302 coding auditor senior jobs found

Description Summary: Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs, including but not limited to Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an on-site position with a remote option. Responsibilities: Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk adjustment....

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Job Description Job Description This is a remote position. We are looking for a Senior Clinical Coding Auditor & Trainer. This position is primarily remote with a small travel expectation on an annual basis. Purpose: Responsible for developing, conducting, administering, and analyzing clinical coding training and auditing programs. The Senior Clinical Coding Auditor & Trainer will conduct audits of inpatient coding processes and assist in development of training and audit tools. Responsibilities: Develop and maintain complex audit processes and audit tools related to inpatient coding Develop and conduct clinical education courses for existing and new employees Audit established guidelines for medical necessity Analyze training needs and identify, select, or develop appropriate training programs including training aids and materials Audit staff in accordance with established auditing processes, work with staff to identify and...

Job DescriptionJob DescriptionJob Summary / PurposeThe Senior Clinical Coding Auditor & Trainer will conduct audits of inpatient coding processes for Fidelis Care and assist in development of training and audit tools.Location :The Senior Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis.Candidates must be willing to travel to New York twice a year to be considered for the position.Pay Range :$68,700.00 - $123,700.00 per yearResponsibilities :Develop and maintain complex audit processes and audit tools related to inpatient codingDevelop and conduct clinical education courses for existing and new employeesAudit established guidelines for medical necessityAnalyze training needs and identify, select, or develop appropriate training programs including training aids and materialsAudit staff in accordance with established auditing processes, work with staff to identify and resolve errors, and present findings and...

Position Summary J2 Integrity Solutions is seeking a Senior Auditor of Coding Quality & Education to lead the review and evaluation of clinical coding accuracy, documentation integrity, and compliance with applicable coding guidelines and regulatory standards. This role serves as a subject matter expert in ICD-10-CM, CPT, HCPCS, modifier, and applicable CMS and payer-specific requirements, ensuring high-quality coding practices that support accurate professional billing and revenue integrity. In addition to performing complex professional audits across multiple specialties and services lines, the Senior Audit develops and delivers targeted education to coders, providers, and documentation staff to promote best practices, reduce denials, and support continuous improvement. The ideal candidate is highly analytical, detailed-oriented leader with a strong understanding of healthcare reimbursement, coding workflows, and training methodologies. This position plays a critical...

Senior Clinical Coding Auditor & Trainer Location: Remote (10% travel - twice yearly to NYC office) Industry: Healthcare / Managed Care Company: Centene - Fidelis Care Type: Permanent Salary: USD $68,700 - $123,700 / year + 8% performance bonus Vendor Fee: $2500 Relocation: None Position Overview Centene is transforming healthcare access and quality for 28 million members nationwide. The Senior Clinical Coding Auditor & Trainer will develop, conduct, and analyze inpatient coding training and audit programs. This role supports compliance, accuracy, and continuous improvement across Fidelis Care's inpatient coding operations. Key Responsibilities Develop, maintain, and execute audit processes and tools for inpatient coding. Design and conduct training sessions for new and existing employees. Evaluate audit results and recommend process improvements. Analyze training needs and create learning materials accordingly. Audit staff...

About Plutus Health Inc. is a healthcare revenue cycle management firm that has been in the industry for 15 years. We offer end-to-end business solutions to healthcare providers in the United States, ensuring that all our services are fully compliant with HIPAA regulations. Our team has extensive experience in the field, and we leverage cutting-edge technology to ensure that your medical billing and collections processes run smoothly. Along with being SOC-certified and HIPPA-compliant, we have: Full-Cycle RCM: We handle everything from medical coding and credentialing to denial management and patient collections. Tech-Driven Efficiency: Our team of 1000+ experts, each with their unique expertise, is backed by 70+ RPA bots for automation, ensuring accuracy and speed. Flexibility: We offer billing software, financial dashboards, and patient portals, and we integrate seamlessly with your existing systems. We have Centers of Excellence worldwide to effectively...

JOB DESCRIPTION To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

Title - Inpatient Facility Medical Coder (40h Day) Location - Clackamas, OR, US Job Type - Permanent | Remote Required: Minimum five (5) years experience in coding with four (4) years inpatient facility coding The candidate must have 1 from the following list: Registered Health Information Technician Certificate Certified Coding Specialist Registered Health Information Administrator Certificate Advanced knowledge of medical terminology, pharmacology and medial coding principles for ICD-10-CM, ICD-10-PCS, HCPCS/CPT and coding. Advance knowledge of disease processes, diagnostic and surgical procedures, ICD-10-CM, ICD-10-PCS, HCPCS/CPT classification systems, health information/medical record department responsibilities with knowledge of government regulations and areas of scrutiny for potential fraud and abuse issues. Job description Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently...

Job Title : Inpatient Facility Medical Coder Location : Clackamas, OR, US Pay Rate : USD $27.26 - $39.37 / hr +Benefits JOB DESCRIPTION : Essential Responsibilities: Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as...

Company Description Job Description To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional...

Inpatient Facility Medical Coder (40h Day) Remote Clackamas, OR Candidates must reside either in Washington or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding...

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a Stanford Health Care - University Healthcare Alliance job. A Brief Overview The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. Locations Stanford Health Care - University Healthcare Alliance What you will do Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records...

The Opportunity Are you an experienced Inpatient RN ready to step away from the bedside without losing your clinical edge As part of the Centene/Fidelis Care team you will ensure the clinical accuracy of care for 28 million members.This is a high-level auditing and education role designed for nurses who love the puzzle of clinical documentation and the reward of teaching others.Key OutcomesDrive Accuracy:Develop and lead complex inpatient coding audits to ensure medical necessity and documentation excellence.Educate Teams:Design training programs that translate complex clinical data into actionable knowledge for staff.Remote Flexibility:Work primarily from home with only two scheduled trips to New York per year.Qualifications :Requirements (Strictly Enforced)Active RN License:Must be currently licensed.Acute Care Foundation:You must have direct nursing experience in an Inpatient Hospital setting.(Candidates with only outpatient or clinic experience will not be considered for this...

Job Title This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS, and ICD-10 codes on an annual basis. Responsibilities Essential Duties: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements. Identify coding discrepancies and formulate suggestions for improvement. Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. Work with the Office of the CMO and provider leadership to identify and assist providers with coding. Report findings and...

Overview This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD-10 codes on an annual basis. Responsibilities Essential Duties: • Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements. • Identify coding discrepancies and formulate suggestions for improvement. • Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. • Work with the Office of the CMO and provider leadership to identify and assist providers with coding. • Report findings and...

OverviewThis position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff.This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD-10 codes on an annual basis.ResponsibilitiesEssential Duties :Conduct prospective and retrospective chart reviews (i.e.baseline, routine periodic, monitoring, and focused) comparing medical and / or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer / title / grant coding requirements.Identify coding discrepancies and formulate suggestions for improvement.Communicate audit results / findings to providers and / or ancillary staff and share improvement ideas.Work with the Office of the CMO and provider leadership to identify and assist providers with coding.Report findings and recommendations to Compliance...

A national managed care organization is expanding its clinical coding quality and education programs and this seniorlevel role sits at the center of that mission.Youll lead inpatient coding audits develop training programs and partner with clinical teams to improve accuracy and compliance across a 28millionmember population.This is a handson highimpact role for an RN who thrives in audit education and continuous improvement.What Youll DoDevelop maintain and execute complex inpatient coding audit processesConduct inpatient coding audits and review medical necessity against guidelinesDesign and deliver clinical coding education and training programsIdentify training gaps and recommend targeted education solutionsPartner with staff to resolve audit findings and improve coding accuracyPresent audit results trends and recommendations to leadershipMaintain training records and documentationSupport updates to policies procedures and workflowsTravel to New York twice per year for onsite...

Overview This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. Responsibilities Essential Functions: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements. Identify coding discrepancies and formulate suggestions for improvement. Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. Work with medical staff department to identify and assist providers with coding. Report findings...