34 coding compliance auditor jobs found

Optum is seeking an Auditor responsible for regulatory compliance audits, ensuring adherence to laws and regulations. The role involves conducting audits, analyzing risks, and providing feedback to the coding team. Candidates should have 5+ years of auditing experience in inpatient settings and a deep knowledge of compliance requirements. This position allows for telecommuting from anywhere in the U.S. Ideal applicants will possess strong coding and auditing skills, including certifications from AAPC or AHIMA. #J-18808-Ljbffr

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:...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Position in this function is responsible for regulatory compliance audits, including but not limited to regulatory agencies, Quality metrics, and coding compliance. The Auditor will monitor changes to laws and regulations to ensure compliance with State and Federal laws, regulations and mandates. Establish and implement standard policies, procedures, and best practice across Optum Middle Revenue Cycle....

About Optima Medical :Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130medical providers, who care for more than 200,000 patients statewide.Our mission is to improve the quality of life throughout Arizona by helping communities Live Better, Live Longer through personalized healthcare, with a focus on preventing the nation's top leading causes of death.We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services.We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard.This position requires an initial 60-day training period at our corporate office in Scottsdale, Arizona.Upon successful completion of training, the position will transition to a fully remote role.Job Responsibilities :Audit Medical Records...

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible. About This Opportunity As a Certified Medical Coding Auditor (Clinical Bill Review Analyst), you’ll review claims upfront and take a deeper dive to catch billing discrepancies, unbundled charges, and other errors based on standard billing practices and coding guidelines. You’ll...

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for a dynamic person to join us, working with our highly skilled Medical Coding Team to fill the role of Medical Coding Auditor & Educator.We are a 100% remote team supporting our clients across the United States! See us at.The ideal applicant will be a subject matter expert in both Facility and Profee medical coding auditing.Job Focus :The Senior Coding Auditor may be responsible for a variety of duties and obligations, depending on the client and assignment.These responsibilities may include inpatient / outpatient / professional fee facility auditing, denial management, coding, implementation specialist, job aid creation, training, and specialty coding.The position may also be responsible for management of the audit team and project management.All coding and auditing are performed within the scope of regulatory and compliance law expectations.Auditing Responsibilities :May include conducting inpatient,...

Become a part of our caring community The 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

Billing Supervisor Under direct supervision, oversees day-to-day patient billing of Medicare, Medicaid, and commercial insurance claims for clinic services and acts as a backup for Medical Billing Supervisor. Major Duties, Responsibilities: Posts payer payments and ensures insurance payments are being posted in a timely manner; ensures all billing issues with payers and patients are resolved timely; research problems; monitors Accounts Receivable Aging Report and follows-up with payers regarding outstanding claims; responds to payer and patient account inquires and completes the necessary documentation. Trains, problem-solves, and assists billing staff with questions and familiarizes them with the medical billing system. Programs new providers and new CPT codes within the NextGen system. Works with the NextGen team within the clinic and with NextGen corporate with billing system problems. Reviews complex medical records and accurately codes the primary/secondary diagnoses and...

Certified Inpatient Coder Dilkon Medical Center - Dilkon, AZ 86047 End Date 06/04/2026 Overview Level: Experienced Position Type: Full-Time Job Shift: Day Education Level: High School Diploma Travel Percentage: Negligible Description Under general supervision of the HIM Director, the Certified Inpatient Coder is responsible for reviewing inpatient medical records and accurately assigning ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, and MS-DRGs in accordance with official coding guidelines, federal regulations, and Tribal 638 facility policies. Upholds the principles of WIHCC's Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times. This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive. Essential Duties & Responsibilities: Maintains regular attendance and punctuality. Review inpatient medical records to identify all diagnoses...

Medical Coder Under general supervision, this position serves as a certified professional coder; performs the full range of coding, assigns ICD, CPT, HCPCS, and medical inpatient codes; abstracts data from the record; perform chart analysis; peer review; and serves as a medical documentation and coding technical expert to TONHC providers. This position is located within Tohono O'odham Nation Health Care (TONHC). The work involves performing specialized medical record tasks and resolving problems using established processes, coding conventions, and guidelines. Performance of duties reflects directly on patient care by recording services performed on the patient. The incumbent works independently under the general supervision of the Supervisor or designee. Essential Duties and Responsibilities: (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below): Assigns codes to diagnoses and procedures using ICD (International...

Job Description Job Description Job Title: Medical Coder (Full-Time) Location: Tucson, Arizona Employment Type: Full-Time Position Summary: We are seeking a detail-oriented and reliable Medical Coder to join our healthcare team in Tucson, Arizona. The Medical Coder will be responsible for accurately reviewing, assigning, and verifying diagnostic and procedural codes for patient records to ensure proper billing and compliance with all applicable regulations. This role plays a key part in optimizing revenue cycle performance while maintaining high standards of accuracy and confidentiality. Key Responsibilities: Review patient medical records, provider notes, and clinical documentation to assign appropriate ICD-10, CPT, and HCPCS codes Ensure coding accuracy and compliance with federal, state, and payer-specific regulations Work closely with healthcare providers to clarify diagnoses and procedures as needed Identify and resolve coding discrepancies or...

Medical Records Supervisor Are you driven to be the guiding light of a team whose goal is to deliver first-class customer service with a smile? If so, opportunity is knocking! The Medical Records Supervisor oversees all aspects of patient registration and medical records management for individuals seeking services at the Public Health Clinic and other regional sites. With a staff of seven, the Medical Records Supervisor will set priorities, develop procedures, and implement creative and innovative ways to enhance patient services. Provide overall supervision of our medical records team and activities pertaining to patient registration, insurance verification, and release of information in accordance with HIPAA guidelines. The position is responsible for coordinating all activities related to developing, managing, and evaluating compliance standards and medical records processes. Come work for Maricopa County Department of Public Health, the 3rd largest health jurisdiction in...

Specialist - Concurrent Coding / Inpatient Coder Full-time Company Description Accounting and Finance/Healthcare Job Description Specialist-Concurrent Coding/Inpatient Scottsdale Arizona 85258 Exp 2-5 Degree Associates Job Summary: The Concurrent Coding Specialist performs and facilitates concurrent inpatient coding in order to establish a working DRG. Ensures high quality documentation that is thorough, accurate and complete to ensure accurate reimbursement capture. He or she will concurrently reviews health records, identifies key clinical data elements within the record, and translate this data from verbal description of disease, injuries and procedures into numerical designations, applying ICD coding systems. Audits for documentation opportunities and queries clinical staff with CDI to fill in any gaps, clarify confusing, incomplete or conflicting information and obtain any needed additional documentation in real time. Ensures coding compliance and acts as technical...

ESSENTIAL FUNCTIONS FOR THIS POSITION Ensures that codes are assigned correctly and sequenced appropriately as per government and insurance regulations Complies with all medical coding guidelines Follows up and clarifies any information that is not clear with the rendering provider Conducts ad‑hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies NONESSENTIAL FUNCTIONS Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program. Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical, and professional guidelines adopted by Southwest Network. Other duties as assigned. WORKING CONDITIONS and DRIVING Travel between Southwest Network sites as well as in the community is required. Must have a...

Job Summary and Responsibilities As a Medical Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. Core Coding & Data Integrity: Applies expert-level knowledge to accurately assign and sequence ICD-10-CM, CPT, and HCPCS codes to outpatient medical records and encounters. Ensures coding decisions are fully substantiated by medical record documentation and...

Medical Billing Specialist This position aids in properly capturing charges and correctly billing for services performed. The Medical Billing Specialist minimizes department rework, reprocessing of multiple claims from misaligned coding, and tracks and trends repeated missed opportunities for compliant charging and proactively finds and/or provides input regarding tools to streamline and/or improve charging processes. MAIN: Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges. Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems. Perform root cause analyses, when warranted by continuous trends, to pinpoint areas, process gaps and...

100% remote Medical Coder needed for part-time contract / Must have hospital and/or acute care experience! This Jobot Consulting Job is hosted by: Christine McNamara Are you a fit? Easy Apply now by clicking the "Quick Apply" buttonand sending us your resume. Salary: $30 - $40 per hour A bit about us: We are currently seeking an experienced Inpatient Medical Coder to join our dynamic and fast-paced team. The successful candidate will play a crucial role in accurately coding patient records for our inpatient services. This is a fantastic opportunity to utilize your coding skills and knowledge in a challenging and rewarding environment, working with a variety of medical specialties and interacting with our dedicated healthcare professionals. This is a long term contract role with strong likelihood of converting to a permanent employee in 2027. Why join us? 100% remote work Flexible work schedule Growth opportunities Job Details Responsibilities 1. Reviewing and analyzing patient...

Job Description Job Description Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opportunities Position Summary The Medical Biller is responsible for managing the full revenue cycle for a small, fastpaced family practice. This role ensures accurate claim submission, timely payment posting, denial management, and patient billing. The ideal candidate is detailoriented, reliable, and able to work independently while maintaining strict compliance with payer rules and practice policies. Key Responsibilities Claims & Billing Prepare, review, and submit clean claims to insurance carriers (electronic and paper). Verify coding accuracy and ensure all required documentation is present before submission. Correct and resubmit rejected or denied claims promptly. Maintain uptodate knowledge of CPT, ICD10, and payerspecific billing guidelines. Payment Posting & Reconciliation Post insurance and patient payments accurately into the practice...

Location: Tucson Employment Type: Full-Time Schedule: Monday – Friday Position Overview The Medical Biller / Coder & Credentialing Specialist will manage key functions of the revenue cycle including coding accuracy, claims processing, payer credentialing, denial management, and provider enrollment. This role works closely with providers, leadership, and clinical teams to ensure accurate billing, compliance with payer requirements, and efficient reimbursement processes. Key Responsibilities Medical Coding Review provider documentation and assign accurate ICD-10, CPT, and HCPCS codes Ensure coding complies with payer regulations and industry guidelines Identify documentation gaps and communicate with providers when clarification is required Support coding compliance and documentation improvement Claims & Billing Prepare and submit electronic claims through the practice management system Monitor claim status and follow up on unpaid or denied claims Investigate...

Surgery Him Coder We are seeking a highly detail-oriented and experienced Surgery HIM Coder to join our Health Information Management team. This position is responsible for reviewing, analyzing, and accurately assigning ICD-10-CM, CPT, and HCPCS codes for surgical procedures based on clinical documentation in the patient medical record. The Surgery Coder ensures coding compliance with federal regulations and internal policies to optimize reimbursement and ensure data integrity. This is a remote position with a 4 day on-site work rotation, every 6-7 weeks. Essential Job Duties Review operative reports, physician documentation, and other clinical records to assign accurate and complete ICD-10-CM, CPT, and HCPCS codes. Abstract relevant information from medical records into the health information system. Ensure compliance with all coding guidelines (AAPC, AHIMA, CMS, and payer-specific). Query physicians when documentation is unclear, conflicting, or incomplete. Meet...

Full-time Company Description Accounting and Finance/Healthcare Job Description Specialist-Concurrent Coding/Inpatient Scottsdale Arizona 85258 Exp 2-5 Degree Associates Job Summary: The Concurrent Coding Specialist performs and facilitates concurrent inpatient coding in order to establish a working DRG. Ensures high quality documentation that is thorough, accurate and complete to ensure accurate reimbursement capture. He or she will concurrently reviews health records, identifies key clinical data elements within the record, and translate this data from verbal description of disease, injuries and procedures into numerical designations, applying ICD coding systems. Audits for documentation opportunities and queries clinical staff with CDI to fill in any gaps, clarify confusing, incomplete or conflicting information and obtain any needed additional documentation in real time. Ensures coding compliance and acts as technical resource, resolves issues, educates and works closely...

Essential Functions for This Position Ensures that codes are assigned correctly and sequenced appropriately as per government and insurance regulations. Complies with all medical coding guidelines. Follows up and clarifies any information that is not clear with the rendering provider. Conducts ad-hoc audits to ensure fidelity to coding guidelines. Serves as relevant expert for Southwest Network on accurate and efficient coding practices. Analyzes medical records and identifies documentation deficiencies. Nonessential Functions Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program. Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical, and professional guidelines adopted by Southwest Network. Other duties as assigned. EDUCATION And/Experience, LICENSURE And CERTIFICATION Associate degree in medical coding or successful...

Sage Clinical RCM, LLC supports leading healthcare organizations nationwide, is collaborative with a quality-driven culture, and an excellent opportunity to contribute to audit accuracy and coding excellence without unrealistic productivity expectations.Come join our team! Position SummaryThe Professional Billing Coder - Vascular Surgery is responsible for accurate coding of professional services related to vascular procedures.This role supports compliant billing practices and contributes to revenue integrity and audit readiness.Key Responsibilities-Assign accurate CPT, HCPCS, and ICD-10-CM codes for vascular surgery procedures-Review operative and procedural documentation for coding accuracy and completeness-Apply appropriate modifiers and NCCI edits-Ensure adherence to CMS, AMA, and payer guildelines-Maintain accuracy and productivity standards in a high-volume enviroment-Support internal audits and quality improvement initiatives Required Qualifications-Minimum 2years of...

Professional Services Certified Coding Reviewer Position Code: Coder-8125 Department: Health Information Management Safety Sensitive: YES Reports to: HIM Director/Manager Exempt Status: NO Position Purpose: All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI's vision to be among the kindest, highest quality health systems in the country. Key Responsibilities: Ensures data quality in compliance with State, Federal and regulatory requirements. Evaluates medical record documentation and charge reports to ensure completeness, accuracy and compliance with the Correct Coding Initiative Edits. Codes all professional charges to ensure accurate and timely billing Perform coding reviews and/or surgical coding for practices and providers. Evaluates and report audit findings or reviews and reports on results to physicians and/or operations directors. Provides technical guidance, training, and on-going coding education when...