25 coding compliance auditor jobs found

Inpatient Medical Coding Auditor Become a part of our caring community and help us put health first. The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes 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. 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...

Health Plan Compliance Auditor page is loaded## Health Plan Compliance Auditorlocations: Banner Health Corp Phoenix (2901 N Central Ave)time type: Full timeposted on: Posted Yesterdayjob requisition id: R4426945**Primary City/State:**Phoenix, Arizona**Department Name:**Internal Audit**Work Shift:**Day**Job Category:**General OperationsYou have a place in the health care industry. At Banner Health, caring for people is at the core of all we do. We are committed to fostering a strong, inclusive culture where every team member feels valued and supported. If that sounds like something you want to be a part of - apply today!In this role you will support compliance oversight regarding Banner Health Plans and Networks. Key responsibilities include investigating issues, performing risk-based regulatory compliance audits, preparing audit reports, and evaluating documentation supporting remediation of compliance action plans.**This position is hybrid for candidates residing in...

A leading health network in Arizona is seeking a detail-oriented professional for a medical coding role. Responsibilities include ensuring the accurate assignment of codes, complying with medical coding guidelines, and conducting audits for adherence to regulations. The ideal candidate will possess strong analytical skills and be knowledgeable about insurance regulations. This role includes travel between network sites and may require evening or weekend hours as needed. #J-18808-Ljbffr

Navajo Preference Employment Act TCRHCC is located within the Navajo Nation and, in accordance with Navajo Nation law and applicable federal law, has implemented a Navajo/Indian Preference in Employment Policy. Pursuant to this Policy, applicants who are enrolled members of the Navajo Nation, Hopi Tribe, and San Juan Southern Paiute Tribe and who meet the necessary qualifications for this position will be given preference in hiring and employment for this position. Applicants who are legally married to an enrolled member of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe, who have resided within the territorial jurisdiction of the Navajo Nation or other federally-recognized American Indian Tribe for at least one continuous year immediately preceding the date of application, and who meet the necessary qualifications for this position will be given secondary preference. Applicants who are enrolled members of any other federally-recognized American Indian Tribe and...

Job Description Staff Position Description Position Title: 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...

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. EDUCATION and/or EXPERIENCE, LICENSURE and CERTIFICATION • Associate degree in medical coding or...

Position Summary TheMedical Coder/Audit Specialist position is an exempt salaried position thatensures that AAAI's coding, documentation, and billing practices are accurate,compliant, and aligned with payer regulations. This role reduces risk exposure,strengthens revenue capture, manages payer portals, and supports providersthrough education and proactive auditing. This position supports timelysubmission of insurance claims to a wide variety of payers and functions as anintermediary between healthcare providers, clients, patients and healthinsurance companies. Must be certified from an accredited organization such as AAPC (CPC) (CCS) is required in coding and / or billing. Reports To: Medical PracticeAdministrator Principal Duties andResponsibilities 1.Revenue Protection & Growth Accurate Coding = Correct Reimbursement: Ensures all CPT/ICD-10 codes and HCPCS are properly supported, reducing underpayments. Audit-Driven Optimization: Identifies missed...

You will be able to work from your home location within the United States PURPOSE AND SCOPE: Conducts data quality audits of outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology. Provides feedback and education to coders. Escalates compliance, risk-related issues to expedite mitigation. PRINCIPAL DUTIES AND RESPONSIBILITIES: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding. Chart Analysis, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA/AAPC). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to...

Medix - 3003 North Central [Medical Records Clerk] As a Coder at Medix, you'll: Analyze medical records to assign appropriate codes for billing and insurance purposes; Ensure accuracy and compliance with coding guidelines and regulations; Collaborate with healthcare professionals to clarify diagnoses and procedures; Maintain confidentiality of patient information; Update coding knowledge through continuous education and training; Assist in audits and reviews to improve coding processes and accuracy...Hiring Immediately >>

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be...

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, fast‑paced family practice. This role ensures accurate claim submission, timely payment posting, denial management, and patient billing. The ideal candidate is detail‑oriented, 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 up‑to‑date knowledge of CPT, ICD‑10, and payer‑specific billing guidelines. Payment Posting & Reconciliation • Post insurance and patient payments accurately into the practice management system. •...

Medical Coder Trajectory RCS joined the MedHQ family in 2024 after enjoying 10 years as a well-established revenue cycle company with an annual growth rate of 40% to 50% and 150 employees. Together they now serve small hospitals, physician groups, ambulatory surgery, and outpatient centers nationwide by optimizing healthcare cash flow through integration of both business office processes and clinical documentation. MedHQ, LLC, is a fast growing, leading provider of consulting and technology enabled expert services for outpatient healthcare. With a 97% long-term, client retention rate spanning over 20 years, MedHQ serves Ambulatory Surgery Centers (ASCs), Surgical Hospitals, Physician Practices, and Hospital and Healthcare Outpatient Facilities nationwide. The MedHQ RITE Values: Respect, Innovation, Trust, and Energy, permeate all service line offerings with a unique personalized approach balancing exceptional transactional and emotional intelligence, and above all excellent...

Job Description Job Description About Optima Medical: Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical 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 dedicated professionals aboard. We are currently seeking a Medical Coding Specialist to join our team! This role will transition to a fully remote position after your first 60 days. To be eligible, you'll need to complete your...

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...

**Department Name:**Coding-Acute Care Compl & Educ**Work Shift:**Day**Job Category:**Revenue Cycle**Estimated Pay Range:**$32.09 - $53.48 / hour, based on location, education, & experience.In accordance with State Pay Transparency Rules.Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certification. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we’re constantly improving to make Banner Health the best place to work and receive care.Our HIMS Auditors play a critical role at Banner Health. Join our team of forward-looking**Facility** **Coding****Auditors** who support our Inpatient Facility Coding teams. **This is** **an Auditing** **position, not a day-to-day coding production role but does require coding proficiency and recent Hospital Facility Coding experience.** In this role you will work alongside the Quality, CDI and...

Position Title and Code Professional Services Certified Coding Reviewer Position Code: Coder-8125 Department and Reporting Department: Health Information Management Reports to: HIM Director/Manager Safety Sensitive: YES 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 Coded 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,...

Abstractor/Coder The University of Chicago Physicians Group (UCPG) team is responsible for the overall management of clinical revenue for physician billing. This includes frontend revenue capture, working of edits and conducting audits for physician education. Ensuring the workflow of charge capture through invoice creation. UCPG is seeking an Abstractor/Coder to work with providers and staff on professional billing and compliance activities. Strong knowledge of evaluation and management coding guidelines and requirements is strongly preferred. This position is eligible for a flexible work arrangement. Responsibilities: Obtain appropriate reimbursement levels for professional services by reviewing and coding medical procedures, diagnoses, and physician visits. Analyze denial and rejection reports, and appeal wherever appropriate. Submit charges in a timely manner. Work in collaboration with the Clinical Revenue Supervisor and others, provide guidance to faculty and staff on...

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

Healthcare Coder – Southwest Network This position requires a candidate who can accurately code healthcare services in compliance with government and insurance regulations, maintain confidentiality, and work efficiently with electronic medical record systems. Essential Functions Assigns codes correctly and sequences them according to regulatory guidelines. Complies with all medical coding guidelines. Follows up and clarifies any unclear information with providers. Conducts ad‑hoc audits to ensure fidelity to coding guidelines. Serves as a subject‑matter expert for accurate and efficient coding practices. Analyzes medical records and identifies documentation deficiencies. Nonessential Functions Follows policies and procedures and adheres to the Corporate Compliance Program. Maintains confidentiality of verbal and written information per HIPAA standards and Southwest Network policy. Performs other duties as assigned. Education, Experience & Certifications Associate degree...

Risk Adjustment Coder Specialist Oscar is the first health insurance company built around a full stack technology platform and a relentless 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, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for...

Datavant is a leading data platform company revolutionizing health data exchange. Our mission is to ensure that every healthcare decision is made with the right data, delivered timely and in the appropriate format. Powered by the most extensive health data network in the U.S., our platform guarantees secure, accessible, and usable data to enhance health decisions. We are proud to be trusted by the foremost life sciences organizations, government bodies, and healthcare providers. By joining our team, you will be part of a high-performing and values-driven culture. Together, we are addressing some of healthcare's most challenging issues with innovative technology solutions. We embrace a diverse array of professional and personal experiences among our team members as we pursue our ambitious goals for healthcare. What We're Seeking We are on the lookout for seasoned and certified inpatient coders to join our team. The perfect candidate will have exceptional attention to...

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...

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 procedural codes for outpatient and professional services. This role requires advanced knowledge of coding guidelines and payer‑specific requirements to support correct billing, compliance, and optimal reimbursement. The PB Coder II works with minimal supervision and may assist with training or mentoring entry‑level coders. Responsibilities Review and interpret...

Essential Functions 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 a 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 Working Conditions and Driving Travel between Southwest Network sites as well as in the community is required; must have a registered...