63 coding auditor facility jobs found

Certified Er Medical Coding AuditorThe Certified ER Medical Coding Auditor is responsible for auditing emergency department medical records to ensure accurate coding, compliance, and optimal reimbursement. This role also includes training and mentoring offshore coding teams to maintain high-quality standards and consistency across operations.Key ResponsibilitiesAudit ER charts for accurate assignment of ICD-10-CM, CPT, and HCPCS codesValidate E/M level selection for emergency department visitsEnsure compliance with payer guidelines and regulatory standards (CMS, HIPAA)Identify under coding, over coding, and documentation deficienciesPrepare detailed audit reports with corrective recommendationsProvide education and feedback to coders and providersTrain and mentor offshore coding teams on ER coding guidelines and audit findingsConduct regular quality review sessions and calibration meetings with offshore staffDevelop and update training materials, review SOPs, and coding...

Job Summary (Par time-Potential for Fulltime) The Certified ER Medical Coding Auditor is responsible for auditing emergency department medical records to ensure accurate coding, compliance, and optimal reimbursement. This role also includes training and mentoring offshore coding teams to maintain high-quality standards and consistency across operations. Key Responsibilities Audit ER charts for accurate assignment of ICD-10-CM, CPT, and HCPCS codes Validate E/M level selection for emergency department visits Ensure compliance with payer guidelines and regulatory standards (CMS, HIPAA) Identify under coding, over coding, and documentation deficiencies Prepare detailed audit reports with corrective recommendations Provide education and feedback to coders and providers Train and mentor offshore coding teams on ER coding guidelines and audit findings Conduct regular quality review sessions and calibration meetings with offshore staff Develop and update training materials,...

About CLS Health CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians! Summary Assigns and aligns predefined codes, tabulates the data into the computer system, generates new codes, resolves edits and denials, and maintains proper records in accordance with CLS guidance and procedures. Conducts regular reviews to ensure billing is timely, accurate, and in compliance. Job Description Assist with implementing and maintaining system-wide billing and coding quality audits. Understands, interprets and applies coding guidelines for coding audits. Review of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including...

Calpion Inc. is seeking a Senior Coding Auditor in Dallas with 15–25 years of medical coding auditing experience, including ER/EM coding expertise. The role involves auditing the team’s coding accuracy, coaching staff, and giving feedback to improve overall quality. The candidate should review medical records, apply facility and professional coding guidelines, and adhere to ACEP guidelines to enhance coding levels. This is a contractual, WFO position with remote flexibility. #J-18808-Ljbffr

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...

Under general supervision of the Director, the Coder II provides consistency and efficiency in outpatient claims processing and data collection to optimize APC reimbursement and facilitate data quality in outpatient services. Reviews, audits, and reports on charge capture. Maintains patient confidentiality at all times. ESSENTIAL JOB FUNCTIONS Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position. Analyzes IP, OP, Recurring, & SDC records and appropriately codes per coding guidelines, ICD-10-CM and CPT rules and updates, creating APC or DRG group assignments. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous,...

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...

Compliance Auditor LeadHF Sinclair Midstream is seeking a Compliance Auditor Lead. The position is open to Dallas, TX; Tulsa, OK; Artesia, NM or Salt Lake City, UT. The Compliance Auditor Lead ensures compliance with regulations and conducts moderate to complex regulatory compliance and auditing assignments for assigned areas under general supervision.Job Duties:Reviews, interprets, and ensures compliance with applicable federal, state, and local regulatory requirements for all assigned locations.Plans, conducts, and leads regulatory compliance and operational risk-based audits, including evaluations and review of internal policies and procedures of the company operations.Serves as the primary liaison to regulatory agencies and as the Company's point of contact for general inquiries, audits, and on-site evaluations.Leads and coordinates follow-up activities associated with regulatory inspections, audits, and enforcement actions by tracking corrective actions, conducting gap...

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. Job Description: Senior Compliance Auditor - RN (Remote) At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Senior Compliance Auditor . Being a part of something this great starts by carrying out our mission every day through your...

Overview The Revenue Cycle Medical Billing Specialist is responsible for the overall account resolution of patient accounts within the revenue cycle management (RCM) process. Ensures timely billing of claims to payers and follow up of denials, appeals, recoupments and balance management. Ability to audit and provide feedback on the billing process and outcomes. Works cooperatively with other departments to ensure timely billing, reporting and patient account management. Supports the organization’s strategic plan and workplace inclusion initiatives. Abides by the organization’s mission in performing job duties. Demonstrates an understanding and commitment to PPGT’s culture of quality, safety and risk awareness. Responsibilities Reviews submission of claims by third party billing team to the clearinghouse to ensure accuracy. Processes reimbursements and payment adjustments with attention to detail, timeliness, and accuracy. Makes corrections and prepares appeals related to claim...

Medical Coder IIILocation: Remote Duration: 12 Months Payrate: $27/hr. on W2Will this role be fully remote?: Yes Are there any specific locations the candidates should be in (i.e., do they need to live in IL): Any approved states What is the expected schedule (include dates/time/time zone): 7-4pm or 8-5pm local time M-F.What are the day-to-day job duties?: Abstract and review inpatient and outpatient medical records for (Hierarchical Condition Categories) HCCs to determine if the HCC is supported by the medical record documentation. Knowledge of ICD-9 ICD10 Official Coding Guidelines, AHA Coding Clinic, including Codling clinic clarifications for DOS year under review. CMS RADV Medical Reviewer Guidance (1/10/2020).Top Skills Required: Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM audits. Must have prior vendor coding review experience. Must have the ability to complete chart review production...

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. Job Description At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there’s no place like home, and that’s why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Senior Compliance Auditor. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of...

Coder II Under general supervision of the Director, the Coder II provides consistency and efficiency in outpatient claims processing and data collection to optimize APC reimbursement and facilitate data quality in outpatient services. Reviews, audits, and reports on charge capture. Maintains patient confidentiality at all times. Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position. Analyzes IP, OP, Recurring, & SDC records and appropriately codes per coding guidelines, ICD-10-CM and CPT rules and updates, creating APC or DRG group assignments. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear...

Coder II, Coding US:TX:McAllen | Health Information Management | Full Time This is a mid-level, work from work position. Coder is responsible for: Analyzing provider documentation Assign and sequence ICD-10-CM, CPT/HCPCS appropriately Append billing modifiers when appropriate Reconcile CPT(s) Resolves billing edits according to 3M Code editor Participates in educational activities and attends staff meetings. Position Education/Qualifications: Coding credential from an accredited coding organization required Credentials from AHIMA, AAPC preferred Extensive knowledge of medical terminology Knowledge of Coding Guidelines Knowledge of CPT rules and regulations Knowledge of NCCI policies Highly reliable Must be a team player with good people skills and possess strong initiative to get daily work finished and processed Maintain productivity levels Job Knowledge/Experience: Extensive experience in medical coding, medical terminology, and anatomy and physiology...

Coder Lll - FT Days - Coding DHR Health - US:TX:McAllen - Days Summary: POSITION SUMMARY: The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the...

Medical Coder Revenue Cycle Management is looking for a full-time Medical Coder to join our team. Remote opportunity after in-person training. The Medical Coder is responsible for reviewing medical documentation and accurately assigning CPT, ICD-10-CM, HCPCS, and/or ICD-10-PCS codes depending on the encounter type. The position ensures accurate billing, compliance, and optimized reimbursement across outpatient and/or facility (inpatient) settings. Essential Functions: Assign accurate diagnosis and procedure codes based on medical record documentation using CPT, ICD-10-CM, HCPCS, and/or ICD-10-PCS. Review provider documentation to ensure coding is supported and complete for billing submission. Apply proper modifiers, sequencing, and coding conventions appropriate to the setting (inpatient or outpatient). Ensure compliance with coding regulations, organizational policies, and HIPAA standards. Meet coding productivity and quality benchmarks. Collaborate with clinical,...

Key Responsibilities Conduct detailed audits of patient medical records to ensure clinical documentation supports quality care, medical necessity, and accurate billing practices. Identify documentation, coding, billing, and compliance discrepancies and develop corrective action recommendations. Prepare comprehensive audit reports and communicate findings to leadership and operational teams. Monitor compliance risks related to Medicare, Medicaid, and other federal healthcare programs. Provide consultative guidance regarding healthcare compliance regulations and best practices. Assist with responses to government audits, investigations, and regulatory inquiries. Review potential refund and repayment obligations related to federal healthcare programs. Support policy and procedure development based on regulatory updates and audit findings. Monitor changes in healthcare laws, regulations, and compliance requirements. Collaborate with clinical, revenue cycle, finance, legal,...

Job Description Job Description Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors with strong expertise in outpatient professional fee coding and coding audits , preferably within academic medical centers. You will review coding records, identify compliance risks, and provide expert feedback to support AI-focused projects. No prior AI experience is required. Key Responsibilities Conduct detailed audits of outpatient professional fee coding records. Review coding accuracy, documentation, and compliance. Identify coding trends, gaps, risks, and improvement opportunities. Apply academic medical center standards and coding guidelines. Document audit findings and provide clear recommendations. Evaluate complex coding and documentation scenarios. Contribute to AI training through expert coding and audit feedback. Support audit program management and quality improvement initiatives. Required Qualifications...

Job Description Job Description Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors with strong expertise in outpatient professional fee coding and coding audits , preferably within academic medical centers. You will review coding records, identify compliance risks, and provide expert feedback to support AI-focused projects. No prior AI experience is required. Key Responsibilities Conduct detailed audits of outpatient professional fee coding records. Review coding accuracy, documentation, and compliance. Identify coding trends, gaps, risks, and improvement opportunities. Apply academic medical center standards and coding guidelines. Document audit findings and provide clear recommendations. Evaluate complex coding and documentation scenarios. Contribute to AI training through expert coding and audit feedback. Support audit program management and quality improvement initiatives. Required Qualifications...

Job Description Job Description Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors with strong expertise in outpatient professional fee coding and coding audits , preferably within academic medical centers. You will review coding records, identify compliance risks, and provide expert feedback to support AI-focused projects. No prior AI experience is required. Key Responsibilities Conduct detailed audits of outpatient professional fee coding records. Review coding accuracy, documentation, and compliance. Identify coding trends, gaps, risks, and improvement opportunities. Apply academic medical center standards and coding guidelines. Document audit findings and provide clear recommendations. Evaluate complex coding and documentation scenarios. Contribute to AI training through expert coding and audit feedback. Support audit program management and quality improvement initiatives. Required Qualifications...

Medical Coding Specialist Key Responsibilities: Analyze patient charts, physician notes and discharge summaries Ensure documentation is complete and accurate before coding Translate diagnoses and procedures into standardized codes using: ICD-10-CM (diagnoses) CPT (procedures) HCPCS (supplies/services) Make sure codes correctly represent services provided Follow healthcare laws and regulations (HIPAA, Medicare/Medicaid guidelines) Company Policies Prevent coding errors that could lead to claim denials or audits Stay updated on coding changes and updates Work with billing teams to submit coded claims to insurance companies Verify claim accuracy to ensure proper reimbursement Fix rejected or denied claims by reviewing and correcting codes Communicate with healthcare providers and insurance companies Protect sensitive patient information Follow strict privacy and data security standards Clarify documentation with physicians when needed Collaborate with billing...

Coder Lll - FT Days - CodingDHR Health - US:TX:McAllen - DaysSummary:POSITION SUMMARY:The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the Standards of...

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts. It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be done accurately and in a timely manner. Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers. Must always adhere to customer service expectations including in-person and virtual (via...