18 coder quality auditor jobs found

Christie Clinic's department of Compliance Quality is seeking a full-time Compliance Auditor/Educator at our Clark Street location in Champaign from Monday-Friday 8:00am-5:00pm, with no night or weekend requirements. Duties include performing ongoing functions related to quality of care and compliance including government and clinic regulations and policies in support of the Christie Clinic Compliance System. JOB DUTIES: (This list may not include all of the duties assigned.) Screen, review, identify and document potential quality and compliance issues. Perform billing and coding audits with both random samples as well as provider and department specific samples; and as required. Meet with providers to share audit results and guidance for accuracy rate improvement. Prepare educational materials specific to new provider's specialty and assist with orientation sessions. Review new providers' daily charges and offer feedback. Notify providers of CPT and diagnosis...

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.Day (United States of America)**Location**Ann & Robert H. Lurie Children's Hospital of Chicago**Job Description****Summary:**Conducts retrospective audit of ambulatory and inpatient physician documentation to ensure billing accuracy and compliance. Accounts for concurrent inpatient billing accuracy and compliance for selected Divisions. Provides physician education on coding and documentation guidelines.**Essential Job Functions:**• Reviews and audits physicians’ documentation in the medical record and...

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. 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 rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending...

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...

Anticipated End Date: 2026-01-05 Position Title: Diagnosis Related Group Clinical Validation Auditor (CDI, MS-DRG, AP-DRG and APR-DRG) Job Description: Be Part of an Extraordinary Team 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. Build the Possibilities. Make an Extraordinary Impact. Title: Diagnosis Related Group Clinical Validation Auditor (CDI, MS-DRG, AP-DRG and APR-DRG) 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from 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 (DRG) methodology,...

Job Description 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 ICD-10-CM and...

Inpatient Medical Coding Auditor page is loaded## Inpatient Medical Coding Auditorlocations: Remote Nationwidetime type: Full timeposted on: Posted Todayjob requisition id: R-397764# **Become a part of our caring community and help us put health first**The Inpatient 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.Where you Come InHumana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and...

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long‑term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare...

Become a part of our caring community and help us put health first The Inpatient 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Medical Coder III Hourly Pay Range: $26.61 - $39.92 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. Position Highlights: Position: Medical Coder III Location: Warrenville, IL Full Time Hours: Monday-Friday, [hybrid] A Brief Overview: The Medical Coder III is a senior-level position responsible for ensuring precise coding of diagnoses and procedures in compliance with established coding guidelines and regulations. This role is integral to maintaining financial accuracy and regulatory compliance within our institution. What you will do: Assign accurate diagnostic (ICD-10-CM) and procedural (CPT) codes to medical records, demonstrating advanced proficiency in complex coding scenarios. Lead and conduct internal audits of medical records and coding work to ensure the accuracy and consistency of code assignments, providing guidance and feedback to junior coders. Analyze clinical documentation in...

* Maintains advanced-level expertise in CPT, ASA, ICD-10, HCPCS, modifier use, medical terminology, payer rules, HIPAA, and institutional billing requirements.* Independently reviews, abstracts, and codes highly complex anesthesiology services, including time-based anesthesia, staffing, and critical event documentation.* Ensures all services documented in the patient record are coded and posted accurately; obtains additional documentation in a timely manner following established protocols.* Meets or exceeds departmental productivity and accuracy standards.* Research and resolves coding-related edits, payer rejections, insurance denials, and PHA account issues.* Tracks inpatient anesthesia services and reconciles professional and PHA charges to ensure complete and accurate capture.* Reviews denial and rejection trends, identifies workflow, documentation, or compliance issues affecting reimbursement, and escalates issues as appropriate.* Serves as a knowledge resource to clinical...

The Senior / Super Coder serves as a high-performing coding professional responsible for the accurate and timely assignment of ICD-10-CM/PCS, CPT, and HCPCS codes for all hospital services including inpatient, outpatient, emergency, surgery, and RHC encounters. This position functions as the department’s top-tier coder and provides advanced coding expertise, mentorship, and support to the Coding Team Leader, enabling her to focus on quality assurance, compliance, and education. The Senior Coder must maintain exceptional accuracy, productivity, and compliance with official coding guidelines, payer requirements, and FMH policy. Key Responsibilities Independently review and abstract complex clinical documentation for accurate code assignment. Assign appropriate ICD-10-CM/PCS, CPT, and HCPCS codes using the 3M encoder across multiple service lines. Resolve coding edits, medical necessity issues, and payer rejections efficiently. Collaborate with providers and the Coding Team...

Join to apply for the HOME HEALTH CODER/OASIS (PT DAYS) role at Riverside Healthcare Overview The Home Health Coder/OASIS is responsible for ensuring accurate and timely coding of home health services, including OASIS (Outcome and Assessment Information Set) data, in compliance with regulatory requirements and Riverside Healthcares standards. This role plays a critical part in the home health billing and reimbursement process, directly contributing to optimal patient care and financial outcomes. The ideal candidate will have a strong background in home health coding, be detail‑oriented, and possess a deep understanding of OASIS documentation submission. Essential Duties Review, analyze, and code home health care documentation according to current coding guidelines and regulations. Ensure accurate and timely submission of OASIS assessments, collaborating with clinical staff to ensure completeness and accuracy. Monitor and audit coding practices to maintain compliance with...

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. All candidates must be within a reasonable commuting distance from the posting location(s) unless an accommodation is required by law. Responsibilities Analyzes and audits claims by integrating advanced coding principles from the Official Coding Guidelines, Coding Clinics, and the ICD‑10 Alphabetic and Tabular Indices, complex clinical guidelines, and maintains objectivity in all audit activities. Draws on advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to substantiate sophisticated conclusions. Utilizes audit tools, workflow systems, and reference information to make audit determinations and generate audit findings letters. Validates accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and...

Medical Coder II page is loaded## Medical Coder IIlocations: SRO Corporate Center Warrenville 4201 Winfield Roadtime type: Full timeposted on: Posted Todayjob requisition id: R36150**Hourly Pay Range:**$24.86 - $37.29 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.**Position Highlights:*** Position: Medical Coder II* Location: Warrenville, IL* Full Time/Part Time: Full Time* Hours: Monday-Friday, during normal business hours**A Brief Overview:** The Medical Coder II plays a key role in our hospital's revenue cycle by accurately coding diagnoses and procedures in accordance with established coding guidelines. This position is essential in maintaining financial accuracy and compliance with regulatory requirements. **What you will do:*** Assign accurate diagnostic (ICD-10-CM) and procedural (CPT) codes to medical records based on clinical documentation, ensuring adherence to coding guidelines and...

Overview Illinois CancerCare is seeking a highly organized Certified Professional Coder (CPC) to join our team as a Coding Specialist. In this role you will translate medical diagnoses and procedure descriptions into accurate codes, ensuring high-quality health‑care data records. This is a great opportunity for someone who thrives in a detail‑oriented environment and enjoys being a key part of a collaborative team. Pay & Benefits Pay Range: $18.00 – $28.00/hour (based on experience, education, and other factors) Medical, dental, and vision insurance (multiple plan options) Special wellness programs – Maven, HingeHealth, Livongo, Vitality, and Wondr 401(k) retirement plan with employer contributions Company‑paid life, short‑term, and long‑term disability insurance Health Savings Account (HSA) & Flexible Spending Accounts (FSA) Paid time off and holidays Employee Assistance Program (EAP) Discounts through our Perks Program Responsibilities Assist office staff,...

Medical Coder II - Surgery Days This position has a deep understanding of disease process, A&P and pharmacology and acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service. Position Highlights: Position: Medical Coder II Location: Elmhurst Hospital Full Time/Part Time: Full Time Hours: Monday-Friday, day shift What you will do: Assigns diagnostic and procedure codes for compliant physician reimbursement and for both evaluation/management, preventive (HCC risk adjustment) and surgical services under general supervision. Communicates daily regularly with physicians and staff to resolve discrepancies with patient records and coding selections. Performs provider audits on E/M services and HCC review on Medicare/Medicare Advantage preventive services and educates providers as needed. Trains physicians and other staff regarding documentation, billing and coding, and documentation. What you...