14 coding compliance auditor jobs found

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 (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...

Coder Quality Auditor The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties. Job Responsibilities: Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders'...

Physician Coding Auditor Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW....

Medical Coding Auditor Become a part of our caring community and help us put health first. 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...

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve...

A healthcare company is seeking a Medical Coding Auditor to work remotely. The role involves reviewing medical claims for compliance with coding guidelines, ensuring accuracy, and maintaining confidentiality. Candidates should have a certification such as CPC, COC, or CCS, with at least 3 years of post-certification experience. This position provides the opportunity for professional development as part of a leading organization focused on improving health. The pay range is $59,300 – $80,900 per year with various benefits. #J-18808-Ljbffr

Sr Analyst, Corp Compliance page is loaded## Sr Analyst, Corp Complianceremote type: Remotelocations: 09567 - Denver HQ Non-CA or CO Remotetime type: Full timeposted on: Posted Yesterdayjob requisition id: R0434559**Posting Date**11/24/20252000 16th St, Denver, Colorado, 80202-5117, United States of America**General Purpose of the Job**DaVita IKC is seeking a highly motivated and experienced Medicare Risk Adjustment Auditor and Educator to join our compliance team. This role is crucial for ensuring the accuracy, integrity, and compliance of our risk adjustment coding and clinical documentation related to professional services provided by both internal and external nephrology partners. The ideal candidate will serve as a subject matter expert, performing detailed medical chart audits and providing targeted education to providers and coding teams to support our commitment to high-quality patient care and adherence to all formal regulatory and coding guidelines.**Essential...

Become a part of our caring community and help us put health first The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy and operating objectives, and follows established guidelines and procedures while making decisions in ambiguous situations. Where you come in The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g.,...

Home Health Clinical Quality Assurance Specialist (OASIS & Medicare Compliance) Base pay range: $55,000 - $75,000 per year. Actual pay based on skills and experience. Position Overview The Home Health Quality Assurance Specialist ensures the accuracy, compliance, and quality of patient care documentation, with a primary focus on OASIS data. Role involves reviewing patient records, conducting quality assurance checks, and exporting OASIS items to Medicare for compliance and reimbursement purposes. Key Responsibilities Review and validate OASIS assessments for accuracy and completeness before submission. Export OASIS data to Medicare, ensuring compliance with CMS regulations. Address discrepancies or errors in OASIS data and collaborate with clinicians to correct inaccuracies. Conduct regular audits of clinical documentation to ensure adherence to state, federal, and agency regulations. Monitor compliance with Medicare guidelines, particularly around OASIS and other key...

Job Description Job Description Description: At STRIDE Community Health Center, we’re dedicated to more than just providing healthcare, we’re committed to making a lasting impact on the lives of our patients and the communities we serve. As one of Colorado’s largest Federally Qualified Health Centers, we offer comprehensive services—including primary care, dental, pharmacy, behavioral health, health education, and outreach, across our 13 clinics in the Denver Metro area. With over 35 years of serving our community, our growing team is at the heart of this mission. We believe healthcare is about more than treating illness; it's about fostering wellness and addressing the unique needs of every person, ensuring that no one is left behind. If you’re passionate about making a meaningful difference, thrive in a collaborative environment, and are ready for a career that transforms lives, including your own, STRIDE is the place for you. General Purpose: This Revenue Cycle Coder...

Job Description Job Description OnPoint Medical Group is searching for an outstanding Certified Professional Coder to join our team! Come join a great group of medical professionals as our network continues to grow! OnPoint Medical Group is a physician-led network of skilled Primary and Urgent care providers who are committed to expanding access to quality healthcare in the most effective and affordable manner possible. Our "Circle of Care" has one primary goal – to ensure the health and wellness of members and their families. We do this by providing access to a comprehensive menu of medical services from one unified physician group in their neighborhoods. With doctors, nurses, specialists, labs and medical records all interlinked and coordinated, patient care has never been in better hands. About the Role: The Certified Professional Coder (CPC) plays a critical role in the healthcare industry by accurately translating medical diagnoses, procedures, and services into...

Coding Auditor & Educator Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings. The Coding Auditor-Educator is an advanced level position utilizing ICD-10-CM, ICD-10 PCS, and CPT-4 Coding Classification systems who supports the facility and Coding Service Center. Responsible for answering coding and billing questions, onboarding and training new staff, performing coding audits, and development and deployment of coding education. Works in conjunction with the Coding Service Center leadership team in planning and performing coding education and training across the system....

A leading healthcare solutions provider is seeking a consultant for a remote position focusing on evaluating coders' work and conducting audits. The ideal candidate has over 5 years of experience in coding and auditing within healthcare settings. Responsibilities include preparing reports, developing training materials, and ensuring compliance with coding standards. Strong analytical and communication skills are essential for interacting with clients and internal teams. This full-time role promotes professional growth within a supportive environment. #J-18808-Ljbffr

Job Description: The HIM Hospital Inpatient & Same Day Surgery Coding Analyst deciphers and interprets provider documentation in the health record and assigns diagnostic information using ICD-10-CM/PCS and CPT codes for a complex range of acute care services for Intermountain Health. The caregiver provides specific coding expertise in the various fields of NCCI edits, Drugs and Biologicals, Revenue Codes, Current Procedural Terminology (CPT) codes, ICD-10 & CPT codes, DRGs, anatomy and physiology, pharmacology. The analyst also performs audits, provides feedback, and advanced training to clinical teams and physicians on ICD-10 and CPT coding best practices. Essential Functions Reviews and analyzes inpatient medical records for completeness, accuracy, and compliance for Same Day Surgery, Observation and Inpatient acute services at Intermountain Health. Performs coding at an advanced level of complexity for inpatient hospitals including governmental and/or...