38 coding auditor jobs found

Humana Inc, a Fortune 100 company, seeks an experienced Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and DRG assignments. You will extract clinical information and assign ICD-10-CM, ICD-10-PCS, and DRG codes while supporting cost reduction through accurate payments. The role emphasizes auditing inpatient coding, resolving provider disputes, and collaborating with teams to improve payment accuracy. #J-18808-Ljbffr

Baylor Scott & White Health is seeking a Coding Auditor 1 to perform coding quality audits and provide feedback to coders. The role requires strong knowledge of ICD-10-CM/PCS, HCPCS, CPT, and related coding references to ensure accurate classification and DRG grouping. The candidate should have 5 years of coding experience with at least 1 year as a coding auditor, and must hold one of several coding certifications. This is a health system focused on quality and compliance. #J-18808-Ljbffr

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified 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 goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following: Review inpatient medical records and claims to ensure accurate coding and reimbursement Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes Audit coding quality and identify opportunities for...

Become a part of our caring community The Inpatient Medical Coding Auditor - PPI Coding Disputes reporting to the Manager reviews the appropriate DRG and ICD-10-CM/ PCS coding assignments for accuracy within the coding disputes team from a variety of medical records. The Disputes Auditor - MSDRG Inpatient Coding on the Disputes Team consults and collaborates with coding professionals within and across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality. Will be an experienced medical coding auditor with in-depth experience in inpatient coding audits (MSDRG/APDRG) Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate coding guidelines and communicates disputes outcomes to providers in a professional and concise manner. Leverages advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices Manages multiple...

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:...

About Us McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio. Coding Auditor Senior Facility Michigan, Shelby...

McLaren Health Care in Michigan is seeking a Senior Coding Auditor Facility to lead ongoing coding and documentation education for physicians, coders, CDI and allied staff to improve documentation and accurately assign codes and charges. Core duties include quality assurance audits, POA indicator validation, audits of MS-DRG/APC assignments and pre-bill compliance, and supporting the Clinical Validation Initiative with guidance for identified conditions. #J-18808-Ljbffr

Compliance Auditor/Educator The Compliance Auditor/Educator serves as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services. Provides professional expertise and education in CPT, ICD and HCC coding. The Compliance Auditor/Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations. This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution. Performs medical record integrity audits and conducts one-on-one meetings with Providers for corrective educational guidance. Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies problems and...

Employment Type: Full time Shift: Description: Purpose Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization's strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge. Note: "patients" refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program...

A leading healthcare data platform is seeking an Inpatient Auditing Specialist. This position offers remote work flexibility and requires extensive coding and auditing experience. Responsibilities include conducting inpatient coding audits, providing coder education, and preparing audit reports. Candidates should have a degree from an AHIMA-certified program and relevant certifications. Competitive pay with a signing bonus and comprehensive benefits are offered. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, reviews medical records, and confirms compliance with state and federal requirements. Strong documentation and communication skills are essential for presenting findings to investigators and leadership. You will audit CPT/HCPCS coding, identify potential fraud or errors, and maintain thorough records. #J-18808-Ljbffr

Yeo & Yeo Medical Billing & Consulting Come grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding. Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies. Our people are our future – we...

POSITION DESCRIPTION :The Compliance Auditor / Educator serves as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services.Provides professional expertise and education in CPT, ICD and HCC coding.The Compliance Auditor / Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations.This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution.Performs medical record integrity audits and conducts one-on-one meetings with Providers for corrective educational guidance.ESSENTIAL JOB FUNCTIONS :Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies...

Job DescriptionJob DescriptionMedical Coding Compliance SpecialistCompensation :Up to $85,000 annually, determined by your experience and qualifications.Job Location :Remote (US)Job Highlights :Work-Life Balance :Monday to Friday schedule for a fulfilling personal and professional life.Competitive Compensation :Be rewarded with a generous salary and benefits package.Career Growth Opportunities :Unlock your potential and advance in your career with our support.Supportive Work Environment :Join a team that values and appreciates your contributions.Comprehensive Training :Enhance your skills and knowledge through our extensive training programs.Compliance and Peace of Mind :Work with confidence knowing that we prioritize compliance with employment laws and regulations.Paid Time Off and Holidays :Enjoy well-deserved time off to relax and recharge.Life Insurance Coverage :Protect your loved ones with our employer-paid life insurance policy.Collaborative Team Environment :Thrive in a...

MICHIGAN RESIDENTS ONLY. Join the team that is redefining how EMS and mobile healthcare is delivered in Michigan. Medstar provides 911 service to more communities in Southeast Michigan than any other provider, and our critical care, air medical, and inter-facility partnerships continue to grow throughout the region. We are currently looking to add an experienced ambulance billing coder to the Medstar team! If you are looking for a fast‑paced, strategic atmosphere to call home, Medstar may be the place for you. This position can be in office, hybrid or remote for individuals located in Michigan. Job Summary The Biller will input all claim information following the CMS coding guidelines. Provides accurate patient demographic and insurance information and inputs information into patient record. Essential Duties and Responsibilities Review patient care reports thoroughly, utilizing all available documentation in order to establish medical necessity, selection of levels of service,...

Ambulance Billing Coder Join the team that is redefining how EMS and mobile healthcare is delivered in Michigan. Medstar provides 911 service to more communities in Southeast Michigan than any other provider, and our critical care, air medical, and inter-facility partnerships continue to grow throughout the region. We are currently looking to add an experienced ambulance billing coder to the Medstar team! If you are looking for a fast-paced, strategic atmosphere to call home, Medstar may be the place for you. This position can be in office, hybrid or remote for individuals located in Michigan. Job Summary The Biller will input all claim information following the CMS coding guidelines. Provides accurate patient demographic and insurance information and inputs information into patient record. Essential Duties and Responsibilities Review patient care reports thoroughly, utilizing all available documentation in order to establish medical necessity, selection of levels of...

Job Opportunity Job ID:51909 Positions Location: Lansing, MI Job Description General Purpose of Job: Advanced Description: Positions Location: Lansing, MI Job Description General Purpose of Job : Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes Optum CAC in accordance with established workflow. Follows...

Ambulance Billing Coder Join the team that is redefining how EMS and mobile healthcare is delivered in Michigan. Medstar provides 911 service to more communities in Southeast Michigan than any other provider, and our critical care, air medical, and inter-facility partnerships continue to grow throughout the region. We are currently looking to add an experienced ambulance billing coder to the Medstar team! If you are looking for a fast-paced, strategic atmosphere to call home, Medstar may be the place for you. This position can be in office, hybrid or remote for individuals located in Michigan. Job Summary The Biller will input all claim information following the CMS coding guidelines. Provides accurate patient demographic and insurance information and inputs information into patient record. Essential Duties and Responsibilities Review patient care reports thoroughly, utilizing all available documentation in order to establish medical necessity, selection of levels of...

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Conduct a...

MICHIGAN RESIDENTS ONLY. Join the team that is redefining how EMS and mobile healthcare is delivered in Michigan. Medstar provides 911 service to more communities in Southeast Michigan than any other provider, and our critical care, air medical, and inter-facility partnerships continue to grow throughout the region. We are currently looking to add an experienced ambulance billing coder to the Medstar team! If you are looking for a fast-paced, strategic atmosphere to call home, Medstar may be the place for you. This position can be in office, hybrid or remote for individuals located in Michigan. Job Summary The Biller will input all claim information following the CMS coding guidelines. Provides accurate patient demographic and insurance information and inputs information into patient record. Essential Duties and Responsibilities Review patient care reports thoroughly, utilizing all available documentation in order to establish medical necessity, selection of levels of service,...

Back-End Medical Biller Full-Time, Temp to Hire Opportunity - Onsite Hours: 8 am to 4:30 pm M-F (30-minute lunch) $19-$20 per hour DOE Professional Summary This position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilities General Responsibilities Able to perform accounts receivable collection activities timely and accurately including prioritizing subtasks Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days Accurately post all insurance payments by line item Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely*...

Medical Billing Specialist Administration - Flint, MI 48502 Overview Position Type Full Time Education Level High School Category Health Care Description This position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third-party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilities. General responsibilities Able to perform accounts receivable collection activities timely and accurately including prioritizing subtasks. Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days. Accurately post all insurance payments by line item. Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely* Collects...

Health Information Management Coding Specialist Outpatient The Health Information Management Coding Specialist Outpatient provides timely and accurate clinical and administration data to ensure optimal reimbursement for facility outpatient, ambulatory surgery, observation, recurring accounts to support the facility coding needs. This may include coverage on some Rehab or Skilled Care accounts. Primary patient contact is only social. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to providing Extraordinary Care for Every Generation. Responsibilities Contributes to organization success targets for patient satisfaction. Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients, and other department staff members. Adhere to coding...

Job Opportunity Positions Location: Lansing, MI Job Description General Purpose of Job: Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes Optum CAC in accordance with established workflow. Follows University of Michigan Medicine Sparrow policies and procedures and maintains required quality and productivity standards....