30 coding auditor facility jobs found

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

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...

This is a remote based position. Applicants can be located nationwide Back 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...

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...

LMHS Compliance Auditor Licking Memorial Health Systems (LMHS) is a leading, non‑profit healthcare organization, passionately dedicated to improving the health and well‑being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting‑edge facility provides a comprehensive spectrum of patient care services, from life‑saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness. When you join the LMHS team, you become a vital part of your local community hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well‑being of your friends, family, and neighbors, and the impact of your work extends beyond the hospital doors into the heart of our community. Position Description Under the general direction...

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 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...

Baylor Scott & White Health is seeking a Coding Auditor I to perform coding quality audits and provide feedback to coders. The role requires strong knowledge of ICD-10-CM/PCS, CPT, HIPAA, and data abstraction, with the ability to interpret health record documentation for accurate code assignment. Collaboration with clinical documentation specialists is essential. Candidates should have at least 5 years of coding experience and one of the listed certifications, with a minimum of 1 year as a #J-18808-Ljbffr

Employer Industry: Healthcare Insurance Why consider this job opportunity: Salary up to $97,800 per year Eligible for a bonus incentive plan based on company and/or individual performance Comprehensive benefits package including medical, dental, vision, and 401(k) retirement savings plan Opportunities for professional development and career advancement within a Fortune 100 company Flexible remote work environment with occasional travel for training or meetings Supportive organizational culture focused on the well-being of employees and consumers What to Expect (Job Responsibilities): Review inpatient hospital claims to ensure proper reimbursement and handle provider disputes Assign appropriate procedural terminology and medical codes to patient records Analyze, enter, and manipulate databases for accurate claims payment and diagnosis-related group assignments Respond to internal requests for medical information and clarify discrepancies Make independent decisions...

Certified Medical Biller/Coder & Revenue Cycle Manager Overview: Focus Clinic is seeking a full-time Certified Medical Biller/Coder and Credentialing Specialist to take ownership of our revenue cycle operations as our clinic continues to grow. This role is ideal for a highly organized, proactive, and mission-driven professional with expertise in medical coding, insurance billing, and accounts receivable. The successful candidate will combine exceptional attention to detail and accountability with the compassion and clear communication our patients and families deserve. Key Responsibilities: Medical Coding and Documentation Review Accurately assign CPT, ICD-10-CM, HCPCS, and applicable modifier codes across Focus Clinic’s multidisciplinary services, including medical visits, diagnostic evaluations and testing, therapy services, and other covered services. Review clinical documentation to confirm that services are supported, appropriately coded, and compliant with payer...

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...

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...

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....

Medical Billing Specialist - Medicaid Managed Care 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. 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...

Medical Billing Specialist 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. 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: 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, state, and federal billing requirements Process...

WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION Coder MAIN FUNCTION: The Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT and DRG codes as needed to all patient charts/accounts. Assists the revenue cycle team by performing audits to detect, assess and resolve re-imbursement and revenue compliance concerns. Involved in the charge capture process. RESPONSIBLE TO: System Director of Revenue Cycle MUST HAVE REQUIREMENTS: Previous coding experience / knowledge. Ability to follow written and verbal directions. Knowledge of state and federal coding regulations. Knowledge of Anatomy, Physiology, Disease Processes, and Medical Terminology. RHIT/RHIA/CCS/ or CCA eligible. If not credentialed at time of hire, then applicant must become credentialed in one of the four areas within 12 months of hire to remain employed. Ability to operate computer on a daily basis and perform basic office procedures. No written disciplinary action within the last...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Coder Full Time, Wooster Community Hospital, Wooster, OH, US Main Function The Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT and DRG codes as needed to all patient charts/accounts. Assists the revenue cycle team by performing audits to detect, assess and resolve reimbursement and revenue compliance concerns. Involved in the charge capture process. Responsibility Report to the System Director of Revenue Cycle. Must Have Requirements Previous coding experience / knowledge. Ability to follow written and verbal directions. Knowledge of state and federal coding regulations. Knowledge of Anatomy, Physiology, Disease Processes, and Medical Terminology. RHIT/RHIA/CCS or CCA eligible. If not credentialed at time of hire, applicant must become credentialed in one of the four areas within 12 months...

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...

Overview 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. Qualifications High school graduate required. Associate Degree preferred | Registered Health Information Technician (RHIT) preferred, (or RHIT eligible) | 2 years experience in Health Information Management or related health care/office experience . Responsibilities Coding quality - 40% - Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRGs. Interprets health...

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...

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare...

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;...

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:...