71 coding auditor and educator jobs found

A community health provider in California is seeking a Coding Auditor and Educator to ensure coding accuracy supported by clinical documentation. This role involves conducting audits, educating teams on compliance, and engaging in coding for PACE participants. Applicants should possess an Associates Degree or equivalent experience with a strong background in HCC coding. This position offers competitive wages, benefits, and opportunities for advancement. #J-18808-Ljbffr

WelbeHealth PACE (All-Inclusive Care for the Elderly) program provides seniors with the opportunity to continue living in their homes and in their communities. Our innovative and comprehensive range of medical services to participants is what ignites our passion to treat the whole person and not the symptoms! We employ a collaborative interdisciplinary team (IDT) approach to evaluate and guide participant care, which is key to WelbeHealth values, team culture, and mission. At the direction of the Coding Supervisor, the Coding Auditor and Educator focuses on ensuring coding is accurate and properly supported by clinical documentation within the health records, as well as educating our teams on best practices to promote compliance. Essential Job Duties Assist with retrospective and concurrent coding for PACE (All-inclusive Care for the Elderly) Dual participants Conduct pre-visit chart preparations and post-visit chart reviews Oversee audits and participate in provider education...

A healthcare solutions company is seeking an Inpatient Auditor and Educator to audit inpatient facility coding for accuracy and compliance while providing education. The role requires an active coding credential and three years of auditing experience, emphasizing collaboration across a global team. Responsibilities include conducting audits, developing educational materials, and ensuring adherence to coding guidelines. This position offers full-time employment with remote or hybrid work options. #J-18808-Ljbffr

Job Description Job Description Description: Job Title: Medical Biller II Salary: $25hr-$28hr DOE Location: Tustin, CA Openings: 1 Position Purpose: The Medical Billing Specialist II supports the revenue cycle team by independently performing a broad range of billing functions with moderate complexity. This role is responsible for accurate insurance verification, charge entry, claim submission, payment posting, and resolution of routine denials to ensure compliance with payer requirements and timely reimbursement. Core Duties and responsibilities, include but are not limited to: Insurance & Eligibility Verification Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO). Research and resolve discrepancies in patient coverage or eligibility. Document eligibility outcomes in the EHR/PM system. Charge Entry & Coding Support Perform charge entry and apply CPT, ICD-10, and HCPCS codes. Review encounter forms...

THE POSITION Under general direction (III, IV), performs and is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements. IDEAL CANDIDATE The ideal candidate has specialized expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal. Skilled in the Medi-Cal Provider Manual and TAR process, they ensure timely, compliant submissions that support access to behavioral health services. They communicate effectively with peers, patients, and payers, resolve billing discrepancies, and address compliance issues in collaboration with the compliance office. Experienced in leading and training staff on Managed Care, Medicaid, Medi-Cal, Medicare, and Commercial Insurance, they ensure accuracy, efficiency, and regulatory adherence in all mental health billing operations. Medical Billin g Specialist III ( $ 25.10 - $31.86...

divh2Coding Specialist/h2pResponsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment./ppstrongMinimum Qualifications:/strong/pp1. Graduate of Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience./pp2. Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), COC (Certified Outpatient Coder), CCS...

Job Description Job Description Benefits: 401(k) Dental insurance Health insurance Paid time off Vision insurance Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opportunities Job Summary We are currently seeking a detail-oriented and dedicated Medical Biller to join our team. In this role, you will be responsible for managing the billing and collection of outstanding account balances for Medi-Cal and managed care payors . You will analyze and interpret complex payor contract language to calculate expected reimbursements accurately and ensure timely collection of all payments owed to the organization. Responsibilities Process medical billing and follow up on claims with Medi-Cal and managed care payors Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County...

divh2Coding Specialist/h2pResponsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment./ppstrongMinimum Qualifications:/strong/pp1. Graduate of Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience./pp2. Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), COC (Certified Outpatient Coder), CCS...

Medical Coding Auditor UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. This position requires extensive knowledge and experience with E/M coding. $2,000 Sign-on Bonus Minimum $56,173 - Midpoint $70,217* Salary is determined based on years of total relevant experience. Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes, medical diagnoses and clinical procedures ensuring that accurate medical billing conforms with legal and regulatory requirements. Trains, instructs and provides technical support...

Job Posting In accordance with federal & state coding compliance laws, rules, regulations, and guidelines, use current ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically/manually record into the 3M 360 Encompass/Computer-Assisted Coding (CAC), 3M Coding & Reimburse System (3M-CRS), and the coding abstracting system (3M-HDM/ARMS), all diagnoses, and minor invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary Visits: Laboratory; Radiology/Imaging; Clinic Visits; Radiation Oncology; Recurring Visits, etc.). Address OCE/NCCI/Medical Necessity edits within 3M-360/ARMS/CRS and those returned to HIM Coding from Patient Financial Services (PFS). Respond timely to all internal/external coding audit results and any feedback from other revenue cycle stakeholder Depts. Understands PFS coding/billing DNFB/DNFC processes & systems such as Oracle's Soarian Financials...

Inpatient Coding Specialist In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non-Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Perform other coding...

Billing Medical Coder The Billing Medical Coder is responsible for the day-to-day coding and billing operations for all services billable under grants, federal, state, and county programs including Medicare, Medi-Cal, managed care and private insurances. This role is located in Midtown - Sacramento, CA (95811). This role allows a hybrid schedule requiring 1-2 days per week on site. Training Period: 46 weeks onsite, 5 days per week Essential Functions Review and adjudicate coding of services from documentation in a timely manner. Code physician/provider visit procedure notes to identify appropriate ICD10 and CPT4 codes for charge processing. Ensures that all diagnosis ICD10 codes and procedure CPT, HCPCS codes are identified, sequenced, and coded in an accurate and ethical manner for optimized reimbursement. Assigns Evaluation and Management codes and key concepts/elements documented in the patient note, utilizing defined coding guidelines applicable to professional and...

Abstractor/Coder The University of Chicago Physicians Group (UCPG) team is responsible for the overall management of clinical revenue for physician billing. This includes frontend revenue capture, working of edits and conducting audits for physician education. Ensuring the workflow of charge capture through invoice creation. UCPG is seeking an Abstractor/Coder to work with providers and staff on professional billing and compliance activities. Strong knowledge of evaluation and management coding guidelines and requirements is strongly preferred. This position is eligible for a flexible work arrangement. Responsibilities: Obtain appropriate reimbursement levels for professional services by reviewing and coding medical procedures, diagnoses, and physician visits. Analyze denial and rejection reports, and appeal wherever appropriate. Submit charges in a timely manner. Work in collaboration with the Clinical Revenue Supervisor and others, provide guidance to faculty and staff on...

Coding Compliance Auditor In accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant. The Coding Compliance Auditor will also provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics Re: coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems...

Health and Information Management – PB / ProFee Coder 2 weeks ago – Be among the first 25 applicants Pay Range Base pay range: $40.40/hr – $41.60/hr Coding Educator (Temp‑to‑Hire, 13 Weeks) Location: Within *** Footprint (Hybrid – Mostly Remote with Local Travel) Type: Contingent / Temp‑to‑Hire Overview Seeking experienced Professional Fee (Pro Fee)–focused Coding Educators to support large‑scale chart review, coding accuracy validation, physician education, and documentation improvement initiatives. These roles are high‑visibility and require strong communication and presentation skills to engage directly with clinicians and support Sutter’s revenue cycle, audit, and education functions. Candidates must live within the *** geographic footprint and be available for occasional on‑site work and local travel. Positions are structured as 13‑week temp‑to‑hire with conversion opportunities. Key Responsibilities Coding Education & Training Deliver physician and coder...

Coder Quality Auditor The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties. Job Responsibilities: Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders'...

Job Summary and Responsibilities As a Senior Coder, you will act as the lead coder for your designated team. This position will train staff on department policies, procedures, systems and correct coding requirements. The Sr. Coder additionally will monitor staff workload, audit coders, fill in for out of office coders, and make recommendations to Physician Coding leadership to help improve the efficiency of the team. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. Train all new coders on department policies, procedures and correct coding principles Provide routine education, training and auditing to their designated coding teams Analyze coder's workload and make recommendations to assigned supervisor to ensure all work is completed by the...

Medical Coding Auditor UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico. This position requires extensive knowledge and experience with E/M coding. $2,000 Sign-on Bonus Minimum $56,173 - Midpoint $70,217 Salary is determined based on years of total relevant experience. Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes, medical...

Overview Riverside University Health System (RUHS) is seeking a skilled Coding Compliance Auditor (Administrative Services Manager I) to support the Compliance Department. The Compliance Auditor will review inpatient and outpatient medical records to ensure quality, accuracy, and comprehensive coding in accordance with regulations. Key Responsibilities Conduct thorough reviews of medical records for compliance with coding regulations Provide feedback and education to coders and physicians to improve coding accuracy and documentation Perform annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested Communicate effectively with all RAC stakeholders, ensuring timely and accurate responses to inquiries Support ongoing program development through training initiatives and process improvements Deliver coding presentations to diverse audiences, including physicians May supervise departmental staff as needed Qualifications Minimum of five...

Health and Information Management – PB / ProFee Coder 3 weeks ago Be among the first 25 applicants TALENT Software Services provided pay range This range is provided by TALENT Software Services. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $40.40/hr - $41.60/hr Coding Educator (Temp-to-Hire, 13 Weeks) Location: Within *** Footprint (Hybrid – Mostly Remote with Local Travel) Type: Contingent / Temp-to-Hire Overview is seeking experienced Professional Fee (Pro Fee)–focused Coding Educators to support large-scale chart review, coding accuracy validation, physician education, and documentation improvement initiatives. These roles are high-visibility and require strong communication and presentation skills to engage directly with clinicians and support Sutter's revenue cycle, audit, and education functions. Key Responsibilities Coding Education & Training Deliver physician and coder education for...

Join to apply for the Sr Coder role at Dignity Health 1 day ago Be among the first 25 applicants Position Summary The Senior Coder (Sr. Coder) acts as the lead coder for their designated team. This position will train staff on department policies, procedures, systems, and correct coding requirements. The Sr. Coder additionally will monitor staff workload, audit coders, fill in for out-of-office coders, and make recommendations to Physician Coding leadership to improve team efficiency. Responsibilities This position is remote. Train all new coders on department policies, procedures, and correct coding principles. Provide routine education, training, and auditing to their designated coding teams. Analyze coder's workload and make recommendations to ensure timely completion of all work. Research and guide coders and staff on coding-related questions or concerns. Create and update coder job aids for accurate coding of all services. Assist with provider education and...

Overview 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...

In accordance with federal coding compliance regulations and guidelines, use current ICD-10-CM, CPT-4, and HCPCS code sets, OCE/NCCI, CMS Transmittals, and other federal billing/coding regulations, manuals, rules, and guidelines to analyze, troubleshoot, and resolve all coding related edits generated within the coding, billing, and Clearinghouse systems: PBAR, nThrive (formerly MedAssets), and Aeos. Analyze, troubleshoot, and resolve all outpatient denial management coding related edits, items, and issues returned from Patient Financial Services (PFS) and assorted claims payers. Accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary/Clinic Visits, and assorted outpatient surgery: GI Lab, Heart Cath Lab, Pain...

Overview Payment Integrity Nurse Coder RN III role at L.A. Care Health Plan . Responsibilities The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs quality audits to include validation of accuracy and completeness of ICD, Rev...