31 coding auditor educator jobs found

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 where to access...

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...

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...

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...

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...

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 candidate for this...

Signature Performance is seeking an Outpatient Coding Auditor to perform quality reviews and audits of medical coding. Candidates must have extensive experience in outpatient coding, along with relevant credentials. This remote position allows applicants nationwide, aiming to enhance coding accuracy through education and feedback. Benefits include health insurance, paid holidays, and tuition assistance. A commitment to quality and professional integrity is essential as you play a key role in guiding and improving processes. #J-18808-Ljbffr

Position: Medical Billing Specialist - Medicaid Location: Lima, OH Job Id: 3271 # of Openings: 1 About Us Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We’re led by a volunteer Board of Directors. Most of our board members are also patients. Our Mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care. Summary With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to the state Medicaid program to support an efficient and effective revenue cycle. Essential Functions and Basic Duties Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billing Prepare, review, submit, and track insurance claims to Medicaid payers in accordance with FQHC,...

Position: Medical Billing Specialist - Medicaid Managed Care Location: Lima, OH Job Id: 3319 # of Openings: 1 POSITION PURPOSE With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to the state Medicaid program to support an efficient and effective revenue cycle. ESSENTIAL FUNCTIONS AND BASIC DUTIES Reviews all claims before submission to insurance companies. Maintains file system for billed claim records and back up for audit purposes. Verifies coverage and follows up on submitted claims. Requests corrected diagnosis for reimbursement purposes from providers. Responds knowledgeably to inquiries from patients, providers, insurance companies regarding covered charges, remittance advices, and billing questions. Works with Medicaid, Medicare, and insurance companies for submission of claims, to verify coverage, to determine status of claims, and to resolve issues and problems with the claims....

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...

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process. Department: Health Information Management Shift/schedule: Full Time (40 hrs/wk), Remote GENERAL SUMMARY Works under the supervision of the Health Information Reimbursement Manager. The primary job function of the HIM Coder Level I is to assign correct ICD-10 and CPT codes to established diagnoses and procedures for outpatient (emergency room, same-day surgery, interventional radiology, observation and/or Urgent Care Center) and/or limited inpatient records. In some instances, may audit OP and/or IP records for charging accuracy. May be asked to add or delete charges for optimal reimbursement as well as compliance following coding and governmental guidelines. The level one coder has mastered a maximum of 2 work types. Performs other duties as assigned. QUALIFICATIONS Education: High School Diploma or successful completion of an equivalent High School Exam...

Position: Medical Billing Specialist - Medicaid Location: Lima, OH Job Id: 3271 # of Openings: 1 About Us Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We’re led by a volunteer Board of Directors. Most of our board members are also patients. Our Mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care. Summary With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to the state Medicaid program to support an efficient and effective revenue cycle. Essential Functions and Basic Duties Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billing Prepare, review, submit, and track insurance claims to Medicaid payers in accordance with...

Purpose of This Position This position is responsible for all medical claims including pre‑billing and follow‑up activities for delayed claims, ensuring that claims are clean and paid promptly by insurers without requiring further intervention. The staff member performs all pre‑claim submission activities, verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. The individual follows departmental productivity and quality‑control measures that support the organization’s operational goals, promotes revenue integrity, and ensures timely and accurate billing and 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 requirements to promote compliant claims submission practices. Adheres to HIPAA related privacy, security and transaction & code set...

Certified Coder, Special Investigations Unit (SIU) (Job ID: 59225) 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....

Administrative/ClericalSummary 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...

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...

Datavant is seeking an Inpatient Auditing Specialist to manage coding quality and compliance assessments. This fully remote role offers a flexible schedule, allowing for comprehensive audits and education in healthcare coding processes. Applicants should have at least 3 years of experience in inpatient auditing and be proficient in specific medical reviews. Datavant provides excellent benefits, including medical and dental insurance, 401(k) plans, and significant paid time off. #J-18808-Ljbffr

Overview Looking to join and lead a dynamic team at Ohio State University Physicians where excellence meets compassion? Who we are With over 100 cutting-edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth. Our culture At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community. Our benefits We know that having options and robust benefit plans are important to you. OSUP prioritizes the...

This is a remote based position. Applicants can be located nationwide Back 1d Outpatient Coding Auditor #2814 United States Apply X Facebook LinkedIn Email Copy Position Description About You You are a person who is passionate about performing quality reviews and audits of the assigned staff. We need someone who ensures standards are met in accordance with department and organization policy. In the role of Outpatient Coding Auditor, you will demonstrate skills in organization, prioritization, professionalism and coaching others. Tell us about your experience with Outpatient Coding Auditing. Are you a team player and a self-motivator? We are counting on you to manage multiple projects using your problem-solving skills. We are looking for someone UNCOMMON. What is uncommon about you? Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you. About The Position Advanced...

Job Title Join our dynamic team at Ohio State University Physicians where excellence meets compassion. Job Description With over 100 cutting-edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth. At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community. We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing of our team and that's why...

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....

Position: Medical Billing Specialist - Medicaid Managed Care Location: Lima, OH Job Id: 3319 # of Openings: 1 POSITION PURPOSE With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to the state Medicaid program to support an efficient and effective revenue cycle. ESSENTIAL FUNCTIONS AND BASIC DUTIES Reviews all claims before submission to insurance companies. Maintains file system for billed claim records and back up for audit purposes. Verifies coverage and follows up on submitted claims. Requests corrected diagnosis for reimbursement purposes from providers. Responds knowledgeably to inquiries from patients, providers, insurance companies regarding covered charges, remittance advices, and billing questions. Works with Medicaid, Medicare, and insurance companies for submission of claims, to verify coverage, to determine status of claims, and to resolve issues and problems with the...

Certified Coder, Special Investigations Unit (SIU) 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...

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...