32 coder auditor professional jobs found

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...

Summary: The Lead Professional Coder is responsible for day‑to‑day operations of the Coding Unit. The Lead Professional Coder will be auditing, coordinating, and ensuring that optimal coding is associated with medical records, data integrity, and quality of documentation is met in accordance with Rogers Medical Staff by‑laws, Joint Commission, Federal and State regulations, in addition to acting as a liaison between clinical and administrative teams such as medical staff, nursing, regulatory, compliance, patient financial services, etc. The Lead Professional Coder is an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Possesses comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. Interacts with all...

Summary: The Lead Professional Coder is responsible for day-to-day operations of the Coding Unit. The Lead Professional Coder will be auditing, coordinating, and ensuring that optimal coding is associated with medical records, data integrity, and quality of documentation is met in accordance with Rogers Medical Staff by-laws, Joint Commission, Federal and State regulations, in addition to acting as a liaison between clinical and administrative teams such as medical staff, nursing, regulatory, compliance, patient financial services, etc. The Lead Professional Coder is an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Possesses comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. Interacts with all...

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...

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...

Your Future Role At A Glance Location: Remote Department: Revenue Cycle Management Schedule: Full-time | Day Shift How You'll Make An Impact In This Role Abstract & Code Records: Abstract relevant medical information and assign accurate ICD, CPT, and HCPCS codes to establish DRG or APC assignments, including handling complex cases. Query & Collaborate: Query physicians to clarify ambiguous, incomplete, or unclear record documentation, and provide appropriate education to physicians and associates. Audit & Comply: Conduct internal coding and physician documentation audits while maintaining strict adherence to AHIMA's Standards of Ethical Coding and official guidelines. Perform & Stay Current: Maintain required productivity and quality standards while continually keeping up-to-date with evolving coding, compliance, and reimbursement rules. What Minimum Requirements You'll Need Licensure / Certification / Registration: Certified Coding Specialist (CCS)...

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...

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 specializing in Risk...

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 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 Responsibilities reviews complex...

Medical Records Technician (Coder-Inpatient/Outpatient)The Medical Records Technician (Coder-Inpatient/Outpatient) is located in the Health Information Management (HIM) section at the Clement J. Zablocki VA Medical Center. Medical Records Technicians (Coder-Inpatient/Outpatient) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, analyze and abstract patients' health records, and assign alpha-numeric codes for each diagnosis and procedure. To perform this task, they must possess expertise in International Classification of Disease(ICD), Current Procedural Terminology(CPT) and the Healthcare Common Procedure Coding System (HCPCS).Duties include but are not limited to:Select and assign codes from current versions of ICD CM, PCS, and/or CPT and HCPCS classification systems for inpatient/outpatient facility and/or professional services.Code all complicated and complex medical/specialty diseases processes, patient...

Your future role at a glance Location: Remote Department: Revenue Cycle Management Schedule: Full-time | Day Shift How you’ll make an impact in this role Abstract & Code Records: Abstract relevant medical information and assign accurate ICD, CPT, and HCPCS codes to establish DRG or APC assignments, including handling complex cases. Query & Collaborate: Query physicians to clarify ambiguous, incomplete, or unclear record documentation, and provide appropriate education to physicians and associates. Audit & Comply: Conduct internal coding and physician documentation audits while maintaining strict adherence to AHIMA's Standards of Ethical Coding and official guidelines. Perform & Stay Current: Maintain required productivity and quality standards while continually keeping up-to-date with evolving coding, compliance, and reimbursement rules. What minimum requirements you’ll need Licensure /...

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...

ThedaCare seeks a Clinic Coding II to review and assign CPT/ICD-10-CM codes for primary and specialty services, ensuring accurate, compliant documentation. You will audit medical records, educate providers, and collaborate with clinical teams to improve coding quality and reimbursement. Based in Neenah, Wisconsin, this full-time, remote-friendly role offers 40 hours weekly, daytime hours, and opportunities for professional growth within ThedaCare's coding organization. #J-18808-Ljbffr

## Medical Coding Specialist - Outpatient (full-time)Applyremote type: Fully Remotelocations: Remote WI - Reside in WI: Remote IL - Reside in ILtime type: Full timeposted on: Posted Todayjob requisition id: JR100604Looking to be part of a team that provides extraordinary healthcare from the heart? You Belong Here.100% Remote position with option to work onsite. **Wisconsin or Illinois residency required****POSITION SPECIFICS****Title:** Medical Coding Specialist – Outpatient**FTE:** 1.0 (40 hours per week)**Schedule:** Monday to Friday, five (5) 8-hour shifts between hours of 6am and 5pm**Holiday Rotation:** None**Weekend Rotation:** None**On Call Requirements:** None**POSITION SUMMARY**Reviews medical reports and physician documentation for clinic and hospital outpatient services in order to apply diagnostic and procedural codes to individual patient health information for claims processing, data retrieval and analysis.This role will primarily focus on Emergency...

Major Responsibilities: 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...

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...

Country-wide Remote US-Nationwide-FIELD Full time 20189391 What Ethics & Compliance contributes to Cardinal Health Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues. Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies. Job Summary The Compliance Auditor is responsible for conducting coding, documentation audits to ensure adherence to regulatory requirements, payer policies, and organizational...

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...

Title: Medical Coding/ Education Specialist Location: Remote, preferably in Texas Compensation: $65,000 - $75,000 per year Must have Post Acute Care Experience We are seeking an accomplished Medical Coding and Education Specialist to join our healthcare team, focusing on enhancing coding accuracy and compliance within our post-acute care facilities. This role involves reviewing medical records, assessing for accurate provider cpt and ICD-10 codes, and developing educational materials. Additionally, the specialist will collaborate closely with our technology and revenue cycle teams to optimize EMR processes, streamline documentation, and reduce coding denials. Responsibilities: Conduct regular coding audits and reviews to ensure compliance with coding guidelines, regulatory requirements, and reimbursement policies. Develop and deliver educational materials, training modules, and resources on coding guidelines, regulatory updates, and documentation...

Rogers Behavioral Health in Wisconsin seeks a Lead Professional Coder to oversee the Coding Unit, audit records, and ensure accurate documentation within EHR systems. You will lead education, maintain data integrity, and ensure compliance with Joint Commission and state regulations while collaborating with clinical and administrative teams. The role requires expertise in ICD-9/ICD-10, CPT/HCPCS coding, DRG assignments, and ongoing regulatory updates. #J-18808-Ljbffr

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...

Rogers Behavioral Health in Wisconsin seeks a Lead Professional Coder to oversee the Coding Unit, audit records, and ensure accurate documentation within EHR systems. You will lead education, maintain data integrity, and ensure compliance with Joint Commission and state regulations while collaborating with clinical and administrative teams. The role requires expertise in ICD-9/ICD-10, CPT/HCPCS coding, DRG assignments, and ongoing regulatory updates. #J-18808-Ljbffr

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 encourage you...

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding compliance. You will review medical records for CPT/HCPCS and Revenue codes, document findings, and communicate findings to investigators, leadership, and regulators. Travel may be required to support cases and audits. Required CPC certification with 3+ years of coding experience, including record review, and proficiency in CPT/HCPCS, CMS 1500, and #J-18808-Ljbffr