18 coder quality auditor jobs found

Physician Coding Auditor This is a full-time, remote position that offers a flexible schedule. Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. Physician Coding Auditor is expected to adhere to MedKoder's internal coding/auditing policies and expectations set forth by department management. Physician Coding Auditor must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals. Candidates ideally have recent auditing experience specializing in some of the following profee areas: Ophthalmology, Behavioral Health, Cardiovascular/Cardiothoracic Surgery, Complex ENT Surgery, Dental, Complex Plastic Surgery, Orthopedic Surgery, Peds...

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 CODING AUDITOR 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 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 is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of...

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...

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 Risk Adjustment Specialist (Coder) At Greenbrook Medical, we believe seniors deserve more from the healthcare systemmore time, more care, more coordination, and more heart. We provide high-touch, relationship-based primary care to seniors, built around one simple idea: deliver the kind of care we'd want for our own parents. Founded by two brothers inspired by their father's pioneering work in Medicare Advantage, Greenbrook is deeply personal and proudly modern. We quarterback our patients through their healthcare journey, making sure they're never alone in a complex system. Our business model is designed around patient outcomes, not volumeso we only succeed when our patients thrive. With roots in Tampa Bay and a partnership with Tampa General Hospital, we're growing thoughtfully to bring our model to more communities. Our team is the heart of it all: mission-driven, values-oriented, and relentlessly committed to taking the best care of our patients. Greenbrook Medical...

Job Type Full-time Description Why you'll want to work at nimble! Interested in becoming a part of a dynamic Coding team? This is a great opportunity to join a well-established and market-leading brand serving a high-growth end market while gaining valuable experience working closely with Executive leadership. As an organization, we are in high-growth mode through acquisition with a laser focus on positive culture building! Who we are: nimble solutions is a leading provider of revenue cycle management solutions for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia groups. Our tech-enabled solutions allow surgical organizations to streamline their revenue cycle processes, reduce administrative burden, and improve financial outcomes. Join more than 1,100 surgical organizations that trust nimble solutions and its advisors to bring deep insights and actionable intelligence to maximize their revenue cycle. On a typical day, here's what...

PURPOSE OF THIS POSITION This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization’s operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES Duty 1: Maintains a thorough understanding and education of federal and state regulations and payer specific policies...

Medical Claims Specialist This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. Job Duties/Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Medical Billing Specialist We are looking for a skilled medical billing specialist to join our team in Dayton, Ohio. In this role, you will be responsible for ensuring accurate and efficient processing of claims related to pathology services. This position is a contract-to-permanent opportunity, providing a chance to grow within the healthcare field while contributing to billing accuracy and compliance. Responsibilities: Process and submit claims for pathology services, adhering to federal, state, and insurance guidelines. Assign appropriate medical codes based on pathology reports and patient records to ensure accuracy. Review documentation for completeness and compliance prior to submitting claims. Investigate and resolve issues related to denied claims, underpayments, and appeals by collaborating with insurance providers. Partner with pathologists, laboratory staff, and coding teams to address complex cases and maintain compliant billing practices. Track claim...

Senior Medical Coder At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America's seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member's complete health history, we ensure better care at a lower costdelivering the highest value to those who need it most. We're building a modern operating model for medical codingone that connects Risk Adjustment, Payment Integrity, and Quality (STARS/HEDIS) into a single, data-driven system. This is a rare opportunity to work at the center of that transformation: ensuring compliant, high-quality coding today while helping design the workflows that will define how a plan of the future operates. As part of the Office of the CEO's AI Ops initiative, you'll combine deep subject matter expertise with an...

Lead, Quality & Regulatory Compliance Auditor Req ID: 52076 Job Category: Regulatory Affairs Location: Mentor, OH, US, 44060 Workplace Type: Hybrid At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. Position Summary The mission of the STERIS Quality & Regulatory Compliance function is to implement repeatable and sustainable processes to ensure on-going compliance with domestic and international regulations and standards. This includes evaluating the relevance to all STERIS facilities and products and implementing efficient and effective processes to ensure adherence to applicable regulations and standards. This is a hybrid role based in STERIS' Corporate Offices in Mentor, Ohio. In order to support the business needs working a minimum of 3 days a week in the Mentor office is expected. 20% domestic and international...

Remote Coding Specialist This is a REMOTE position. Provides high level technical competency and subject matter expertise analyzing charge review errors and claim edits for complex services, including code selection of surgical procedures, and assessment of high-acuity type services. Ensures correct charge capture and coding with proper CPT, HCPCS, and ICD-10 codes, as well as proper modifiers, adhering to local ministry and Trinity Health practices and policies. Analyzes medical documentation verifying diagnoses, assigning diagnostic codes, selecting simple and complex surgical/procedural codes, and modifiers using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS), performing charge entry, and charge capture reconciliation and discrepancy resolution as required. Serves as a liaison between other Centralized Coding positions in Revenue Site Operations and physicians/clinical sites/departments. Interprets, researches and resolves issues and...

Coding Specialist This is a PRN (pro re nata/as needed) position. Hours are not guaranteed and will vary based on the needs of the organization. Scheduling is at the discretion of management and may change. PRN employees are not eligible for benefits unless required by applicable law. Why you'll want to work at nimble! Interested in becoming a part of a dynamic Coding team? This is a great opportunity to join a well-established and market-leading brand serving a high-growth end market while gaining valuable experience working closely with Executive leadership. As an organization, we are in high-growth mode through acquisition with a laser focus on positive culture building! Who we are: Nimble solutions is a leading provider of revenue cycle management solutions for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia groups. Our tech-enabled solutions allow surgical organizations to streamline their revenue cycle processes, reduce...

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...

Outpatient Coding Auditor Join UASI today and work with the top HIM experts in the industry! We are currently seeking an experienced Facility Outpatient Coding Auditor to join our team working remotely from a home office. Responsibilities include: Performs coding quality audits and reviews on a variety of facility outpatient records including but not limited to: same day surgery, observations and ED Provides feedback and education to coding staff 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 Assists in developing educational training content and materials for coding staff Presents educational seminars to clients and staff Work with other members of the Consulting Division on Senior Level Projects such as assessment and analysis, development of tools to assist in the audit process, develop coding test material for applicants and develop coding content...

Inpatient Coder Opportunity 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 of our...