33 coding compliance auditor jobs found

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring compliant coding and documentation across medical, behavioral health, transportation, and other services. The role requires auditing current records, communicating findings to investigators and regulators, and staying up-to-date on coding guidelines. The ideal candidate has CPC certification, 3+ years of coding or auditing experience, proficiency with CPT/HCPCS/ICD-10 and CMS #J-18808-Ljbffr

Baylor Scott & White Health in Phoenix is seeking a Coding Auditor 1 to perform coding quality audits using ICD-10-CM/PCS, HCPCS, CPT and related references to support accurate classification and reimbursement. You will collaborate with Clinical Documentation Specialists, provide constructive feedback, and help ensure compliant documentation across internal teams and third-party vendors. A strong knowledge of coding rules and HIPAA is essential. #J-18808-Ljbffr

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...

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...

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:...

Job # 25233 Coding Auditor/Educator Acclivity Healthcare - Your personable, proven partner! Since 1999, Acclivity Healthcare has served the specialized recruiting and staffing needs of leading healthcare employers nationwide. Our clients range from independent physician practices to national healthcare systems and insurance providers. We are proud of our 18,000+ successful placements with quality-oriented organizations that recognize the value of better talent. Compensation and Schedule for the Coding Auditor/Educator Coding Auditor/Educator - Full-time, work-from-home, $28-$35 per hour, Monday to Friday, 7:00am to 3:30pm within Arizona time zone during training. Join a a remote team dedicated to employee growth! Required Qualifications of the Coding Auditor/Educator - 3+ years of recent E/M coding experience required - 2+ years of recent auditing and provider education experience required - Surgical coding experience preferred - High school diploma or GED...

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed....

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...

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral health, transportation and other provider records, ensuring correct coding and documentation and adherence to regulatory standards. You will audit across Medicaid lines, identify FWA patterns, educate providers, and support regulator submissions while maintaining compliance with policies. Strong analytical skills and collaboration are essential. #J-18808-Ljbffr

CVS Health is looking for a Program Integrity Auditor in Phoenix, Arizona. This role involves reviewing medical records to ensure compliance with coding standards and identifying any fraudulent activities. Candidates should have 3-5 years of experience in claims data, be knowledgeable in coding guidelines, and hold an active CPC, CCS, or CPMA license. The ideal applicant will have strong analytical skills and the ability to work independently as well as collaboratively. This full-time position offers a competitive salary and a comprehensive benefits package. #J-18808-Ljbffr

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,...

Job Description Job Description Location: Tucson  Employment Type: Full-Time Schedule: Monday – Friday Our multi-location healthcare organization is seeking a highly organized professional who understands both medical billing/coding and provider credentialing and can support operational improvements within the revenue cycle. 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...

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...

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...

Serco Inc. is seeking Medical Coding Auditing Specialists to support the Defense Health Agency's DHA Medical Coding Program Branch. The role involves auditing medical documentation and coding to ensure compliance with official policies and standards across DHA markets, with duties spanning routine, targeted, and surveillance audits. Candidates must possess extensive coding experience, including ICD-CM/PCS, CPT, HCPCS, and DRG concepts, and demonstrate knowledge of revenue cycle management. #J-18808-Ljbffr

PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center. Position Summary The Lead Medical Coder serves as a certified professional coder and assists the Medical Coding Office Manager with oversight of daily coding operations. Performs the full range of coding, assigns ICD, CPT, HCPCS, and medical inpatient codes; abstracts data from the record; performs chart analysis, research coding issues; peer reviews; and serves as a medical documentation and coding technical expert to TONHC providers. Scope of Work 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...

Join to apply for the Professional Billing Coder II role at Onvida Health 2 days ago Be among the first 25 applicants Join to apply for the Professional Billing Coder II role at Onvida Health Get AI-powered advice on this job and more exclusive features. Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Shift: Days Pay Rate Type: Hourly Location: Remote Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates. Min = $22.62 Mid = $28.28 Max = $33.93 Summary The Professional Billing Coder II is an intermediate-level coding professional responsible for independently reviewing medical documentation and assigning accurate diagnostic and...

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. The ED / Observation Coder oversees assigned departments’ charging through software systems. Benefits (Full Time Employees) We offer you an excellent total compensation package, including a competitive salary, comprehensive benefits, and growth opportunities: Exceptional Colleagues Join us and you'll be a part of a culture where we support each other and celebrate what makes each of us a special person as we work together with integrity, compassion, teamwork, respect, and accountability. Our leaders demonstrate their commitment by gathering feedback, supporting, and empowering team members to do their best work through regular leadership rounding. Health and Well-Being Medical, Dental, Vision, Employer Paid HSA for HDHP participants, Robust Wellness and Employee Assistance...

Professional Services Certified Coding Reviewer 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. 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 instructed, to physicians and their office staff and other ancillary departments on both general and specific coding issues to include documentation and guidance in quality coding for proper...

Company Intro At American Vision Partners (AVP) , we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 120 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers. At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing...

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...

Datavant is seeking a Profee Auditing Specialist to perform coding audits and enhance educational support related to coding quality and compliance. Candidates should have over 5 years of Professional Fee coding experience and hold a CPC certification. This fully remote role offers a competitive salary of $35—$45 per hour, alongside comprehensive benefits including medical, dental, and retirement plans. Join Datavant to contribute to transformative healthcare data solutions. #J-18808-Ljbffr

A health data exchange leader is seeking an Inpatient Auditing Specialist to perform coding audits, provide coder education, and ensure regulatory compliance. This fully remote position allows for flexible scheduling, catering to professionals with over 5 years of inpatient coding experience. Candidates should hold certifications like CCS, RHIA, or RHIT and have experience with software such as Epic and Cerner. #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: Benefits may vary based upon position type and/or level. Job...