13 coder quality auditor jobs found

Compliance Coding Auditor Hours: Variable Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $48.140 - $62.110 - $76.080 The 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. What You Will Do 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...

Inspire health. Serve with compassion. Be the difference. Job Summary The Professional Billing Quality Coding Auditor will support the Medical Group Coding and Education department by performing routine reviews of coders to ensure accurate coding. This position will also perform specialty reviews as identified by Coding and Education leadership. Prepares a summary of findings and presents reports to leadership on a monthly basis. Will assist with training coders on identified opportunities for improvement. Will also assist in preventing coding denials when applicable. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings. Performs review of all...

Quality Medical Auditor - Coding Specialist life insurance, paid time off, 401(k), remote work United States, South Carolina, Columbia Jan 01, 2026 Internal Reference Number: R1048322 Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Position Purpose : Performs validation reviews of Diagnosis Related Groups...

Inspire health. Serve with compassion. Be the difference. Job Summary The Professional Billing Quality Coding Auditor will support the Medical Group Coding and Education department by performing routine reviews of coders to ensure accurate coding. This position will also perform specialty reviews as identified by Coding and Education leadership. Prepares a summary of findings and presents reports to leadership on a monthly basis. Will assist with training coders on identified opportunities for improvement. Will also assist in preventing coding denials when applicable. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings. Performs review of all coders within the...

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.,...

## **Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.**## ## ## Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery. This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery. We are committed to bringing critical services to communities across the U.S. to improve access to treatment for over 26,500 patients. Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania,...

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 team. The ideal candidate...

Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work que management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Reviews and responds to inpatient denials as needed. Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference....

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...

A regional healthcare provider is seeking a Professional Billing Quality Coding Auditor to ensure accurate coding and mentor coders. This role involves reviewing multi-specialty coding, presenting findings monthly, and facilitating training for coders. Applicants should hold a Bachelor's degree and have three years of relevant coding experience, along with the necessary CPC and CPMA certifications. Join us to transform healthcare and serve the community effectively. #J-18808-Ljbffr

Overview The Coder III, under the direct supervision of the Hospital Coding Supervisor, serves a dual role focusing on coding accuracy and team education. This position is responsible for abstracting medical record documentation across various settings (inpatient, outpatient, clinic, and emergency department) to select and sequence appropriate ICD-10-CM/PCS, HCPCS, and CPT4 codes. The Coder III ensures adherence to coding compliance guidelines for accurate and timely assignment of codes, including final DRG assignment. A key aspect of the position is providing ongoing education and training to care team members to enhance coding proficiency and compliance with regulatory requirements. Entity Entity: Medical University Hospital Authority (MUHA) Worker Type Worker Type: Employee Worker Sub-Type Worker Sub-Type: Regular Cost Center Cost Center: CC002307 SYS - Hospital Coding Pay Rate Type Pay Rate Type: Hourly Pay Grade Pay Grade: Health-26 Scheduled Weekly Hours...

Job Description Job Description Medical Coder W2 Contract – This will convert to a full-time role. Pay rate: $36 Location: Columbia South Carolina (on-site) - Hybrid Hours: Monday-Friday 8:00am - 4:30pm Do you have any of these certifications on your resume: RHIT, RHIA, CIC, CPMA, or CPC? If so… we want to talk to you! About the Role: Step into a key role within our healthcare organization, where you’ll help safeguard the accuracy and reliability of medical coding and billing operations. In this position, you’ll oversee detailed validation reviews across multiple business areas, drive initiatives that support cost efficiency, and uphold critical regulatory requirements including HIPAA compliance. This is an excellent opportunity to strengthen healthcare quality, support financial integrity, and expand your expertise in medical auditing and coding oversight. Responsibilities In this role, you will take the lead in performing detailed reviews of medical coding accuracy,...

Overview Job Description Summary The Coder III, under the direct supervision of the Hospital Coding Supervisor, serves a dual role focusing on coding accuracy and team education. This position is responsible for abstracting medical record documentation across various settings (inpatient, outpatient, clinic, and emergency department) to select and sequence appropriate ICD-10-CM/PCS, HCPCS, and CPT4 codes. The Coder III ensures adherence to coding compliance guidelines for accurate and timely assignment of codes, including final DRG assignment. A key aspect of the position is providing ongoing education and training to care team members to enhance coding proficiency and compliance with regulatory requirements. Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type Regular Cost Center CC002307 SYS - Hospital Coding Pay Rate Type Hourly Pay Grade Health-26 Scheduled Weekly Hours 40 Work Shift Job Description Key Responsibilities: Provide...