45 coder quality auditor jobs found

Coder Quality Auditor The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties. Job Responsibilities: Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders'...

Compliance Coding Auditor The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct. This role will help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures. The position plays a key role in oversight of Sharp HealthCare's (SHC) compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits. Required Qualifications: 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT. Preferred Qualifications: Strong...

Professional Coding Auditor El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen. Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for. FTE: 1 Scheduled Bi-Weekly Hours: 80 Work Shift: Day: 8 hours Job Description The Professional Coding Auditor performs reviews for professional/clinic based clinic visits and hospital setting claims reviewing provider's diagnosis and procedural coded claims in ensuring coded data is in compliance with Official Coding Guidelines and American Medical Association CPT/HCPCS procedural coding conventions. The role of the auditor is to educate providers performing services...

Coding Compliance Auditor In accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant. The Coding Compliance Auditor will also provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics Re: coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems...

DRG Coding Auditor Principal 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 considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case...

Multispecialty Surgery Coder II The Multispecialty Surgery Coder II will code for multispecialty surgery physicians primarily single path coding. Multi-specialty surgical coding experience, any trauma, urology, ENT, plastics, gen surg, OB/GYN, cardiovascular, interventional radiology, etc. Ability to extract data and apply appropriate ICD-10 diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding managerthe coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM official guidelines for coding and reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve...

Job Description Job Description Education and/or Experience :   Must have these requirements under the umbrella of the HCC industry: Requires knowledge in HCC Coding documentation guidelines. Requires technical expertise in ICD-9-CM or ICD-10-CM. Strong skills in medical record audit and review. Regulatory requirements for coded data. Medical record documentation requirements. Understanding of healthcare data systems. Proficiency in MS Outlook and Word. Strong proficiency with Excel--must have ability to prepare spreadsheets. Excellent written and verbal communication skills. Certification is a plus with HCC. AHA coding clinic is a plus. Certification required in CPC and/or CCS, and CRC is a plus. Hybrid Schedule Requirements Part A Monday - Wednesday onsite / Thursday - Friday Remote Part B Wednesday - Friday Onsite / Monday - Tuesday Remote   We are looking for HCC Risk Adjustment Auditors/Coders to join our team!   Position...

Compliance Coding Auditor page is loaded## Compliance Coding Auditorlocations: System Services-Telecommutertime type: Full timeposted on: Posted 30+ Days Agojob requisition id: JR180837**Hours****:****Shift Start Time:**Variable**Shift End Time:**Variable**AWS Hours Requirement:**8/40 - 8 Hour Shift**Additional Shift Information:****Weekend Requirements:**No Weekends**On-Call Required:**No**Hourly Pay Range (Minimum - Midpoint - Maximum):**$49.700 - $64.130 - $71.820The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. \*This is a remote position\***What You Will Do** The Compliance Coding Auditor is responsible for the...

DRG Coding Auditor Principal _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 considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group...

. Remote Coding Auditor - Risk Adjustment Are you a risk adjustment coder that is wanting to expand into an auditing role?Do you have 3 years or more of risk adjustment coding experience? Perks: Flexible, full time schedule Stable and ongoing consulting position $30-40 an hour! Equipment provided World-class training and technology Job Description The Risk Adjustment Coding Auditor will be responsible for conducting documentation reviews to assess the accuracy, completeness, and highest ICD-10 specificity related to risk adjustment and HCC coding guidelines, and assist educating in medical necessity coverage of diagnostic studies.Responsible for performing quality review audits of medical records coded by Risk Adjustment coding team to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance...

Overview Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all. The Compliance Auditor supports Marin Community Clinics’ compliance, risk management, and quality programs by performing independent audits, monitoring activities, and data validation to ensure adherence to federal and state regulations. This includes HRSA Health Center Program requirements, FTCA, CMS billing and documentation rules, Medi-Cal, TJC standards, HIPAA/HITECH, 42 CFR Part 2, California health laws, and internal policies. The role works closely with...

Shared Services: Compliance- (Full-Time, Day Shift) - Job Summary: The Compliance Auditor-Physician monitors and audits established mechanisms and controls to ensure compliance with regulations. Audits the activities of various departments for compliance with plans, policies and procedures prescribed by management. Prepares and submits reports on the results of audits, recommending improvements in policies and procedures. Cooperates with outside auditors in any undertaking that may expedite their work. Performs other duties as needed. Conducts full range of physician-based audits/projects and develops partnerships with internal and external customers. Performs other duties as needed. Education and Experience: Bachelor's Degree required. Master's Degree preferred. Minimum three years of experience in auditing within healthcare, compliance, regulatory oversight agency, quality management, quality assurance or business analysis. Knowledge and Skills: Experience with...

Description The Departments of Obstetrics & Gynecology, Surgery, and Urology at UCLA seek to hire a Controls and Compliance Auditor. The Controls and Compliance Auditor is an important member of the departmental administrative team, reporting to the Director of Business Analytics & Quality Improvement. in this role you will be the subject-matter expert on UCLA’s Distributed Administrative Computing Security System (DACSS) and associated systems. You will also provide oversight and support in the daily operations of internal controls for a variety of accounting cycles including financial reporting, travel and entertainment, and revenue. Pay Range: $78,500.00 - $163,600.00 annually. #J-18808-Ljbffr

Coding Auditor - Drg/Apc Coordinator Be a part of a world-class academic healthcare system at UChicago Medicine as a Coding Auditor - DRG/APC Coordinator for the Health Information Management department. This is a remote, work from home opportunity and you may be based outside of the greater Chicagoland area. In this role, the Coding Auditor - DRG/APC Coordinator is responsible for ensuring accuracy and quality of coding assignments for all records requiring DRG and/or APC coding, and ensures optimal and timely reimbursement. Essential Job Functions Performs data quality reviews on inpatient and outpatient records to ensure proper coding guidelines have been followed and appropriate DRG or APC assignments have been made for appropriate reimbursement Provides DRG/APC and coding quality information and statistical reports to the Coding Manager Communicates with the Medical Staff and House staff as needed to discuss clinical questions with respect to the assignment of...

Medical Biller I, II, III Under the direct supervision of the Director of Business Office, the Medical Biller is responsible for utilizing both practice management systems; Athena and NextGen. The employee is responsible for preparing and posting fee tickets for various sites and programs. The Medical Biller will post and balance payments received, handle all incoming billing calls, and work aging for various programs and payers. The employee will send patient statements, run month end reports, and submit third party claims electronically and/or manually. The employee will ensure that all providers and facilities are paneled with the various insurances and state programs. The Medical Biller will maintain current knowledge of CPT, HCPC and ICD10 coding practices. The Medical Biller will also maintain knowledge of all programs and payer sources requirements and guidelines. The employee will adhere to HIPAA guidelines and regulations. It is the primary purpose of CHCCC to provide...

Vista Community Clinic (VCC) At Vista Community Clinic (VCC), we believe healthcare is more than medicine, it's about hope, community, and impact. For over 50 years, we've been a leader in the community clinic movement, growing from a small volunteer-driven effort in Vista to a nationally recognized network of state-of-the-art clinics across San Diego, Orange, Los Angeles, and Riverside counties. Today VCC has 14 clinics serving over 70,000 patients annually, we continue our mission of delivering exceptional, patient-centered care where it's needed most. As a private, non-profit, multi-specialty outpatient clinic, VCC provides more than healthcare, we provide opportunity. Here your skills are celebrated, your growth is supported and your work makes a difference. We know that our success is a direct result of the exceptional talents and dedication of our employees. Benefits include: Competitive compensation & benefits Medical, dental, vision Company-paid life insurance...

Outpatient Facility-Clinic Medical Coder (Multi-Specialty) Part-Time We are seeking a detail-oriented and analytical Outpatient Facility-Clinic Medical Coder (Multi-Specialty) to join our remote US-based coding team. In this role, you will be responsible for accurately assigning diagnostic and procedural codes for various medical specialties in an outpatient setting. The ideal candidate will have a strong understanding of medical coding principles and healthcare regulations. Schedule & Compensation This is a part-time position (2030 hours per week) with a pay range of $30$40 per hour. Initial training will be conducted during standard business hours (MondayFriday, 8 a.m.5 p.m.) for approximately 2030 hours per week. Following training, work hours can transition to a flexible schedule. Job Description Analyze patient medical records and assign appropriate ICD-10-CM, CPT, and HCPCS codes for outpatient services across multiple specialties Ensure coding accuracy and...

Benefits: 401(k) 401(k) matching Company parties Competitive salary Employee discounts Health insurance Paid time off Training & development Vision insurance Position Overview The ICD-10 Home Health & Hospice Medical Coder is responsible for accurately reviewing, analyzing, and assigning ICD-10-CM diagnosis codes to clinical documentation for home health and hospice services. This role ensures compliance with CMS guidelines, OASIS requirements, and agency policies to support precise reimbursement, high-quality patient care, and regulatory compliance. The ideal candidate has demonstrated experience in Home Health ICD-10 coding, strong knowledge of OASIS/Evaluation criteria, and a thorough understanding of PDGM (Patient-Driven Groupings Model). Key Responsibilities Coding & Documentation Review Review clinical documentation to identify appropriate and accurate ICD-10-CM codes for home health and hospice encounters. Assign primary and...

Job Description Job Description Description: Join Elica’s mission and become a part of a team where every day is an opportunity to make a positive impact in your community! At Elica Health Centers, we share a common goal: provide the best possible patient care to our growing community! Our passion extends throughout Elica, from the exceptional healthcare services we provide to our underserved patients at our Community Health Clinics and state-of-the-art mobile medicine program, Health on Wheels, to our Resource Center where we empower patients and members of the community to connect with resources to help them build healthy and full lives. WHAT YOU'LL DO: Oversees the back office clinic operations to ensure the work flow runs smoothly. The Back Office Supervisor ensures adequate staffing levels for the back office by managing medical assistant schedules and monitors daily medical assistant functions. The Back Office Supervisor ensures that patients receive excellent...

Medical Record Coder At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding. Submits daily productivity report to HIM manager by defined deadline. Meets and maintains HIM coding quality and...

Medical Coder Bizforce and our medical billing division, MedCore Solutions, are seeking skilled Medical Coders to join our growing team. As a Medical Coder at MedCore, you will be responsible for translating details from a patient's medical documents into medical codes for health insurance claims purposes. Additionally, you will be liaising with the client and team members for coding-related queries and concerns, performing audits for coding denials and missing information, and maintaining a tracking system for coded charts. MedCore allows the best talent in PH to work remotely from home with the latest technology and resources. We are partnering with some of the largest healthcare platforms in the world. If you are looking to advance your career and improve your skills with an industry leader, we encourage you to apply today! MedCore Solutions (MCS) is a single-source solution for Healthcare administration. MCS is an industry leader in medical billing, credentialing, scribing,...

Job Opportunity At The GEO Group Are you looking for a career you can feel good about? We hire only those that strive to do their best. By joining our family, you'll receive the honor and recognition that comes with working for the industry's global leader in evidenced based rehabilitation. GEO provides complementary, turnkey solutions for numerous government partners worldwide across a spectrum of diversified correctional and community reentry services. From the development of state-of-the-art facilities and the provision of management services and evidence-based rehabilitation to the post-release reintegration and supervision of individuals in the community, GEO offers fully diversified, cost-effective services that deliver enhanced quality and improved outcomes. We believe that work is more than a place you go to every day. It is about being inspired and motivated to achieve extraordinary things. Employee benefits play an important role in making The GEO Group a great place...

Medical Coder Trajectory RCS joined the MedHQ family in 2024 after enjoying 10 years as a well-established revenue cycle company with an annual growth rate of 40% to 50% and 150 employees. Together they now serve small hospitals, physician groups, ambulatory surgery, and outpatient centers nationwide by optimizing healthcare cash flow through integration of both business office processes and clinical documentation. MedHQ, LLC, is a fast growing, leading provider of consulting and technology enabled expert services for outpatient healthcare. With a 97% long-term, client retention rate spanning over 20 years, MedHQ serves Ambulatory Surgery Centers (ASCs), Surgical Hospitals, Physician Practices, and Hospital and Healthcare Outpatient Facilities nationwide. The MedHQ RITE Values: Respect, Innovation, Trust, and Energy, permeate all service line offerings with a unique personalized approach balancing exceptional transactional and emotional intelligence, and above all excellent...