38 coder auditor professional jobs found

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, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region....

Become a part of our caring communityThe 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...

Job Description Job Description Join the ICHS Team! Discover how you can make a difference in people’s lives and help strengthen communities. International Community Health Services (ICHS) is a nationally recognized community health center. For over 50 years, we have provided medical, dental, and wellness care to individuals and families from all regions and all walks of life many of whom face significant barriers to receiving the care they need. We believe that quality health care supports stronger families, healthier communities, and a more just society. At ICHS, we are proud of our team-based approach and the shared commitment that drives our work. We value respect, collaboration, and compassion in everything we do. When you join ICHS, you become part of a mission-driven team that believes everyone deserves the opportunity to thrive. We offer  Competitive salary for the Seattle/Puget Sound region “Share the success” bonuses Insurance premiums 100%...

Job Title: Coding Auditor and Educator (Remote - WA Residents Only) Req: 2026-0713 Location: VMC Main Campus Department: Health Information Mgmt Shift: Days Type: Full Time FTE: 1 Hours: 8:00 - 4:30 City State: Renton, WA Category: Professional ( NCNM) Salary Range: Min $32.39 - Max $46.96/hourly DOE JOB DESCRIPTION The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization. TITLE: Coding Auditor and Educator JOB OVERVIEW: The Coding Auditor and Educator plays a key role in the orientation, auditing, and education of all healthcare providers involved in professional fee coding and documentation at Valley Medical Center. This position conducts both new and routine physician coding and documentation audits, delivers targeted education, and...

Join the ICHS Team! Discover how you can make an impact on people, communities and creating greater health equity. International Community Health Services (ICHS) is a nationally-recognized federally qualified health center, and for over 50 years ICHS has provided culturally and linguistically appropriate health and wellness services, including increasing health equity for uninsured and medically underserved individuals of all languages and walks of life. We firmly believe that access to quality health care strengthens our families and communities, and promotes a more just society. We take pride in our diverse and inclusive workforce and at ICHS we value respect and support each other so each individual can achieve his or her full potential. We invite you to join us and be inspired by colleagues that share your mission and purpose. We invite you to watch this video to learn more about working at ICHS. We offer: Competitive salary for the Seattle/Puget Sound region...

Join the ICHS Team!Discover how you can make an impact on people, communities and creating greater health equity.International Community Health Services (ICHS) is a nationally-recognized federally qualified health center, and for over 50 years ICHS has provided culturally and linguistically appropriate health and wellness services, including increasing health equity for uninsured and medically underserved individuals of all languages and walks of life. We firmly believe that access to quality health care strengthens our families and communities, and promotes a more just society. We take pride in our diverse and inclusive workforce and at ICHS we value respect and support each other so each individual can achieve his or her full potential. We invite you to join us and be inspired by colleagues that share your mission and purpose.We invite you to watch this video to learn more about working at ICHS.We offer:Competitive salary for the Seattle/Puget Sound region"Share the success"...

Inpatient Facility Medical CoderTo independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

All Jobs Inpatient Medical Coder Inpatient Medical Coder COMPANY OVERVIEW Health Partners Management Group, Inc (HPMG) is a government contracting company in Poplar Bluff, Missouri. HPMG currently bidding on a contract with the Federal Government for several coding positions. You would be a W-2 employee for HPMG and NOT a government employee. SUMMARY: Responsible for assignment of accurate ICD codes for diagnoses and procedures. Medical Severity - Diagnostic Related Group (MS-DRG) is automatically assigned by the grouper software) for inpatient stays. Inpatient coders may also be responsible for the assignment of accurate ICD diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities from medical record documentation (paper or electronic) for inpatient professional services (a.k.a., rounds or IBWA encounters). Trains and educates MTF staff on coding issues and plays a significant role in coding compliance...

Job Summary and Responsibilities As a Coding Auditor, you will be a central figure ensuring accurate and timely reimbursement by proactively resolving medical coding claim defects before billing. You will play a vital role in optimizing our revenue cycle and maintaining financial integrity. Every day, you will meticulously research and review coding-related claim denials, providing expert guidance on corrections to prevent future issues and recover lost revenue. You will also proactively address pre-billing resolution of coding defects, safeguarding against reimbursement impacts. To be successful in this role, you will combine a robust understanding of medical coding and reimbursement methodologies, exceptional analytical skills, and meticulous attention to detail. You will demonstrate a proactive problem-solving approach, driven by a commitment to maximizing financial accuracy and efficiency. Job Requirements Required High school diploma or equivalent...

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...

Coding AuditorInspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings.The posted compensation range of $32.32 - $53.32 / hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.As a Coding Auditor, you will be a central figure ensuring accurate and timely reimbursement by proactively resolving medical coding claim defects before billing. You will play...

About the role As a Medical Coding Quality Auditor, you will play a critical role in ensuring coding accuracy, compliance, and quality across healthcare records. You will collaborate with coding professionals and physicians to support accurate clinical documentation, regulatory compliance, and operational excellence while maintaining high quality and productivity standards in a remote work environment. In this role, you will: Review medical documentation to accurately assign diagnosis and procedure codes. Communicate with physicians and other healthcare providers to obtain or clarify diagnoses and procedures through the coding query process. Assign accurate codes using electronic encoder applications in accordance with company policies, coding guidelines, and regulatory requirements. Perform peer reviews and quality audits of Health Information Management coding auditors and coders. Prepare and complete reports, audit findings, and other deliverables as requested. Monitor...

UnitedHealth Group in San Juan, Puerto Rico, is seeking a skilled Clinical Auditor to review professional and facility claims, compare with medical records, and determine claim viability for further processing. The role emphasizes data accuracy, compliance, and clear clinical reasoning for providers. The position requires a Coding Certificate or Nursing Licensure, proficiency with Microsoft Office, and fluency in English and Spanish. #J-18808-Ljbffr

Forks Community Hospital is seeking HIM/RHC certified coders to review and validate procedural coding and charging for Hospital, Ambulatory Surgical Department, Emergency Department, and clinics. You will ensure CPT/HCPCS accuracy, review modifiers, units, revenue codes, and supporting documentation to prevent revenue leakage and improve claim quality. You will research ICD-10 concepts as needed, perform audits, and collaborate with Patient Financial Services and other Revenue Cycle staff to #J-18808-Ljbffr

HIM/RHC Certified Coders are responsible for reviewing, validating, and analyzing procedural coding and charging for Hospital, Ambulatory Surgical Department, Emergency Department, ancillary departments, and Clinic Services. The primary focus of the position is procedural and charge accuracy, including review of CPT and HCPCS codes, modifiers, units, revenue codes, charges, and supporting clinical documentation. Coders compare documented procedures and services with the charges and codes submitted for billing to identify missing, incorrect, duplicate, unsupported, or otherwise discrepant charges that may affect reimbursement or revenue integrity. The position researches ICD 10, CPT, HCPCS, modifier, payer, billing, and reimbursement requirements; performs charge and coding audits; analyzes procedural claim edits and denials; and works with clinical departments, Patient Financial Services, Charge Capture, and other Revenue Cycle staff to research and resolve discrepancies. ICD-10...

About this position At Vancouver Sleep Center, we know how stressful it can be when sleep feels out of reach. That’s why we’ve built our practice around experience, accessibility, and patient-focused care. Our board-certified sleep specialists have decades of experience helping people improve their sleep and feel better in their daily lives. We guide you every step of the way, from detailed sleep consultations and in-depth studies to personalized treatment plans and medical equipment. As one of the sleep centers Portland, OR and the surrounding areas have relied on for decades, we understand how urgent sleep problems can be, so we strive to see new patients within a week of their first call. Position Summary The Medical Biller is responsible for ensuring the financial viability of the center by managing the full revenue cycle. This role requires a specialist who can navigate the unique coding requirements of polysomnography (PSG) and Home Sleep Apnea Testing (HSAT), ensuring that...

Experience preferred. Certified Coder with 5+ years experience coding professional and facility fees for surgical cases and office visits. Specialties include Obstetrics/Women's Health, Orthopedics, Podiatry, Cardiology, Urology & General Surgery. JOB SUMMARY The Coder is responsible for reviewing discharge abstracts and patient charts in order to assign the appropriate ICD-CM/CPT codes to diagnoses and procedures. Reviews charts for potential liability risk and documents specific information as necessary. Performs studies as requested by physicians or administration. Maintains State reporting documentation for certain procedures in compliance with regulations. The Coder encounters the mission of providing quality healthcare to the patients of WhidbeyHealth to ensure medical records are charged and coded accurately and efficiently. This position may be responsible for applying the appropriate codes for ICD-10, CPT / HCPCS, evaluation and management, and/ or modifiers...

Description Under the general supervision of the Kadlec Clinic Billing Manager, analyzes, codes, and compiles medical records to document patient condition and treatment in Family Practice, Specialty Practice, Hospital and ASC settings. The Clinic - Coder, Certified - Level II will audit Provider documentation and provide continuous, meaningful provider feedback. Providence caregivers are not simply valued - they're invaluable. Join our team at Kadlec Regional Medical Center and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: Certification from American Academy of Professional Coders upon hire or, Certification from American Health Information Management Association upon hire. 3 years - Related experience and/or training. Preferred Qualifications: 5 years -...

Confluence Health in Wenatchee, WA is seeking a Certified Facility Coder to review medical records, extract data, and apply ICD-10CM/PCS, CPT, and HCPCS codes for billing and reporting. This role requires attention to official guidelines and collaboration with the Coding Department supervisors. The position supports remote work with residency in WA, OR, ID, WI, FL, MT, TX, AZ, VA, or TN, and offers a comprehensive benefits package. Experience with EPIC and coding audits is valued. #J-18808-Ljbffr

Salary Range $26.62 - $41.66 Overview Located in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members. Pool Employees of Confluence Health receive a range of benefits in addition to compensation. Retirement Plan Pool Differential Sick Leave Shift Differential Employee Assistance Program For more information on our Benefits & Perks, click here! Summary This position has the option to work virtually. Must reside in the state of WA, OR, ID, WI, FL, MT, TX, AZ, VA, TN. The Certified Facility Coder will be responsible for reviewing all medical record information to extract data and apply appropriate diagnoses and procedure codes for billing,...

Inpatient Coder (CCS Certified) – Remote Location: Remote (work from home office) Experience: 3+ years of facility-based inpatient coding Job Summary The Inpatient Coder is a key role supporting one or more Cognizant clients, responsible for reviewing medical documentation and accurately assigning ICD-10-CM diagnosis and ICD-10-PCS procedure codes. This role works independently and as part of a team, queries physicians to clarify documentation, and supports coding quality through peer review, while meeting accuracy and productivity standards in a fast-paced remote environment. Key Responsibilities Review documentation to code diagnoses (ICD-10-CM) and procedures (ICD-10-PCS). Communicate with physicians to obtain or clarify diagnoses and/or procedures through the query process. Assign accurate codes using an electronic encoder application in accordance with practice policy and regulatory guidelines. Perform peer reviews of company Health Information Management coding...

CTHCA Certified Professional Coder (CS-49653)# CTHCA Certified Professional Coder (CS-49653)Hot JobNespelem - Nespelem, WA 99155## OverviewSalary Range$25.27 - $30.78 HourlyPosition TypeFull Time## Description**CLOSING DATE:**Open until filled: bi-weekly review**POSITION: CTHCA**Certified Professional Coder**SALARY:**$25.27 - $30.78, per hour DOE**REPORTS TO:** Revenue Cycle Program Manager**LOCATION:** Colville Tribal Healthcare Authority, Nespelem## SUMMARY:Researches and analyzes data needed for reimbursement. Analyzes medical records and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff. Reviews and verifies documentation supports diagnoses, procedures and treatment results.The Certified Professional Coder is the second in the Medical career ladder. Certified Professional Coder will work cooperatively in full compliance with all relevant claims reimbursement requirements by maintaining high ethical standards, strict...

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...

Humana is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify codes, review documentation, and ensure CPT/HCPCS accuracy while maintaining confidentiality and regulatory compliance. The role supports process improvements and requires strong coding knowledge. The position offers a remote work setup with occasional travel to Humana offices for training or meetings. Typical hours are Monday–Friday, with a 40-hour workweek and opportunities for professional #J-18808-Ljbffr