14 coding auditor provider educator jobs found

Company Overview Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast‑growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Job Summary Alignment Health is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities related to risk adjustment data submitted to CMS. In this role, you will conduct provider and coder‑level audits, review medical record documentation and coding accuracy, identify compliance risks and...

Become a part of our caring community The 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 Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Coder Reimbursement Specialist - Hospital The Coding and Reimbursement Specialist, CCS is responsible for coding and abstracting thoroughly, clinical data from the medical record. This includes both inpatient, outpatient, commercial, Medicare, Medicaid, and Illinois Public Aid, plus any other payor types. This accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis, grouped to the DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General. Manages workload and assigns work to three inpatient and two outpatient coders and oversees the day to day workings of the coding/reimbursement area. Monitors various regulatory sources to keep HIM coding and other staff informed and trained on various coding rules, regulations and related issues. Works closely with patient financial services to resolve any...

COMPANY OVERVIEW Health Partners Management Group, Inc (HPMG) is a government contracting company in Poplar Bluff, Missouri. HPMG currently bidding on a contract with the Federal Government for several coding positions. You would be a W-2 employee for HPMG and NOT a government employee. SUMMARY Responsible for assignment of accurate ICD codes for diagnoses and procedures. Medical Severity - Diagnostic Related Group (MS-DRG) is automatically assigned by the grouper software for inpatient stays. Inpatient coders may also be responsible for the assignment of accurate ICD diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities from medical record documentation (paper or electronic) for inpatient professional services (a.k.a., rounds or IBWA encounters). Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities. MANDATORY KNOWLEDGE AND SKILLS Position requires...

Job Type: Full-time Description The Certified Coder will play a key role in converting diagnoses and treatment procedures into ICD-10, CPT and HCPCS codes. The Coder will review and accurately code office and hospital procedures for reimbursement. Essential Functions Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications. Researches and analyzes data needs for reimbursement. Analyzes medical records and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff. Reviews and verifies documentation supports diagnoses, procedures, and treatment results. Identifies diagnostic and procedural information. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Assigns codes for reimbursements, research and compliance with regulatory requirements...

Job Posting Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. No matter where you start with us, we're committed to taking our team to the top. If you're ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family. General Summary The coder is responsible for ensuring appropriate levels of service being billed according to the American Medical Association (AMA) and Center for Medicare and Medicaid Services (CMS) guidelines, insurance credentialing, and provider/staff education in relation to coding and billing guidelines. Maintain routine chart audits for providers. Essential Duties And Responsibilities Assigns ICD-10-CM, CPT, and HCPCS Level II codes to completed and signed medical documentation creating an appropriate assigned medical claim. Abstracts specified data and information from patient records in order to determine...

HIM Coder II – Billings Clinic Main Campus Location: Billings, Montana Shift: Day Employment Status: Full-Time (.75 or greater) Hours per Pay Period: 80 hours every two weeks (Non-Exempt) Starting Wage (DOE): $21.70 - $27.12 Position Summary: Responsible for coding and abstracting diagnoses and procedures from patient charts using ICD-CM, ICD PCS and/or CPT-4/HCPCS codes for statistical and reimbursement purposes for all Billings Clinic inpatient and outpatient services. Also audits or assigns CPT and E&M codes to clinic encounters, captures primary and secondary ICD-CM diagnoses, adds HCPCS modifiers, and verifies units of service for pharmacy items and supplies. Actively queries physicians for clarification, provides coding education, and serves as an on‑site resource for providers and staff. Calculates MSDRG and APR-DRG, ensuring adherence to all internal and regulatory compliance policies and procedures governing medical records coding, billing, and...

You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. Billings Clinic has been in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006. And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here. About Us Billings Clinic is a community‑owned, not‑for‑profit, Physician‑led health system based in Billings with more than 4,700 employees, including over 550 physicians and non‑physician providers. Our integrated organization consists of a...

Hiring Department University Physicians Job Description This position is a dual post linked to Job ID 59698 - MCS-C and the department will be hiring for two positions. Review complex clinical documentation and diagnostic results timely to accurately assign codes for diagnoses (ICD-10-CM), procedures (CPT), and applicable modifiers for services provided to assure maximum reimbursement and regulatory compliance. Assist in the audit of medical records to identify potential problems with coding and reimbursement, such as edits, denials, and appeal letters. Act as liaison between third-party payers and assigned departments to coordinate all aspects of professional coding. Provide assistance to faculty, residents, and department staff in standards of medical record documentation and coding. Assist in the presentation of training sessions for faculty, residents, and staff to inform them of changes made to Medicare billing, federal laws and regulations, and other specific standards...

Become a part of our caring community The Senior Market Consultation / Partnership Professional (Nurse Medical Coder) supports Clinical Support Team (CST) initiatives by promoting accurate, compliant, and complete documentation and coding practices that enhance the quality and measurement of programs across risk adjustment. Work assignments involve moderately complex to complex issues where analysis of clinical documentation, coding accuracy, and risk adjustment data requires evaluation of multiple variable factors. Key Responsibilities Perform detailed medical record reviews to ensure accurate ICD-10-CM coding, risk adjustment capture, and alignment with CMS-HCC (e.g., V24/V28) models Validate diagnosis coding and ensure documentation meets compliance standards Identify and escalate coding trends and documentation gaps Serve as a coding subject matter expert supporting CST workflows, including PDV, chart review prioritization, and provider outreach...

Certified Professional Coder, Outpatient Billing Full Time Corporate 3 days ago Requisition ID: 4107 Salary Range: $27.00 To $35.00 Hourly Position Summary This role is responsible for ensuring accurate, compliant, and complete coding of professional outpatient encounters in a high-volume urgent care environment. This role reviews provider documentation, validates and corrects CPT® and ICD-10-CM code selection, queries providers for missing or unclear documentation, and ensures all claims meet CCI, payer, and outpatient coding requirements prior to billing. This role also plays a key role in supporting provider coding and documentation audits and manual coding activities required during system downtime or special operational needs. Key Responsibilities Documentation Review & Coding Validation Review clinical documentation to confirm all services rendered are documented completely and accurately prior to billing. Validate provider-selected CPT® and ICD-10-CM codes to...

Become a part of our caring community The Inpatient Medical Coding Auditor - PPI Coding Disputes reporting to the Manager reviews the appropriate DRG and ICD-10-CM/ PCS coding assignments for accuracy within the coding disputes team from a variety of medical records. The Disputes Auditor - MSDRG Inpatient Coding on the Disputes Team consults and collaborates with coding professionals within and across departments 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 inpatient coding audits (MSDRG/APDRG) Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate coding guidelines and communicates disputes outcomes to providers in a professional and concise manner. Leverages advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices Manages multiple...

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 on 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...

Join a dedicated healthcare team serving the heart of the Midwest region. This role is perfect for a detail-oriented medical coder who thrives in a remote work environment and values accuracy and compliance. General Summary The medical coder ensures accurate billing by assigning appropriate ICD-10-CM, CPT, and HCPCS Level II codes in accordance with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. This position involves insurance credentialing and educating providers and staff on coding and billing standards. Routine chart audits and timely documentation review are essential components of this role. Essential Duties and Responsibilities Assign ICD-10-CM, CPT, and HCPCS Level II codes to finalized medical documentation to create accurate medical claims. Abstract relevant data from patient records to determine appropriate claim modifiers. Communicate with providers to clarify unclear or incomplete documentation and...