194 coding compliance auditor jobs found

Baptist Health in Florida seeks a Compliance Auditor (RN) to support audits across hospital service lines, focusing on documentation, coding accuracy, and compliance. The role collaborates with clinical and operational leaders to mitigate risk and strengthen controls. Ideal candidates hold an RN license with 5+ years of nursing and healthcare auditing experience, including DRG validation and CDI practices, and can work remotely within Florida while reporting to leadership.

Baptist Health in Florida seeks a Compliance Auditor (RN) to support audits across hospital service lines, focusing on documentation, coding accuracy, and compliance. The role collaborates with clinical and operational leaders to mitigate risk and strengthen controls. Ideal candidates hold an RN license with 5+ years of nursing and healthcare auditing experience, including DRG validation and CDI practices. Remote Florida position with reporting to leadership.

Baptist Health in Florida seeks a Compliance Auditor (RN) to support audits across hospital service lines, focusing on documentation, coding accuracy, and compliance. The role collaborates with clinical and operational leaders to mitigate risk and strengthen controls. Ideal candidates hold an RN license with 5+ years of nursing and healthcare auditing experience, including DRG validation and CDI practices. Remote Florida position with reporting to leadership. #J-18808-Ljbffr

Baptist Health (Jacksonville) seeks a Physician Services Coding Auditor to conduct comprehensive audits of physician and APP documentation and coding, ensuring accuracy and regulatory compliance. You will identify discrepancies, educate clinicians, and partner with Revenue Cycle teams to promote compliant coding and continuous improvement. Responsibilities include in-depth audits, detailed reporting, and delivering education to clinicians and leadership on coding trends and improvement #J-18808-Ljbffr

A healthcare organization in Sunrise, Florida is seeking a Certified Medical Coder to conduct audits related to potential fraud, waste, and abuse. The role involves post-payment medical records reviews to ensure compliance with coding guidelines. Candidates must have medical coding certification and knowledge of Medicaid rules. The position offers a hybrid work schedule and requires strong analytical and communication skills. #J-18808-Ljbffr

Riverside Health System is seeking a Clinical Coder with extensive experience in acute care coding to ensure high-quality documentation and coding compliance across inpatient and outpatient settings. You will audit records, support denial management, and educate teams to improve revenue integrity. Responsibilities include applying coding guidelines, mentoring staff, coordinating with CDI and payor relations, and preparing audit reports for leadership. #J-18808-Ljbffr

Job Description Job Description Position Summary: The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through pre and post payment medical records review and appeal records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines, coverage policies and regulatory and contract requirements. Qualifications:  Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required. Prior experience in Medicaid claims role and/or post payment medical coding auditor role preferred. Knowledge of Medicaid rules, claims processing, medical terminology and coding principles and practices. Knowledge of auditing, investigation, and research. Knowledge of...

Location Miramar, Florida Summary Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance. Responsibilities Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Research electronic medical record for any additional diagnoses documented to meet medical necessity. Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and assign anesthesia procedure codes (hospital) following specific payer requirements. Reads and interprets all provider documentation which includes all dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to...

Location Miramar, Florida Summary Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections, when advised, and follows procedure to notify billing. Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding...

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will...

Medical Coder Educator Serves as the coding reviewer and documentation educator for USFTGP Revenue Cycle Operations. Collaborate extensively with compliance; utilizing approved coding industry tools and approved internal documentation. This position is responsible for providing coding literacy and awareness using adult methodologies to revenue cycle, coding professionals, department managers, medical staff and others, ensuring proficiency is accurate and within compliant coding practices for billing. Analyze and report review findings indicating documentation gaps reimbursement and data internation, inpatient, outpatient and professional service coded. Report to compliance focused areas of improvements, recommendations and actions taken to improve medical staff knowledge and coding accuracy. Conduct individual and group coding and documentation support instructions as assigned and acts as an internal coding expert resource. Qualifications Required: High School Diploma or GED...

Job Description Job Description   PYA is seeking an experienced Inpatient/Outpatient Facility Coding Auditor to join our nationally recognized  Revenue and Compliance Advisory team. As a trusted advisor to leading healthcare organizations, you will apply your expertise in coding, reimbursement, compliance, and documentation to help clients improve revenue integrity and reduce risk. WHAT YOU'LL DO Perform inpatient and outpatient facility coding audits and reimbursement reviews, including:  ICD-10-CM/PCS, CPT, and HCPCS coding validation MS-DRG and APC validation Charge capture and revenue integrity reviews Clinical documentation improvement (CDI) assessments Third-party payer compliance evaluations Deliver high-quality client reports, recommendations, and presentations  Manage multiple engagements while maintaining exceptional quality and compliance standards  Collaborate with PYA's consulting, compliance, and executive teams to deliver comprehensive...

Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will have a strong clinical nursing background combined with experience in healthcare

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children’s Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will have...

Job Description Job Description Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors with strong expertise in outpatient professional fee coding and coding audits , preferably within academic medical centers. You will review coding records, identify compliance risks, and provide expert feedback to support AI-focused projects. No prior AI experience is required. Key Responsibilities Conduct detailed audits of outpatient professional fee coding records. Review coding accuracy, documentation, and compliance. Identify coding trends, gaps, risks, and improvement opportunities. Apply academic medical center standards and coding guidelines. Document audit findings and provide clear recommendations. Evaluate complex coding and documentation scenarios. Contribute to AI training through expert coding and audit feedback. Support audit program management and quality improvement initiatives. Required Qualifications...

Job Description Job Description Job Title: Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors to contribute their specialized expertise to an innovative healthcare AI project. In this role, you will help improve next-generation AI systems by reviewing, evaluating, and refining medical coding and audit-related content. This opportunity is ideal for professionals with strong experience in outpatient professional fee coding, auditing, and academic medical center environments. No prior AI experience is required—your healthcare expertise is what matters most. Key Responsibilities Conduct detailed reviews and audits of outpatient professional fee coding records for accuracy, compliance, and quality. Identify coding trends, gaps, risks, and opportunities for improvement. Evaluate audit findings using knowledge of academic medical center protocols and industry best practices. Document audit results and...

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that...

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will...

Baptist Health System, Inc. seeks a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing across hospital service lines. You will evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvements and mitigating risk. The ideal candidate has a strong nursing background with experience in healthcare auditing, revenue integrity, compliance, or coding, and collaborates with leadership to strengthen internal #J-18808-Ljbffr

Physician Coding Education SpecialistPerforms, develops, and implements coding related efficiency processes to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Education Specialist is responsible for analyzing physician coding trends and providing educations that will contribute to effective productivities.Responsibilities Essential Functions:Responsible for internal auditing and analyzing professional coding for all service lines.Guide and educate coding team members by addressing errors, performance issues, and trends identified through reporting.Takes an active role in developing and presenting educational programs to physicians, physician extenders, and physician offices.Effectively communicates best practice physician coding related feedback with physicians, non-physician providers, physician office staff, administration, practice managers, and team members of...

About the Job Job Summary: The Certified Professional Coder (CPC) is responsible for accurate review, abstraction, coding, and charge validation of professional and facility services for a large multi-site pain management practice and Ambulatory Surgery Center (ASC). This position ensures all services are coded in compliance with federal and state regulations, payer guidelines, National Correct Coding Initiative (NCCI) edits, and organizational policies. The CPC will review provider documentation to accurately assign CPT®, HCPCS, and ICD-10-CM codes for office visits, interventional pain procedures, ASC procedures, fluoroscopy, ultrasound guidance, and related ancillary services. The coder serves as a resource for physicians, advanced practice providers, clinical staff, and revenue cycle teams regarding documentation and coding requirements. Essential Functions: Reasonable accommodation may be made to enable individuals with disabilities to perform the essential...

About Baptist HealthRecognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We're Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.Job SummaryBaptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will have a...

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

Minimum Qualifications Certification: ONE of the following recognized professional coding certifications: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) Certified Evaluation and Management Coder (CEMC), or National Alliance of Medical Auditing Specialists' (NAMAS) Certified Evaluation and Management Auditor (CEMA) certifications are a plus. Core Duties Accurately assigns Evaluation and Management (E/M) codes, International Classification of Diseases, Clinical Modification (ICD-CM) diagnoses, ICD-10 Procedure Coding System (ICD-10-PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities derived from medical record documentation for the professional and facility components of ambulatory emergency room. May also code ambulatory or outpatient encounters as directed. Reviews encounter and/or...