18 coder quality auditor jobs found

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...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note:...

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...

About the Job About the Job: Our OBGYN practice is seeking to enhance our billing staff with the addition of a new full-time member to our dynamic team. The right candidate should possess a desire to provide high-quality customer service with efficiency and compassion. A growth mindset is vital in this position as we all have an opportunity to learn more every day. Job Summary: The Medical Coder is responsible for accurately assigning diagnosis, procedure, and modifier codes for obstetrics and gynecology services to ensure compliant billing and optimal reimbursement. This role requires in-depth knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines. Specific to OBGYN is a plus. The Medical Coder works closely with providers, billing staff, and clinical teams to resolve documentation issues, reduce claim denials, and maintain compliance with federal, state, and payer regulations. Essential Job Responsibilities : Review clinical documentation to accurately...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in 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 for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

Overview Become a part of our caring community and help us put health first 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 Durable Medical Equipment (DME) auditing and is part of the PPI Coding Disputes Team with Humana. The Disputes Auditor – DME Outpatient Coding 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. Responsibilities Will be an experienced medical coding auditor with in-depth experience in outpatient DME coding disputes...

Remote Coding Specialist Newport News, Virginia FOR APPLICATION REVIEW - PROVIDE YOUR AAPC CERTIFICATION NUMBER ON YOUR APPLICATION OR RESUME This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, PA, SC, SD, TN, VA. Some county exclusions may apply. Overview Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. What You Will Do Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits for documentation opportunities...

Job Description: The HIM Hospital Inpatient & Same Day Surgery Coding Analyst deciphers and interprets provider documentation in the health record and assigns diagnostic information using ICD-10-CM/PCS and CPT codes for a complex range of acute care services for Intermountain Health. The caregiver provides specific coding expertise in the various fields of NCCI edits, Drugs and Biologicals, Revenue Codes, Current Procedural Terminology (CPT) codes, ICD-10 & CPT codes, DRGs, anatomy and physiology, pharmacology. The analyst also performs audits, provides feedback, and advanced training to clinical teams and physicians on ICD-10 and CPT coding best practices. Essential Functions Reviews and analyzes inpatient medical records for completeness, accuracy, and compliance for Same Day Surgery, Observation and Inpatient acute services at Intermountain Health. Performs coding at an advanced level of complexity for inpatient hospitals including governmental and/or...

This is a remote based position. Applicants can be located nationwide Back Outpatient Coding Auditor #2675 United States Apply X Facebook LinkedIn Email Copy Position Description About You You are a person who is passionate about performing quality reviews and audits of the assigned staff. We need someone who ensures standards are met in accordance with department and organization policy. In the role of Outpatient Coding Auditor, you will demonstrate skills in organization, prioritization, professionalism and coaching others. Tell us about your experience with Outpatient Coding Auditing. Are you a team player and a self-motivator? We are counting on you to manage multiple projects using your problem-solving skills. We are looking for someone UNCOMMON. What is uncommon about you? Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you. About The Position Advanced knowledge...

Claims Resolution Coder Responsible for reviewing medical documentation to assign modifiers to insurance claims with issues identified by the National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), or other third party payer specific claims processing guidelines. Works with Coding, Billing and Reimbursement staff to resolve edits. Is additionally responsible for trending errors, supporting identification of root causes, and effective communication with coding and training staff to improve coding accuracy and clean claims processing. Researches regulations to ensure accuracy of CPT codes and documentation. Associates degree in Health Information Technology or Medical Billing preferred. 2 years direct application of coding, medical billing or reimbursement in health care setting, hospital or physician office required. CPC or CCS coding certification required at time of hire. Thorough knowledge of lab, radiology and other ancillary, CPT, HCPCS related...

Medical Coder Job Duties: Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications. Researches and analyzes data needs for reimbursement. Analyzes medical records and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff. Reviews and verifies documentation supports diagnoses, procedures and treatment results. Identifies diagnostic and procedural information. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines. Follows coding conventions. Serves as coding consultant to care providers. Identifies discrepancies, potential quality of care, and billing issues. Researches, analyzes, recommends, and facilitates plan of action...

Under the direction of the Enterprise Coding Manager, the Enterprise Coding Supervisor is responsible for providing first-line supervision for Medical Coding staff. Supervisor responsibilities include but are not limited to: daily supervision and monitoring of quality and productivity performance, interviewing, hiring, and any necessary discipline of staff. This position also involves participation in process improvement projects and supporting the work needed to meet department and institutional wide goals. Provides daily supervision of coding staff and provides feedback to the Coding Manager on exceptional and/or substandard performance. Leads all efforts associated with hiring, interviewing, onboarding and discipline Provides ongoing feedback to staff on areas for improvement Ensures that all members of the coding team are following official policies and standard procedures and conducts discipline for those in violation Counsels coding staff on actions...

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...

Description The Medical Coder III position plays a critical role in ensuring accurate medical coding and documentation. This involves handling complex case scenarios, applying a combination of facility coding and professional coding, and aligning with industry standards like ICD-10-CM, CPT, and HCPCS codes. The coders will code inpatient facility and inpatient professional rounds and facilitate proper documentation and communication with medical staff to enhance compliance and coding accuracy. Accurately assigns Evaluation and Management (E&M) codes, International Classification of Diseases, Clinical Modification (ICD-CM) diagnoses, ICD-10 Procedure Coding System (ICD-10-PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities derived from medical record documentation (paper or electronic) for the professional and institutional (facility) components of inpatient facility discharges (stays); inpatient...

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Medical Coder Supervisor to join our growing team. Job Summary: Acentra Health is seeking an experienced Medical Coding Supervisor to lead and oversee medical coding operations in support of...

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

Coder RMG page is loaded## Coder RMGremote type: Remotelocations: Newport Square Professional Center - Newport News, Virginiatime type: Full timeposted on: Posted Todayjob requisition id: 2026-032853Newport News, Virginia**FOR APPLICATION REVIEW - PROVIDE YOUR AAPC CERTIFICATION NUMBER ON YOUR APPLICATION OR RESUME*****This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, PA\*, SC, SD, TN, VA. \*Some county exclusions may apply.*****Overview** Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. **What you will do*** Organizes and prioritizes assigned work to...

FOR APPLICATION REVIEW - PROVIDE YOUR AAPC CERTIFICATION NUMBER ON YOUR APPLICATION OR RESUME This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Overview Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. Newport News, Virginia What You Will Do Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits for documentation opportunities and queries clinical staff to fill in any gaps to clarify...