31 coder auditor professional jobs found

Become a part of our caring community The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we...

CorroHealth Inc in Wisconsin is looking for a qualified Coding Auditor to perform complex analyses of medical records to identify errors and ensure compliance. The position requires a recognized coding credential and at least two years of related experience. The Coding Auditor will collaborate with coders, providing technical support and monitoring quality. Strong communication and analytical skills, coupled with attention to detail, are essential for success. The role offers a supportive work environment with opportunities for professional development. #J-18808-Ljbffr

At Suvida Healthcare, we are not just caregivers; we’re compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well‑being of an underserved community and their families. Our multi‑disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare‑eligible Hispanic seniors. Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service‑centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos , to help achieve our Higher Purpose? What Makes Us Unique We are an empowered...

This role will have all responsibilities of coder I, II and III in addition to: reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Responsible for coding high dollar and long length of stay cases for all patient types. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate. Serves as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations. Maintain continuing education by attending...

CorroHealth Inc in Wisconsin is looking for a qualified Coding Auditor to perform complex analyses of medical records to identify errors and ensure compliance. The position requires a recognized coding credential and at least two years of related experience. The Coding Auditor will collaborate with coders, providing technical support and monitoring quality. Strong communication and analytical skills, coupled with attention to detail, are essential for success. The role offers a supportive work environment with opportunities for professional development. #J-18808-Ljbffr

Job Description Job Description The Ambulatory Coding and Reimbursement Specialist is responsible for reviewing, analyzing, and accurately coding ambulatory and/or hospital-based encounters. This role performs initial charge review for E/M visits, diagnostic tests, and procedures across multiple specialty departments to determine the appropriate assignment of CPT, ICD-10, HCPCS codes, and modifiers for reporting physician services to third-party payers. The Specialist ensures all coding aligns with established coding standards, regulatory requirements, and reimbursement policies. Essential Duties and Responsibilities: Analyzes provider documentation to assure the appropriate Evaluation & Management levels are assigned using the correct CPT and current Evaluation and Management Guidelines Interprets outpatient office visit notes and charge documents to determine services provided and accurately assign CPT , Modifiers, and ICD-10 coding to these services. Performs...

Susan Graham Consulting is seeking a knowledgeable Risk Adjustment Coder to support healthcare audit and validation initiatives. This remote contract role focuses on reviewing medical records and ensuring coding accuracy while collaborating with teams to resolve discrepancies. The ideal candidate will have a CRC certification and a minimum of 3 years of relevant experience, excel in attention to detail, and understand risk adjustment methodologies. This opportunity offers a chance to work in a fast-paced environment supporting healthcare projects. #J-18808-Ljbffr

Job Opportunity at SSM Health St. Mary's Hospital - Madison It's more than a career, it's a calling. Worker Type: Regular Job Highlights: Monday to Friday, 8:00 to 4:30 (flexible), full-time (.9/36 hours). This is a new role supporting imaging and procedure lab charges and charge reconciliation. The individual will help define and build the role. The position supports St. Mary's and the WI region as needed. Job Summary Supports assigned department(s) as a subject matter expert for achieving operational efficiency, compliance, and exceptional patient care. Serves as a liaison between and resource for clinical and Revenue/Financial departments with strong understanding of both components. Job Responsibilities and Requirements PRIMARY RESPONSIBILITIES Serves as a resource and subject matter expert to the department for workflows, documentation, coding, charging, and software applications. Manages all work queues using subject matter expertise to investigate/correct errors...

Become a part of our caring community. Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will perform quarterly...

Humana Inc is seeking an IPA Consultative Coder to collaborate with multi-disciplinary teams in delivering quality care. The role involves educating providers on coding best practices, conducting documentation audits, and supporting coding accuracy within assigned clinics. Qualified candidates will have at least 3 years of risk adjustment medical coding experience and relevant certifications like CCS, CRC, or CPC. This is a hybrid position requiring occasional travel within the assigned market. #J-18808-Ljbffr

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 Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Minimum Qualifications Education: High school diploma or GED, required....

Overview This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. Responsibilities Essential Functions: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements. Identify coding discrepancies and formulate suggestions for improvement. Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. Work with medical staff department to identify and assist providers with coding. Report findings and recommendations...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based on documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

600 Advocate Health, Inc. is seeking an experienced coder for inpatient operations in Milwaukee, Wisconsin. The role involves reviewing complex documentation and ensuring compliance with coding standards. Candidates need at least 7 years of acute care coding experience, a coding certification from AAPC or AHIMA, and a strong understanding of the relevant coding guidelines. Key responsibilities include coding diagnosis and procedure codes, participating in audits, and collaborating with clinical teams to improve coding accuracy. #J-18808-Ljbffr

Major Responsibilities This role will have all responsibilities of coder I, II and III in addition to reviewing complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Responsible for coding high dollar and long length of stay cases for all patient types. Expertise in query guidelines and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate. Serve as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations. Maintain continuing...

Position Summary Applies CPT-4 and HCPCS codes to medical records for the cardiovascular lab and interventional radiology departments based on physicians’ documentation. Adheres to strict federal coding rules and guidelines, achieving 95% coding accuracy while meeting billing deadlines. Essential Responsibilities Code surgical procedures performed by cardiologists and interventional radiologists. Verify supplies used during procedures. Use encoders and other reference materials effectively. Maintain appropriate non‑leading queries to physicians. Abstract services from physician documentation and procedure logs. Reconcile monthly surgical logs. Manage multiple job tasks daily (WQs, emails, surgical logs, census, etc.). Prepare Excel analysis, including V‑Lookups and pivot tables. Gather and compile data systematically, document assumptions, and validate accuracy to resolve inconsistencies. Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and...

OU Health in Wisconsin is looking for a Professional Coding Specialist III to act as a senior coding expert and mentor within their Revenue Integrity department. This role is pivotal in ensuring compliant coding and high audit defensibility. The ideal candidate will have over five years of experience in complex coding, specifically for high-dollar services, while also supporting training and development for Coding Specialists. Benefits include PTO, 401(k), and comprehensive medical plans in a supportive environment. #J-18808-Ljbffr

Department 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status Full time Benefits Eligible Yes Hours Per Week 40 Schedule Details/Additional Information This role will comply with all departmental scheduling policies and expectations. Will support Inpatient Community Core - WI/IL division Schedule Monday - Friday 1st shift 40 hours a 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 $28.55 - $42.85 Major Responsibilities This role will have all responsibilities of coder I, II and III in addition to: reviews complex...

Position Summary Applies CPT-4 and HCPCS codes to medical records for the cardiovascular lab and interventional radiology departments based on physicians’ documentation. Adheres to strict federal coding rules and guidelines, achieving 95% coding accuracy while meeting billing deadlines. Essential Responsibilities Code surgical procedures performed by cardiologists and interventional radiologists. Verify supplies used during procedures. Use encoders and other reference materials effectively. Maintain appropriate non‑leading queries to physicians. Abstract services from physician documentation and procedure logs. Reconcile monthly surgical logs. Manage multiple job tasks daily (WQs, emails, surgical logs, census, etc.). Prepare Excel analysis, including V‑Lookups and pivot tables. Gather and compile data systematically, document assumptions, and validate accuracy to resolve inconsistencies. Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and...

JOB SUMMARY: The primary purpose of the position is to review both procedural and diagnostic (ICD-10) coding to ensure appropriate billing and insurance regulations are met. This position will be staffed during clinic hours and is largely remote. Occasionally in-person meetings with providers will be required. Must live within reasonable traveling distance from Hudson, WI.CORE DUTIES AND RESPONSIBILITIES:Have in-depth understanding of coding and compliance rules and regulations.Responsible for reviewing provider documentation, coding and posting charges for healthcare services; including Primary Care, Lab/Pathology, Podiatry and more.Provide coding education and engage with assigned providers.Research and communicate governmental and payer-specific rules and regulations to ensure coding compliance.Identify and communicate best practices based on provider documentation, insurance payer medical policies and CMS guidelines.Review, code and post charges for hospital outpatient and...

Overview Providence requires a Compliance Auditor – Remote. The Revenue Cycle Compliance Hospital Auditor evaluates compliance with federal and state laws, regulatory rules, and Providence policies and procedures across a variety of audit focus areas, including clinical and nonclinical services related to revenue cycle operations. The auditor works collaboratively with Case Management, Utilization Review, Revenue Integrity, the Professional Revenue Cycle Compliance Team, Clinical Risk, Internal Legal Affairs, and Finance under the supervision of the Rev Cycle Compliance Senior Manager. The role involves navigating and analyzing data across clinical EMR and Epic billing systems, reviewing line-item charges, revenue codes, CPT descriptions, status, orders, supporting documentation, and reimbursement. Audit findings are presented verbally and visually to reduce risk within the Providence system. Overpayments received in error are refunded following the CMS Voluntary Self Disclosure...

Job Opportunity at SSM Health St. Mary's Hospital - Madison It's more than a career, it's a calling. Worker Type: Regular Job Highlights: Monday to Friday, 8:00 to 4:30 (flexible), full-time (.9/36 hours). This is a new role supporting imaging and procedure lab charges and charge reconciliation. The individual will help define and build the role. The position supports St. Mary's and the WI region as needed. Job Summary Supports assigned department(s) as a subject matter expert for achieving operational efficiency, compliance, and exceptional patient care. Serves as a liaison between and resource for clinical and Revenue/Financial departments with strong understanding of both components. Job Responsibilities and Requirements PRIMARY RESPONSIBILITIES Serves as a resource and subject matter expert to the department for workflows, documentation, coding, charging, and software applications. Manages all work queues using subject matter expertise to investigate/correct...

Houston Methodist is seeking a Lead Outpatient Coder to provide administrative support and ensure accurate coding to outpatient encounters. This position interacts with management, staff, and physicians, resolving routine matters and conducting quality assurance audits. The ideal candidate should have at least five years of outpatient coding experience and certifications as RHIT, RHIA, or CCS. Candidate will also mentor staff and participate in continuous quality improvement activities. #J-18808-Ljbffr