24 coding auditor educator jobs found

Professional Coding Auditor & Educator The Professional Coding Auditor & Educator works collaboratively with physicians, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to all patients, as well as ensuring compliant reimbursement of patient care services. Responsibilities: Responsible for reviewing and analyzing all aspects of the department clinical documentation and care to ensure timely, accurate, and compliant charge capture and submission Works as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges Collaborates with Coding Supervisor to ensure clinical documentation in high-risk areas is consistent and complete Identifies...

The Professional Coding Auditor & Educator works collaboratively with physicians, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to all patients, as well as ensuring compliant reimbursement of patient care services. Responsibilities: Responsible for reviewing and analyzing all aspects of the department clinical documentation and care to ensure timely, accurate, and compliant charge capture and submission Works as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges Collaborates with Coding Supervisor to ensure clinical documentation in high-risk areas is consistent and complete Identifies inconsistencies in medical reports and works...

A healthcare organization based in Atlanta is seeking a Physician Compliance Auditor to conduct audits, report findings, and lead training sessions on coding and billing. The ideal candidate will possess at least five years of coding experience, with a strong organizational skill set and effective communication abilities. Preferred qualifications include a Certified Professional Coder certification and experience in auditing. Join a team committed to ensuring compliance and excellence in healthcare billing processes. #J-18808-Ljbffr

Description WHAT IT'S LIKE AT SGMC HEALTH Purpose . No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place. Excellence . We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service. Team Spirit. We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment. Award Winning Performance. We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides. WHY YOU WILL LOVE SGMC HEALTH SGMC has great benefit options, depending on the role that you are going into- including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities...

Overview Reviews, analyzes, and codes medical record documentation to include, but not limited to, medical diagnostic and complex procedural information for general surgical specialties for the correct ICD-10, CPT and/or HCPCS codes to the greatest specificity. Abstracts demographic and coding information into the information system accurately and completely. Reviews documentation for medical necessity. Audits orders and claims before submission for entirety and accuracy and to minimize claim denials. Assesses records and prepares reports. Provides technical guidance to physicians and other departmental staff in identifying and resolving issues or errors. Develops effective working relationship with physicians and other stakeholders. Primary coding responsibility is diagnostic and complex procedural and surgery coding. Responsibilities Reviews, analyzes, and codes medical record documentation to include, but not limited to, medical diagnostic and complex procedural information...

Become a part of our caring community 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 Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor 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. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

Overview Be inspired. Be valued. Belong . At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoingmentorshipand leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Individuals with Orthopedic and Neuro surgery experience are encouraged to apply!!! Description This position ensures the accuracy, completeness, and compliance of medical coding and clinical documentation for professional coding services. The role supports accurate coding practices, appropriate reimbursement, and regulatory compliance by reviewing patient records and...

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Review medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines Utilize encoders and various coding resources Perform CPT Procedure reviews Maintain strict patient and...

Overview Be inspired. Be valued. Belong. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs...and more! Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. Reviews discrepancies...

Inpatient Drg Coding Auditor Be inspired. Be valued. Belong. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student loan repayment assistance & reimbursement programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs...and more! Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: Review inpatient medical records for select payer populations post-discharge and pre-bill; audit the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, discharge disposition. Review discrepancies...

Compliance Auditor – Nurse (2604178) Description Job Purpose The Compliance Auditor (CA) reports directly to the Vice President of Compliance (VPC) to conduct compliance audits for Health Care Centers (HCC), Hospice, Home Health and/or SOURCE/CCSP service lines. The CA performs routine and focused internal compliance investigations, audits and assessments throughout the organization and develops detailed reports of findings. Key Responsibilities Demonstrates good analytical and organizational skills and the ability to collect, analyze and utilize data. Possesses good people skills for effective liaison with department, company and agencies while maintaining objectivity, accuracy, and confidentiality. Demonstrates knowledge of state and federal laws and regulations that apply to Home Health, Hospice and HCC operations and billing requirements. In addition to state policies related to community services. Demonstrates knowledge of organizational processes, policies, procedures,...

Position Summary The Compliance Auditor will support the compliance functions at SJ/C. The auditor is expected to conduct independent compliance audits and monitor revenue cycle and related processes as identified in the annual compliance plan. Completes audits to ensure revenue cycle and related process compliance with Health System policies, third party payer contracts and government regulations. Prepares detailed reports on audit results and provides education related to billing and coding as well as other compliance requirements. Works with all employees of SJ/C to enhance the efficiency and effectiveness of the billing process at SJ/C and all other SJ/C Affiliates. Education Bachelors - Preferred Completion of relevant continuing education related to recent changes in coding, health care billing, medical terminology and reimbursement - Preferred Experience 3-5 Years combination of school and work experience - Required Recent work experience in...

Join Datavant, the trusted data collaboration platform for healthcare. Our mission is to make health data secure, accessible, and actionable. We provide vital data solutions for healthcare providers, health plans, researchers, and life sciences companies. From assisting with individual patient requests to advancing AI in healthcare, our team is dedicated to shaping the future of health data. By becoming a Datavanter, you will be part of a dynamic and collaborative team committed to transformative change in the healthcare landscape. What We're Looking For We are seeking experienced and certified inpatient coders to join our team. The ideal candidate will have exceptional attention to detail and a solid understanding of medical terminology. This fully remote position offers a flexible schedule, allowing you to influence the future of healthcare from wherever you work best! Key Responsibilities: Assign diagnostic and procedural codes using ICD-10-CM and ICD-10-PCS...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Senior auditor responsible for clinical or physician compliance topics. Assigned the most complex clinical/documentation/coding/billing reviews. Provides guidance to other auditors within AHN on audit approach and analysis. Responsible for creating and overseeing orientation of auditors. Leads all hospital or physician audits/investigations, auditing support and responses related to external audit activity. ESSENTIAL RESPONSIBILITIES: Establishes and implements orientation for all members of the AHN audit compliance team. Evaluates the progress of team members including review of reports and audit activities. Works with senior management responsible for AHN-wide case management/physician programs to develop processes that meet Medicare and 3rd party payor requirements. Provides guidance to staff auditors on audit topics and reports. (20%) Conducts educational sessions for...

Become a part of our caring community 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 Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor 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. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS...

Compliance Audit And Analysis Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship and leadership programs And more Description Primary function: Reporting to the Manager, Compliance Audit and Analysis, develops and executes audit, monitoring, and education for professional billing, coding and documentation programs that confirm compliance, identifies reimbursement implications, and provides billing providers with relevant and timely information regarding audit results and risk areas. Serves as a resource for providers...

Description Primary function: Reporting to the Manager, Compliance Audit and Analysis, develops and executes audit, monitoring, and education for professional billing, coding and documentation programs that confirm compliance, identifies reimbursement implications, and provides billing providers with relevant and timely information regarding audit results and risk areas. Serves as a resource for providers on professional billing and coding. Principal duties and responsibilities: Prepares and oversees professional billing and coding components of the Compliance work plan reflecting scheduled activities and target dates. Leads focused audits and reviews to assess adherence with professional billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas. Assists in development of organizational compliance auditing and monitoring activities for professional billing and coding, including periodic reviews of the...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

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...

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....

JOB PURPOSE: The Compliance Auditor (CA) reports directly to the Vice President of Compliance (VPC) to conduct compliance audits for Health Care Centers (HCC), Hospice, Home Health and/or SOURCE/CCSP service lines. The CA performs routine and focused internal compliance investigations, audits and assessments throughout the organization and develops detailed reports of findings. KEY RESPONSIBILITIES: 1. Demonstrates good analytical and organizational skills and the ability to collect, analyze and utilize data. 2. Possesses good people skills for effective liaison with department, company and agencies while maintaining objectivity, accuracy, and confidentiality. 3. Demonstrates knowledge of state and federal laws and regulations that apply to Home Health, Hospice and HCC operations and billing requirements. In addition to state policies related to community services. 4. Demonstrates knowledge of organizational processes, policies, procedures, and systems related to...

A major healthcare provider seeks a qualified individual to ensure the accuracy and compliance of medical coding and clinical documentation. The position involves conducting coding audits, preparing detailed reports, and providing education to healthcare professionals. Successful candidates will have a high school diploma, two years of experience in medical coding, and relevant certification from recognized organizations. This role offers a supportive environment conducive to professional growth. #J-18808-Ljbffr

Overview Be inspired. Be valued. Belong. At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Description This position ensures the accuracy, completeness, and compliance of medical coding and clinical documentation for professional coding services. The role supports accurate coding practices, appropriate reimbursement, and regulatory compliance by reviewing patient records and collaborating with healthcare providers, coding teams, and compliance staff. RESPONSIBILITIES Ensures the accuracy, completeness, and...

A healthcare provider in Atlanta is seeking a Coding Provider Liaison to ensure accurate clinical documentation and compliance in medical billing. The successful candidate will review and analyze charge capture, educate on regulations, and audit provider documentation. Candidates must hold an active CPC or CCS certification and have over 3 years of experience in medical billing. Strong organizational skills and the ability to handle pressure in a fast-paced environment are essential. Join us to make a difference in patient care! #J-18808-Ljbffr