how proper coding directly impacts compliance, reimbursement, and the overall revenue cycle. Why This Role Stands Out Fully remote opportunity for Oklahoma residents Consistent weekday schedule with early Fridays Direct impact on accurate reimbursement and provider success...

Coding Specialist PositionYour future role at a glanceLocation: Tulsa, OK On-siteFacility: Ascension Medical GroupDepartment/Specialty: Revenue CycleSchedule: Full-time days, Monday - Friday, 8a - 5pHow You'll Make An Impact In This RoleTransform patient records into accurate care stories by evaluating clinical charts and applying precise diagnostic and procedural codes, directly driving accurate reimbursement and flawless claims processing.Collaborate directly with physicians to clarify ambiguous documentation, fostering open communication that elevates health record quality and protects compliance standards.Champion coding accuracy and team growth through regular chart audits and continuous clinical education for both providers and peers.Uphold industry excellence by maintaining high productivity and quality standards while strictly adhering to AHIMA ethical coding guidelines and regulatory updates.What Minimum Requirements You'll NeedLicensure / Certification / Registration:One...

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...

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) Location: This position is remote for candidates that live in the following states: With travel to Virginia Beach 1x a year. 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 claims processing and ensures adherence to policies and procedures for its various product offerings. Triage and prioritize leads/member complaints from internal sources. Assist in the...

Your future role at a glance Location: Tulsa, OK On-site Facility: Ascension Medical Group Department/Specialty: Revenue Cycle Schedule: Full-time days, Monday - Friday, 8a - 5p How you'll make an impact in this role Transform patient records into accurate care stories by evaluating clinical charts and applying precise diagnostic and procedural codes, directly driving accurate reimbursement and flawless claims processing. Collaborate directly with physicians to clarify ambiguous documentation, fostering open communication that elevates health record quality and protects compliance standards. Champion coding accuracy and team growth through regular chart audits and continuous clinical education for both providers and peers. Uphold industry excellence by maintaining high productivity and quality standards while strictly adhering to AHIMA ethical coding guidelines and regulatory updates. What minimum...

Fallon Health seeks an SIU ICD10 Professional Coder to join the Healthcare Fraud, Waste and Abuse team in Worcester, MA. The role is hybrid with 2 days in office, focusing on auditing medical records for E&M, DME and other services to identify potential over-payments and fraud indicators. Responsibilities include coding audits, investigative support, pattern identification and collaboration with providers and clinical teams to ensure compliant billing. #J-18808-Ljbffr

**When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.**Under the general supervision of the Outpatient (OP) Coding Manager and OP Coding Supervisor, the OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing.**Job Description:****Essential Duties & Responsibilities** including but not limited to:Hospital Coding:· Review the complete electronic and...

Job Title: Remote Ambulance Coder Work Location: Pafford Medical Services, Inc. - Oklahoma City Division/Department: PMBS Reports To: Coding Supervisor Full-Time Nonexempt The Ambulance Coder is responsible for reviewing ambulance patient care reports (PCRs) and accurately assigning diagnosis, procedure, level-of-service, and other required billing codes based on the clinical documentation provided. This position evaluates the patient's condition, services rendered, medical necessity, origin and destination, and transport circumstances to support accurate and compliant ambulance billing. The Ambulance Coder applies Medicare, Medicaid, commercial payer, and other applicable regulatory requirements when determining the appropriate level of service and coding for ambulance transports. Essential Duties And Responsibilities Review ambulance patient care reports and supporting medical documentation for completeness and coding accuracy. Interpret clinical documentation,...

Oklahoma Arthritis Center Billing SpecialistOklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.Job Summary:Reviews billing data from medical office or hospital records to ensure amounts and account numbers are accurate, responsible for account posting, collections, and verifying patient benefits. Responsible for accurate diagnose and procedure coding. Responsible for insurance pre-certifications, pre-authorizations, pre-determinations and other required insurance notifications for procedures performed in the clinic.Essential Functions:Review and analyze patient records and physician documentation for completeness and accuracy, focusing on areas such as radiology reports, neurological procedures, office visit notes, and laboratory results.Assign precise CPT, ICD-10, HCPCS (and when applicable,...

Inpatient Coder - Part TimeFully Remote • Home Office - Oklahoma City, OK 73134OverviewPosition Type Full Time Job Shift Day Education Level Certification Travel Percentage Occasional Category Health Information Management (HIM)DescriptionJOB PURPOSE: To abstract and code compliantly, accurately and completely as well as group each account to the appropriate DRG to facilitate data quality and ensure accurate and timely reimbursement. Verifies reviews, analyzes, and abstracts medical information; researches missing medical information; assigns accurate codes; appropriately queries physicians when required; elevates documentation issues to management; ensures valid orders are on the record prior to coding; communicates with HIM Director regarding obstacles with orders, charges, physician documentation. Demonstrates proficiency in the coding and grouping of inpatient accounts.ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:Assures data quality by capturing codes and data while...

Medical Coding Specialist Job Summary: Reviews medical record to assign diagnosis and procedures codes using 3M coding software. Accurately sequences codes according to departmental and AHIMA guidelines. Ensures records are coded in accurate and timely manner. Demonstrates Competency in the Following Areas: Reviews charts thoroughly to ascertain all diagnosis and procedures. Codes are sequenced according to coding guidelines. Productivity standards are met. Utilizes computerized coding system to assign proper codes. Assigns facility and professional E/M levels as applicable. Assigns infusion and injection charges as applicable. Enters observation charges as applicable. Contacts responsible physician, in professional manner, if diagnosis is unclear. Meets quality standards of 96% or greater. Responds to denials received from third party auditors meeting deadlines on 100% of cases. Monitors Delinquent Bill Report to ensure timely completion for...

Must have the following requirements: Must Have a minimum of 3 years of Hospital Inpatient Coding Experience Must have one or more of the following; (CCS, RHIT, RHIA) Full Time Only - 40hrs/week Trauma 1 / Teaching Hospital Experience Required Are you interested in working from home? Would you like to travel for consulting project opportunities? Working with Oxford is an opportunity to manage your career, with full-time assignment options available! We have immediate openings for contract, remote, Hospital Coders. Oxford offers competitive pay and excellent benefits to qualified medical coders/auditors and HIM Management professionals. All qualified applicants will be contacted. #J-18808-Ljbffr