53 coder quality auditor jobs found

Physician Coding Auditor The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding. Orlando Health is committed to providing benefits that go beyond the expected, with career-growing free education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective populations in our...

Physician Practice E&M Auditor Educator, MCVI Administration, FT, 8A-4:30P (Remote) Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the...

Health Information Management (HIM) Coder Location: Miramar, Florida 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. Summary Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance. Responsibilities For hospital encounters, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing. Reviews chargemaster generated CPT/HCPCS codes, when errors are found Coding Management is notified to alert Charge Management to educate department making errors. Makes appropriate coding corrections when...

Overview Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families...

Physician Coding Auditor The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding. Orlando Health is committed to providing benefits that go beyond the expected, with career-growing free education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective populations in our...

Location: Miramar, Florida 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. Summary: 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. Responsibilities: Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and...

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. Summary: Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements. Responsibilities: Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify...

Position Summary Department : Patient Accounting- Physicians Status: Full Time Shift: Remote Location: Orlando, FL Title: Physician Coding Auditor Summary: The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding. Forbes has named Orlando Health as one of America's Best-In-State Employers. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not...

Job Description This entry-level position is responsible for auditing outpatient and ambulatory services claims to federally funded healthcare payors across the Baptist Physician Enterprise (BPE) organization. The position audits and provides feedback as needed and attends BPE department meetings as needed to respond to compliance related coding and billing questions and provide feedback on audit findings and necessary remediation/corrective action requirements. The position analyzes coded records for compliance with federal, state and third-party insurer rules and regulations and note trends. The position educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements; and maximize reimbursement. This role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the...

At **ModMed**, we’re not just building software—we’re reimagining the healthcare experience. Founded in 2010 by a practicing physician and a successful tech entrepreneur, we took a radically different approach: **we hired doctors and taught them how to code.** This "for doctors, by doctors" philosophy has allowed us to create an AI-enabled, specialty-specific cloud platform that places patients at the center of care.* Responsible for analyzing, reviewing and providing feedback when performing quality assurance activities and completing QA audits, including but not limited to: + Ensuring all federal and state coding guidelines and regulations are met as well as payer guidelines + Provide effective feedback to the global coding teams to aid in their successful coding of BOOST clients + Maintaining a communication log to show successful training of the global coding team when coding trends or issues are found + Report all coding trends and issues to the department lead as they are...

Overview Department : Patient Accounting- Physicians Status : Full Time Shift : Remote Location : Orlando, FL Title : Physician Coding Auditor Summary : The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the governing compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for surgical, procedural and E/M based coding. Responsibilities Responsible for internal auditing and analyzing professional coding for all service lines. Monitor the audit results closely to identify any potential coding inaccuracy. Provide the Educators the needed support in identifying coding errors. Provide results or trends with Education Team for physician education. Review medical records to ensure coding accuracy. Identify and communicate physician documentation and coding opportunities for improvement. Provide feedback to...

Job Description Job Description Description: Position Overview The Professional Billing Coder – Vascular Surgery is responsible for accurate coding of professional services related to vascular procedures. This role supports compliant billing practices and contributes to revenue integrity and audit readiness. Requirements: Key Responsibilities • Assign accurate CPT, HCPCS, and ICD-10-CM codes for vascular surgery procedures • Review operative and procedural documentation for coding accuracy and completeness • Apply appropriate modifiers and NCCI edits • Ensure adherence to CMS, AMA, and payer guidelines • Maintain accuracy and productivity standards in a high-volume environment • Support internal audits and quality improvement initiatives Required Qualifications • Minimum 2+ years of professional billing coding experience • Proven experience with vascular surgery coding • Strong knowledge of CPT, ICD-10-CM, modifiers, and NCCI edits • CPC or equivalent certification...

Clinical Technical Supervisor The Clinical Technical Supervisor is responsible for the technical and scientific oversight of the laboratory's daily operations to ensure accurate, reliable, and timely patient test results in accordance with COLA, CLIA, and all applicable federal and state regulations. This position provides direct supervision of testing personnel, ensures compliance with quality assurance and quality control policies, and supports the laboratory's mission to deliver high-quality, patient-centered diagnostic services. The supervisor will also perform occasional bench work as needed or when short-staffed. Essential Duties and Responsibilities Technical Oversight & Quality Assurance Provide day-to-day technical supervision of all laboratory testing in compliance with COLA and CLIA requirements. Ensure that testing systems are properly functioning and providing accurate and timely results. Oversee verification, calibration, and maintenance of...

Job Description Job Description General Responsibilities: Reporting to the Director of Revenue Cycle, the Medical Coder translates clinical documentation into standardized codes for billing, reporting, and quality initiatives. This role supports coding audits, revenue cycle workflows, and regulatory compliance. Key responsibilities include verifying clinical information with medical staff, resolving documentation gaps, and collaborating with billing staff to ensure accurate claims submission. The medical coder ensures appropriate codes are assigned to all procedures and diagnoses. Essential Functions: Assigns and sequences of ICD-10-CM, CPT & HCPCS codes accurately in compliance with government and insurance regulations. Ensures codes reflect patient diagnoses and procedures as documented by clinicians, meeting payer, OSHA, and HIPAA requirements. Reviews and abstracts clinical documentation from outpatient encounters to assign accurate ICD-10-CM, CPT/HCPCS codes,...

Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Schedule: Full time Shift: Day (United States of America) Address:...

Our Promise To You Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Job Description Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding...

Essential Duties and Responsibilities: - Abstract and code clinical data. - Audit medical records to ensure compliance with the organization's coding procedures and standards. - Accurately enter coded data in a system and validate data entered. - Research correct coding practices, clearly document and share findings with others. - Review denials and recommend billing corrections. - Train staff members on the coding process. Minimum Requirements - High School diploma or equivalent with 0 - 2 years of experience. - Additional clinical licensure may be required based on project. - Must be a Certified Medical Coder, Certified Professional Coder, or a Certified Coding Specialist. - Knowledge of Medical Billing and Coding Systems such as CPT and HCPCS is essential. - Ability to work a schedule between the hours of 8:00am - 5:00pm EST Monday - Friday required. Additional Skills and Experience: - Familiarity with retrospective payment reimbursement highly preferred....

Risk Adjustment Nurse/Coder AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! Full-time permanent position (40 hours) Standard working hours: 8am to 4:30pm EST, M-F This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories...

Job Description Job Description Description: Position Overview The Professional Billing Coder – Cardiothoracic / Special Surgical is responsible for accurate and compliant coding of physician professional services for complex surgical procedures. This role supports timely claim submission, regulatory compliance, and revenue integrity within a hospital-based professional billing environment. Requirements: Key Responsibilities • Assign accurate CPT, HCPCS, and ICD-10-CM codes for cardiothoracic and other special surgical services • Review operative reports, clinic notes, and supporting documentation to ensure complete and compliant coding • Apply appropriate modifiers, bundling rules, and NCCI edits • Ensure compliance with CMS, AMA, and payer-specific billing guidelines • Identify documentation gaps and communicate clarification needs as appropriate • Meet established productivity and quality standards • Participate in internal quality reviews and audits as required...

Job Description Job Description Porter is hiring a Risk Adjustment Coder to join our Team!   Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience.    Position Overview We are seeking a certified coder with expertise in risk adjustment coding and...

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS...

A leading medical center in Florida seeks a Risk Adjustment Coder to perform coding audits and ensure accuracy in health records. Candidates should have 10+ years in coding, strong knowledge in coding guidelines, and relevant certifications. This position emphasizes teamwork to improve patient care and data quality through education and compliance initiatives. Competitive pay starting at $25.23 per hour with benefits included. #J-18808-Ljbffr

Department: Health Information Management Address: 1611 NW 12 Ave, Miami, FL 33136 Shift Details: Monday to Friday, 7:30 AM to 4 PM (Remote but open to applicants who reside in the state of Florida) Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world's top medical providers for all levels of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University of Miami Miller School of Medicine. Here, the best people come together to deliver Jackson's mission for our diverse communities. Our employees are committed to providing the best CARE by demonstrating compassion, accountability, respect, and expertise in everything we do. Summary HIM Outpatient Coder 2 is responsible...

Job Description Job Description Position Summary The Clinical Technical Supervisor is responsible for the technical and scientific oversight of the laboratory’s daily operations to ensure accurate, reliable, and timely patient test results in accordance with COLA, CLIA, and all applicable federal and state regulations. This position provides direct supervision of testing personnel, ensures compliance with quality assurance and quality control policies, and supports the laboratory’s mission to deliver high-quality, patient-centered diagnostic services. The supervisor will also perform occasional bench work as needed or when short-staffed. --- Essential Duties and Responsibilities Technical Oversight & Quality Assurance · Provide day-to-day technical supervision of all laboratory testing in compliance with COLA and CLIA requirements. · Ensure that testing systems are properly functioning and providing accurate and timely results. · Oversee verification,...