42 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'...

Physician Compliance Auditor Grady Health System offers many career paths for experienced professionals. Whether you have many years of experience or are in the early stages of your career, you can find a rewarding career at Grady! Location: Atlanta, GA Job Type: FTE Shift/Schedule: Days This is a remote role, but the ideal candidate will be required to come into the office occasionally to meet with the providers. The Physician Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, the appropriateness of treatment setting, HIPAA matters, and other compliance issues as directed by the Physician Coding Director, Compliance Director. This position requires effective communication with internal...

Location Miramar, Florida 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. For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, 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 and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM...

divh2Coding Auditor Provider Educator/h2pNAH reserves the right to make hiring decisions based on applicants state of residence if outside the state of Arizona. NAH currently hires for remote positions in the following states:/pulliAlabama/liliArizona/liliFlorida/liliGeorgia/liliIdaho/liliIndiana/liliKansas/liliMichigan/liliMissouri/liliNorth Carolina/liliOhio/liliOklahoma/liliPennsylvania/liliSouth Carolina/liliTennessee/liliTexas/liliVirginia/li/ulpThe Coding Auditor Provider Educator is a critical role responsible for ensuring the accuracy, completeness, and compliance of medical coding (CPT, HCPCS, ICD-10-CM) for professional services. This individual will conduct thorough coding audits, identify areas for improvement in documentation and coding practices, and develop and deliver targeted educational programs to physicians, advanced practice providers (APPs), and clinical staff. The primary goal is to optimize revenue integrity, mitigate compliance risks, and foster a culture...

6 days ago Be among the first 25 applicants This range is provided by TalentPlug LLC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $55,100.00/yr - $99,000.00/yr Direct message the job poster from TalentPlug LLC Job Title Clinical Coding Auditor & Trainer Job Location Remote (Candidates must be residents of New York) Summary The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Position Purpose Responsible for developing and conducting training and quality auditing programs for the Diagnosis Related Group (DRG) and Medical Record Audit Programs for Fidelis Care. Applicants must be willing to travel to New York twice a year. Responsibilities Conducts auditing of work performed by staff and present findings and recommendation for areas...

Req Number 174853 Lead Compliance Auditor - Heavy Anesthesia & Healthcare Expertise Needed. This is a HYBRID position- MUST be in the office located in Chappaqua, NY 3 days a week. Are you a seasoned compliance professional with a passion for anesthesia and healthcare auditing? Do you thrive in fast-paced environments where your expertise can make a real impact? FlexStaff is seeking a dynamic, detail-oriented Lead Compliance Auditor to join our client's team and lead the charge in safeguarding healthcare integrity and regulatory excellence! Position Summary: As a Lead Compliance Auditor, you will leverage your extensive anesthesia auditing experience to oversee comprehensive compliance reviews, develop training programs, and collaborate with senior leadership to enhance our compliance framework. Your expertise will ensure the organization remains at the forefront of regulatory adherence, risk mitigation, and quality improvement. Ready to make a difference in...

Req Number 172252 Surgical Anesthesia Compliance AuditorCompliance Auditor MUST HAVE CPC CERTIFICATON This is a HYBRID position- MUST be in the office located in Chappaqua, NY 3 days a week. Surgical Anesthesia Compliance Auditor- Hybrid position- Chappaqua, NY- $100K-$115K Are you passionate about healthcare compliance and eager to make a meaningful impact? FlexStaff is seeking a detail-oriented and experienced Compliance Auditor to join our client's dynamic team! This hybrid position offers the perfect blend of in-office collaboration and remote work, all while contributing to an organization committed to excellence in patient care and regulatory adherence. In this pivotal role, you'll leverage your healthcare environment experience-whether as a Certified Professional Coder or similar professional-to audit and monitor clinical records, ensuring accuracy, completeness, and compliance. Your expertise with medical terminology, coding, and documentation will support our...

Job Description Lead Compliance Auditor - Heavy Anesthesia & Healthcare Expertise Needed. This is a HYBRID position- MUST be in the office located in Chappaqua, NY 3 days a week. Are you a seasoned compliance professional with a passion for anesthesia and healthcare auditing? Do you thrive in fast-paced environments where your expertise can make a real impact? FlexStaff is seeking a dynamic, detail-oriented Lead Compliance Auditor to join our client's team and lead the charge in safeguarding healthcare integrity and regulatory excellence! Position Summary: As a Lead Compliance Auditor, you will leverage your extensive anesthesia auditing experience to oversee comprehensive compliance reviews, develop training programs, and collaborate with senior leadership to enhance our compliance framework. Your expertise will ensure the organization remains at the forefront of regulatory adherence, risk mitigation, and quality improvement. Ready to make a difference in...

Become a part of our caring community and help us put health first The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy and operating objectives, and follows established guidelines and procedures while making decisions in ambiguous situations. Where you come in The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g.,...

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. Description Medical Coder and Auditor Family Care Practice Full-Time Monday - Friday Flexible Schedule (hybrid schedule after required onsite training period) $22.00 -$28.00 per hour (depending on experience) Medical Coder and Auditor Benefits: Generous paid time-off that increases with years of service 8 paid holidays per year Closed on major holidays Annual performance review, performance-based merit increase Health, dental and vision benefits available with coverage effective the first of the month following date of hire Full complement of voluntary benefits $1,000 annual employer HSA contribution for employees enrolled in CNYFC...

A healthcare institution in Albany, NY, is seeking a Senior Hospital Coder to perform detailed coding audits, provide education and feedback to staff, and ensure compliance with coding practices. The ideal candidate will possess strong knowledge in ICD-10-CM and CPT coding alongside leadership skills. The role demands commitment to ethical practices and involves educating clinical staff. The salary for this full-time position ranges from $60,367.47 to $90,551.20 depending on experience. #J-18808-Ljbffr

Medical Records - Coder I - Full Time - Days Under the general direction of the Director CDI/Coding or designee, the Medical Records Coder I will improve documentation, data quality and revenue cycle operations. The coder assigns International Classification of Disease system- 10 (ICD), CM, and PCS codes according to AHA AMA Guidelines, CMS and NGS. Core Job Responsibilities Assign diagnosis and procedure codes, for accurate and timely billing of most appropriate payer Audit charges and establish proper coding in collaboration with providers Initiate and follow up on queries with providers Assist departments with diagnostic and procedural coding Respond to Insurance, compliance and RAC denials Review and assist in the maintenance of coding related policies and procedures Perform other duties as required. Education/Experience Requirements Required: AS in Health Information Management, a related degree or equivalent experience Knowledge of EMR, Coding Software,...

$65,000.00 Annually Are you Ready to Launch Your Career? Join us in our mission as a Compliance Auditor at Catholic Charities of Executive Office & Support Services . Imagine yourself as part of an organization with a profound commitment to making a positive impact. When you choose Catholic Charities, you step into a world of endless opportunities, where your efforts collectively contribute to a brighter community. We consider it a privilege to make a meaningful difference, and we love what we do. As the Compliance Auditor for the 1115 Waiver Program , you will play a pivotal role in individuals' lives, making a significant impact through: 1115 Waiver Service audits would include but not necessarily be limited to attention to detailed and specific documentation requirements, verification of documentation that supports the need for the service, verification of qualifications of staff performing service, verification of documentation that reflects service was...

A leading health data exchange company is seeking an Inpatient Auditing Specialist to conduct coding audits and ensure compliance with quality standards. This fully remote position requires significant coding experience, especially in MS-DRG and APR-DRG coding. Candidates will also engage in coder education and client interaction, contributing meaningfully to healthcare decisions. Join a high-performing team committed to innovative healthcare solutions. #J-18808-Ljbffr

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 In 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...

The Supervisor, Medical Coding - Outpatient is responsible for the oversight and development of the office coding department. This includes mentorship and direct management of the outpatient medical coding team. The Supervisor of Medical Coding understands the organization’s core information technology and information management competencies to bring value to business processes and quality improvement initiatives. The Supervisor interacts with internal and external customers to ensure continuous improvement efforts are being achieved and new coding practices are being implemented. This will require periodic audits of documentation and productivity reports of staff. The Supervisor is responsible for the planning, organizing, and final execution of all processes necessary to provide timely, accurate, and complete posting and billing of patient demographic and clinical coding data as well as managing and tracking results. SECTION II: EDUCATION AND EXPERIENCE REQUIREMENTS: Bachelors...

Overview Requisition ID: 2025-52091 Location: US--US: Remote Position Type: Full Time HR Rep / Recruiter: Marcia Harrison Contact: Responsibilities The Coding Specialist is responsible for coordinating and participating in the coding of pertinent medical information from a variety of complex records and coding edits to include diagnosis, treatment of illness and procedures performed while ensuring accuracy of work adherence to established coding procedures of ICD-CM (International Classification of Diseases) and CPT-4 (Current Procedural Terminology). Perform concurrent audit of provider-selected coding data during the coding and billing process, interpreting medical records and updating and/or verifying all valid diagnoses, procedure codes, modifiers, providers, and place of service as determined by the coder. Participate in SOX control review (audit) processes. Review all pertinent medical records for diagnosis and procedures performed and documented while maintaining...

Job Description Job Description Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part...

Join to apply for the Risk Adjustment Coder role at VillageCare . Position: Risk Adjustment Coder Location: Remote (Must reside in NY/NJ/CT) Schedule: Monday – Friday 9am–15pm Compensation: $77,506.87 – $87,195.23 annual salary Certifications Required: CPC, CCS, RHIT or RHIA and CRC Join VillageCare as a Full Time Risk Adjustment Coder and embrace the opportunity to work remotely while making a significant impact in the Health Care sector. This role offers the flexibility of a work-from-home environment, allowing you to balance your professional and personal commitments without the daily commute. You'll be part of a dynamic team that thrives on innovation, problem-solving, and a customer-centric approach, all while contributing to the excellence and integrity that VillageCare stands for. With a competitive salary up to $77,506.87 – $87,195.23, this is not just a job but a chance to build your career in a forward-thinking organization dedicated to healthcare...

Medical Coder Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Medical Coder to join our healthcare consulting practice. The role is fully remote within the US, with infrequent travel to client locations for onboarding and training. We are proud of our national presence, and excited to offer great career opportunities within the organization. What you'll do: Accurately assign ICD-10 CM, E/M, ICD-10 PCS, CPT, HCPCS, modifiers and units based on documentation. Adhere to systems and standards required in multi-specialty medical coding encounters, including Outpatient, Emergency Room, Surgery, Inpatient facilities, Inpatient Professional Rounds, and others. Process encounters within required SLA on contract with deficiencies identified escalated as necessary. Review and respond to each audit within set...

We are hiring detail-oriented professionals to manage end-to-end revenue cycle management (RCM) for our growing network of dental and medical practices across the United States. This role offers a unique opportunity to launch a career in healthcare billing without prior experience— we provide comprehensive training, all required compliance certifications, and ongoing support. Key Responsibilities Claims Processing & Insurance Management Submit dental and medical insurance claims daily through secure clearinghouses. Post insurance payments and process Explanations of Benefits (EOBs). Process claim denials and initiate appeals with insurance companies. Manage aging reports to ensure no claims miss timely filing deadlines. Maintain accurate patient ledgers and reconciliation records. Eligibility Verification & Pre-Authorization Verify patient insurance eligibility 48–72 hours before scheduled appointments. Confirm coverage details including deductibles, copays, and...

This position follows a hybrid model with 1-2 onsite days. Job Description Conducts concurrent and occasionally onsite medical chart reviews for pediatric and neonatal ICU patients. Collaborates with medical directors and staff to enhance the quality of physician documentation, ensuring a precise representation of the patients' severity of illness, anticipated risk of mortality, and the complexity of care administered. Ensures the accuracy, completeness, and compliance of medical coding and documentation for all pediatric patient encounters. Strives to optimize coding practices, minimize denials, and maintain the highest standards of data integrity. Job Responsibility Analyzes and interprets complex pediatric medical records to ensure accurate capture and coding of diagnoses, procedures, and appropriate levels of service, adhering to established coding guidelines (ICD-10-CM, CPT, HCPCS). Applies advanced knowledge of pediatric anatomy, physiology, and medical terminology to...

Experienced Multi-Specialty Surgery Coder The experienced multi-specialty surgery coder is responsible for daily coding, denial management, charge hold, RAI resolution and abstraction. The coder is responsible for escalation of coding questions and requests for coding guidance to the Coding Coordinator and/or Supervisor. Participate in internal QA audits and provide feedback in the compliance QA process. Hours: Monday - Friday, working 40 hours a week Location: Fully Remote - U.S You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Provide coding and abstraction of physician or professional records Provide communications to Coordinator, Supervisors and Managers Complete RAI's, denials, charge hold reports, and coding edits Assist on special coding projects as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear...

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...