20 coder quality auditor jobs found

Risk Adjustment Coding Auditor, Sr page is loaded## Risk Adjustment Coding Auditor, Srremote type: Remotelocations: Remote Oregon: Remote Utah: Remote Texas: Remote Idaho: Remote Wisconsintime type: Full timeposted on: Posted 2 Days Agojob requisition id: JR100739Risk Adjustment Coding Auditor, Sr---------------------------------------------------------------The Coding Auditor, Senior performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department.**Estimated Hiring Range:**$81,000.00 - $99,000.00**Bonus Target:**Bonus - SIP Target, 5% AnnualCurrent...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with...

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:...

Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure The Coding Auditor, Senior performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department. Estimated Hiring Range $81,000.00 - $99,000.00 Bonus Target Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. Essential Responsibilities Perform and lead a variety of coding-related audits for providers and other entities. Review medical records to verify that complete and accurate...

Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Work Location: Remote - Even though this position is remote, we are looking for candidates who are located in Wisconsin.   Job Overview We are seeking a detail-oriented and motivated Certified Medical Coder/Professional Biller to join our dynamic healthcare consulting team. In this vital role, you will be responsible for accurately coding medical diagnoses, procedures, and services using standardized coding systems such as ICD-10, CPT, and DRG. Your expertise will ensure precise billing processes, optimize revenue cycle management, and facilitate seamless communication between healthcare providers and payers. This position offers an exciting opportunity to contribute to high-quality patient care through meticulous documentation and coding accuracy. Responsibilities Review and analyze medical records to verify appropriate ICD-10 diagnosis codes, CPT procedure codes, and modifiers. Ensure all billing information complies with current healthcare regulations...

Essential Duties and Responsibilities: - Abstract and code clinical data. - Audit medical records to ensure compliance with the organization's coding procedures and standards. - Accurately enter coded data in a system and validate data entered. - Research correct coding practices, clearly document and share findings with others. - Review denials and recommend billing corrections. - Train staff members on the coding process. Minimum Requirements - High School diploma or equivalent with 0 - 2 years of experience. - Additional clinical licensure may be required based on project. - Must be a Certified Medical Coder, Certified Professional Coder, or a Certified Coding Specialist. - Knowledge of Medical Billing and Coding Systems such as CPT and HCPCS is essential. - Ability to work a schedule between the hours of 8:00am - 5:00pm EST Monday - Friday required. Additional Skills and Experience: - Familiarity with retrospective payment reimbursement highly preferred....

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...

Your future role at a glance Location: Remote Department/Specialty: Revenue Cycle | Coding Schedule: Full-time | 1st shift Salary Range: $23.60 - $31.92 per hour. Life at Ascension: Where purpose meets opportunity Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter. Benefits that help you thrive Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance Time to recharge: pro-rated paid time off (PTO) and...

Location: Remote (WI/IL preferred). Candidates must reside in the U.S.; not eligible from CA, CO, CT, IL, ME, MN, NJ, NY, OR, or WA. Schedule: Full-time, remote | Flexible hours after training Work Setup: Private, dedicated workspace with a door required About the Role We're seeking a detail-oriented and experienced Inpatient Coder (Coder Inpatient II) to join our Health Information Management team. In this remote role, you will accurately assign ICD diagnosis/procedure codes and MS-DRGs for inpatient hospital services at an academic, Level I Trauma environment. You'll code across complex specialties (e.g., Neurology, Oncology, Urology, Transplant, OB/Newborn, Orthopedics, Cardiology, Critical Care), collaborate with providers via compliant queries, and partner closely with CDI to ensure documentation supports the most appropriate DRG assignment. This is an advanced, independent role where accuracy, communication, and sound judgment are essential. What You'll Do...

This position is full-time and will work 40-hours per week. It is full-time benefit eligible. Remote and/or hybrid can be an option after 6-months of on-site training. Coder Certified Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care. Job Summary The Certified Coder is responsible for accurately translating medical records and patient services into standardized numerical codes for billing and reimbursement purposes. This role ensures compliance with federal, state, and organizational regulations, while maintaining the highest standards of patient confidentiality. The Certified Coder works...

*Location:* *Remote (WI/IL preferred).* Candidates must reside in the U.S.; *not eligible* from CA, CO, CT, IL, ME, MN, NJ, NY, OR, or WA. *Schedule:* Full-time, remote | Flexible hours after training *Work Setup:* Private, dedicated workspace with a door required *About the Role* We're seeking a detail-oriented and experienced *Inpatient Coder (Coder Inpatient II)* to join our Health Information Management team. In this remote role, you will accurately assign *ICD diagnosis/procedure codes* and *MS-DRGs* for inpatient hospital services at an academic, Level I Trauma environment. You'll code across complex specialties (e.g., Neurology, Oncology, Urology, Transplant, OB/Newborn, Orthopedics, Cardiology, Critical Care), collaborate with providers via compliant queries, and partner closely with CDI to ensure documentation supports the most appropriate DRG assignment. This is an advanced, independent role where accuracy, communication, and sound judgment are essential. *What...

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...

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...

CODER INPATIENT III – Froedtert Health Location: Menomonee Falls, WI – Woodland Prime 400 facility (Remote) Sign-On Bonus: Eligible for a $2,000 sign‑on bonus. Job Summary This is a remote, high‑level coding position functioning under general supervision. The Coder III accurately assigns ICD diagnosis and procedure codes, MS‑DRGs, and APR‑DRGs for inpatient hospital services at Froedtert Health, which includes an academic Level I Trauma Center. The role focuses on highly complex trauma and acutely ill patients, including mortality, extended length of stay, and high‑dollar cases. A key responsibility is performing chart audits for levels I and II coders, applying official and departmental coding rules, regulations, and guidelines, and meeting or exceeding productivity and quality standards. Coding staff communicate directly with care providers to clarify information needed for complete and accurate coding and partner with clinical documentation improvement specialists....

Major Responsibilities This role will have all responsibilities of coder I, II and III in addition to: reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Responsible for coding high dollar and long length of stay cases for all patient types. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate. Serves as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations. Maintain...

Location: Any city, TX, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for anInpatient Coding Auditor, Senior Associatewho is responsible for performing coding reviews of inpatient medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing...

Location: Any city, TX, US, 99999 Work Mode: Virtual (Exception only) Summary We are seeking a talented individual for an Outpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have an extensive background in outpatient coding edits and a high level of understanding in reimbursement guidelines specifically an understanding of the EAPG, ASC and APC payment systems. What you will do Perform audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adhere to official coding guidelines, coding clinics...

Education/Experience Minimum of five years' of coding experience in an academic medical center or an equivalent combination of coding experience and education with demonstrated competency of knowledge base. Coding QA background or similar experience preferred. Satisfactory completion of college level courses in anatomy, physiology and medical terminology preferred. EPIC health information system experience preferred. Licensure, Certification, and/or Registration Coding certification CCA, CIC, CPC-H, CPC, CCS, RHIT, or RHIA required Essential Functions Ensures the timely and accurate coding and completion of patient accounts within established departmental accuracy and productivity standards. Applies correct ICD CM/PCS (Inpatient) and ICD CM/CPT codes (Outpatient) guidelines meeting departmental policy regarding compliant methods, timeframes, use of applications and productivity. Assists in demonstrating medical necessity for procedures performed by ensuring that all...