32 coding auditor educator jobs found

Datavant is seeking a Profee Auditing & Education Specialist to perform professional fee coding audits and educate healthcare professionals. Remote role with a flexible schedule, involving audits, education development, and collaboration with clients to improve coding accuracy and compliance. You will present coding and compliance topics, identify trends, and deliver webinars and materials. Requires CPC, CPMA preferred, 5+ years in coding/auditing, and strong MS Office skills. #J-18808-Ljbffr

Summary of Position To aid and assist in providing direction, instruction, and guidance to a team of individuals with the purpose of training and developing staff. Works with the CBO A/R Manager to manage projects and develop process improvements, while providing the daily guidance and assistance needed to maintain optimal performance and productivity within the team. Provides supervisory guidance to the team as directed by the A/R Manager and perform all functions with a high level of discretion and professionalism. Nature and Scope An effective Senior Team Lead will provide guidance to their team based on management direction, will use their experience and knowledge of the tools the team uses (e.g., EPIC), policies, and guidelines to educate team members, will identify areas for improvement systematically and within their team, and will communicate directly with management the status of resolved and outstanding issues/roadblocks within the team. Principal Duties and...

Medical Claims SpecialistThis position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts.Job Duties/ResponsibilitiesMaintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Medical Claims Specialist This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. Job Duties/Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Full-Time Days Two (2) years of work experience in a physician’s office or Out-patient/In-patient setting performing documentation review per compliance and Medicare/Medicaid Standards, diagnostic code sequencing and familiarity to Medical Terminology required. Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Medical Coder (CMC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) reqired. Summa Health Medical Group Akron, OH 44304 Full-Time Days Will work remote after training and orientation Two (2) years of work experience in a physician’s office or Out-patient/In-patient setting performing documentation review per compliance and Medicare/Medicaid Standards, diagnostic code sequencing and familiarity to Medical Terminology required. Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Medical Coder (CMC), Certified Professional Coder (CPC), Certified Professional...

Summa Health System is seeking an experienced Medical Coding Auditor to review and audit medical records per Medicare/Medicaid standards. You will prepare detailed reports, deliver recommendations, and educate providers on coding compliance. Requires two years’ experience in a physician office or hospital setting and CCS, CCS-P, CMC, CPC, CPMA certifications, with remote work possible after training. #J-18808-Ljbffr

Medical Coding and Billing Compliance Auditor Location: Remote Division: Coding Compliance About the Role: The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have extensive knowledge of CPT coding, ICD-10-CM coding, E/M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know...

Job Description Using established policies and procedures; the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series, and emergency room cases) and may be called upon to code highly complex inpatient records (to include trauma, burns, open heart and transplant cases) based on experience and skill set. Responsibilities Coding quality: Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRG's. Interprets health record content to ensure that all diagnoses and procedures coded are supported by physician documentation. Maintains a coding accuracy rating of at least 95% on records assigned. Queries physicians when necessary to ensure documentation supports...

Job Description Interpret clinical documentation/records from patient records to ensure all diagnoses and procedures are documented and coded accurately. Ensure highest level of reimbursement practice efficiencies and compliance related to coding procedures. Provide feedback and support to physicians. Responsibilities Responsible for translating healthcare providers' diagnostic and procedural documentation into coded form, applying regulatory and organizational guidelines. Review patient reports and extract data necessary to apply appropriate ICD and CPT codes for billing, internal and external reporting, research and regulatory compliance. Utilize technical coding principals and reimbursement rule expertise to assign appropriate ICD diagnosis and CPT procedures as appropriate, with understanding of E/M coding elements. Collaborates with direct supervisor and or team lead prior to communication with assigned healthcare providers to ensure documentation and coding accurately...

Become a part of our caring community 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. Where you Come In 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 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...

PURPOSE OF THIS POSITION This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization’s operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES Duty 1: Maintains a thorough understanding and education of federal and state regulations and payer specific policies...

Job TitleJob DescriptionDutiesHelpsAssigns codes to documented patient care encounters (inpatient or outpatient) covering the full range of health care services provided by the VAACC.Applies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services.Selects and assigns codes from the current version of several coding systems to include current versions of the International Classification of Diseases-Clinical Modification (ICD-CM), Current Procedural Terminology (CPT), Diagnostic and Statistical Manual of Mental Disorders (DSM), and Healthcare Common Procedure Coding System (HCPCS).Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management (E&M) code to ensure ethical, accurate, and complete coding.Applies codes based...

Summary This position is in the Health Information Management (HIM) section of the Patient Business Services (PBS) at the Columbus VA Ambulatory Care Center. MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. Learn more about this agency Duties Help Assigns codes to documented patient care encounters (inpatient or outpatient) covering the full range of health care services provided by the VAACC. Applies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services. Selects and assigns codes from the current version of several coding systems to include current versions of the International Classification of Diseases-Clinical Modification...

Location: This role enables associates to work virtually full-time, except for 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 if candidates reside within a commuting distance from an office. 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 accommodation is granted as required by law. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding...

Job Description Job Description Description: About Primary Health Solutions Our Mission We meet people where they are and partner with them on their journey towards wellness. Our Vision The destination for servant leaders to provide comprehensive and exceptional care. Our Values R – Respect I – Innovation S – Stewardship E – Excellence Billing and Coding Specialist Summary Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. A Day in the Life · Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. · Review incomplete encounters and code based on available documentation in EHR systems. · Know and understand several different...

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...

Ensemble Health Partners seeks an Inpatient/DRG Validation Coding Auditor to review medical records and ensure accurate DRG assignment and documentation. You will identify discrepancies, educate coders, and help improve reimbursement accuracy for hospital clients. The role requires 5+ years of coding and 3+ years of facility audit experience, proficiency with EMR systems and encoders, and maintaining HIPAA compliance. #J-18808-Ljbffr

Senior Team Lead Summary of Position To aid and assist in providing direction, instruction, and guidance to a team of individuals with the purpose of training and developing staff. Works with the CBO A/R Manager to manage projects and develop process improvements, while providing the daily guidance and assistance needed to maintain optimal performance and productivity within the team. Provides supervisory guidance to the team as directed by the A/R Manager and perform all functions with a high level of discretion and professionalism. Nature and Scope An effective Senior Team Lead will provide guidance to their team based on management direction, will use their experience and knowledge of the tools the team uses (e.g., EPIC), policies, and guidelines to educate team members, will identify areas for improvement systematically and within their team, and will communicate directly with management the status of resolved and outstanding issues/roadblocks within the team. Principal Duties...

Description - External Summary of Position To aid and assist in providing direction, instruction, and guidance to a team of individuals with the purpose of training and developing staff. Works with the CBO A/R Manager to manage projects and develop process improvements, while providing the daily guidance and assistance needed to maintain optimal performance and productivity within the team. Provides supervisory guidance to the team as directed by the A/R Manager and perform all functions with a high level of discretion and professionalism. Nature and Scope An effective Senior Team Lead will provide guidance to their team based on management direction, will use their experience and knowledge of the tools the team uses (e.g., EPIC), policies, and guidelines to educate team members, will identify areas for improvement systematically and within their team, and will communicate directly with management the status of resolved and outstanding issues/roadblocks within the team....

Job DescriptionUsing established policies and procedures; the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series, and emergency room cases) and may be called upon to code highly complex inpatient records (to include trauma, burns, open heart and transplant cases) based on experience and skill set.ResponsibilitiesCoding quality:Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRG's.Interprets health record content to ensure that all diagnoses and procedures coded are supported by physician documentation.Maintains a coding accuracy rating of at least 95% on records assigned.Queries physicians when necessary to ensure documentation supports the codes...

SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 hours / Days Hybrid or Remote Join a mission‑driven health plan where precision and expertise protect both members and resources—we’re seeking a certified coder who can identify discrepancies others miss, analyze coding patterns with accuracy, and turn complex clinical data into clear, actionable insights; if you bring deep knowledge of coding standards, a sharp analytical mindset, and a passion for ensuring integrity in healthcare claims, this is your opportunity to make a meaningful impact and strengthen the quality of care delivery. Summary Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met. Makes recommendations to Medical Directors, Compliance, Internal...

Location: This role enables associates to work virtually full-time, except for 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 if candidates reside within a commuting distance from an office. 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 accommodation is granted as required by law. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG...

Anderson Hills Pediatrics' Expectations of all Employees Adhere to all Anderson Hills Pediatrics' Policies and Procedures Conduct self in a manner that represents Anderson Hills Pediatrics' core values at all times Maintain a positive and respectful attitude with all work-related contacts Consistently reports to work prepared to perform the duties of the position Meets productivity standards and performs duties as workload necessitates Primary Function Assists the Billing Manager with the claims submission and revenue cycle of the practice. Major Duties and Responsibilities Adherence to current HIPAA regulations and federal/state laws for patient protected health information (PHI) and/or medical records; adherence to all AHP policies/procedures as they pertain to patient PHI and the medical record; maintain strict confidentiality of all patient information Update patient demographic information including insurance coverage; make changes/corrections as needed;...