42 coding compliance auditor jobs found

University of Michigan Michigan Medicine is seeking a Coding Compliance Auditor to perform outpatient coding quality audits ensuring CPT/HCPCS, ICD-10-CM code assignments and modifiers align with CMS guidelines. You will provide ongoing feedback to the coding staff and develop educational programs for the outpatient coding department. The ideal candidate holds CPC/COC/RHIT/RHIA/CCS/CCS-P credentials, an associate degree in healthcare, and at least three years of coding/auditing experience, with #J-18808-Ljbffr

University of Michigan's Michigan Medicine is seeking an experienced Coding Quality Auditor to perform outpatient coding audits for CPT/ICD-10-CM, ensuring accuracy and CMS guideline compliance. You will develop and deliver educational programs, and act as a subject matter expert for the outpatient coding department. The role requires coordinating training, providing feedback to improve code accuracy, and contributing to departmental policies and process improvements within Revenue Cycle #J-18808-Ljbffr

Compliance Coding Auditor-EducatorTrinity Health IHA Medical Group is looking for a customer-focused Compliance Coding Auditor-Educator to join our team. In this role, you will serve as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services. Provides professional expertise and education in CPT, ICD and HCC coding.What You'll Do:Develops and leads audit projects for medical record integrity.Reports audit results utilizing a standard reporting process.Identifies new errors while performing audits, investigates and assesses root cause.Performs one-on-one Audit meetings and provides for corrective educational guidance.Maintains complete knowledge and complies with all relevant insurance, CPT coding and diagnosis guidelinesProvides training for IHA staff and providers on CPT, ICD10 and HCC coding standards and procedures.General Requirements:EDUCATION: Bachelor's degree or...

Trinity Health IHA Medical Group is seeking a Compliance Coding Auditor-Educator to serve as the subject matter expert for CPT, ICD and HCC coding across IHA offices. You will lead audits, report results, and provide corrective educational guidance to staff and providers. The role requires a bachelor’s degree and coding credentials (CPC or RHIT), with at least two years of experience in coding, reimbursement analysis, and medical record auditing. #J-18808-Ljbffr

Job Title Coding Compliance Auditor Job Description Perform coding quality audits on outpatient records to assure appropriateness, accuracy, and compliance for CPT/HCPCs, ICD-10-CM code assignments, and modifier assignment in accordance with Center of Medicare and Medicaid Service (CMS) Guidelines, AMA and AHA Official ICD-10-CM Coding Guidelines. Provide ongoing feedback to managers and coders. Develop and implement educational programs regarding elements of the coding compliance program and act as a subject matter expert for the outpatient coding department. Responsibilities Characteristics, Duties, & Responsibilities: OPERATIONS Perform pre and/or post bill secondary chart review to validate modifier selection, E&M, procedural, and diagnosis coding in accordance with established coding guidelines Provide workflow and coding training to new hires Continuously provide feedback to coding staff to improve code selections that accurately describe the procedures and...

Certified Professional Coder ConsultantCome grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding.Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies.Our people are our future – we provide the venue for...

Certified Professional Coder Consultant Come grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding. Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies. Our people are our future – we provide the...

Job Description Job Description Company Description More Than Just Care, It’s Community   Imagine doing meaningful work in a place where people vacation. That’s life at Munson Healthcare - northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties.   If you want a career in healthcare and a lifestyle most people only dream about – with freshwater lakes, scenic trails, charming downtowns, a vibrant arts scene, and endless outdoor adventures - you might just be  Munson Material.  To us, that means teammates who live by our values of  excellence, teamness, positivity, creativity,  and a commitment to creating  exceptional experiences  for our patients and each other. Join a team that delivers outstanding care in one of the most beautiful regions in the country. Invested in You   Grow:  Tuition reimbursement, in-person and online development, and access to our career hub to...

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. Follows...

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...

Trinity Health in Livonia, MI seeks an experienced Health Information Management Auditor with strong coding expertise to review complex procedures, CPT/ICD-10, HCPCS and HCC guidelines. You will conduct audits, provide feedback, and develop training materials for providers and coders. Responsibilities include analyzing documentation patterns, ensuring regulatory compliance, and supporting leadership with data-driven recommendations. #J-18808-Ljbffr

Job TitleUses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization's strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.Note: "patients" refers to patients, clients, residents, participants, customers, membersEssential FunctionsOur Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of...

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...

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring CPT/HCPCS coding accuracy and guideline adherence. The role supports APC/outpatient coding, uses encoders, and performs CPT/HCPCS reviews while protecting patient confidentiality. You will work remotely with potential occasional travel for training or meetings, typical hours Monday–Friday, and focus on Outpatient Facility/APC coding teams with emphasis on accuracy and compliance. #J-18808-Ljbffr

Employment Type: Full time Shift: Description: Purpose Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge. Note: “patients” refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency &...

About the role As a Medical Coding Quality Auditor, you will play a critical role in ensuring coding accuracy, compliance, and quality across healthcare records. You will collaborate with coding professionals and physicians to support accurate clinical documentation, regulatory compliance, and operational excellence while maintaining high quality and productivity standards in a remote work environment. In this role, you will: Review medical documentation to accurately assign diagnosis and procedure codes. Communicate with physicians and other healthcare providers to obtain or clarify diagnoses and procedures through the coding query process. Assign accurate codes using electronic encoder applications in accordance with company policies, coding guidelines, and regulatory requirements. Perform peer reviews and quality audits of Health Information Management coding auditors and coders. Prepare and complete reports, audit findings, and other deliverables as requested. Monitor...

POSITION DESCRIPTION :The Compliance Auditor / Educator serves as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services.Provides professional expertise and education in CPT, ICD and HCC coding.The Compliance Auditor / Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations.This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution.Performs medical record integrity audits and conducts one-on-one meetings with Providers for corrective educational guidance.ESSENTIAL JOB FUNCTIONS :Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies...

Job DescriptionJob DescriptionMedical Coding Compliance SpecialistCompensation :Up to $85,000 annually, determined by your experience and qualifications.Job Location :Remote (US)Job Highlights :Work-Life Balance :Monday to Friday schedule for a fulfilling personal and professional life.Competitive Compensation :Be rewarded with a generous salary and benefits package.Career Growth Opportunities :Unlock your potential and advance in your career with our support.Supportive Work Environment :Join a team that values and appreciates your contributions.Comprehensive Training :Enhance your skills and knowledge through our extensive training programs.Compliance and Peace of Mind :Work with confidence knowing that we prioritize compliance with employment laws and regulations.Paid Time Off and Holidays :Enjoy well-deserved time off to relax and recharge.Life Insurance Coverage :Protect your loved ones with our employer-paid life insurance policy.Collaborative Team Environment :Thrive in a...

Medical Billing Specialist Administration - Flint, MI 48502 Overview Position Type Full Time Education Level High School Category Health Care Description This position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third-party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilities. General responsibilities Able to perform accounts receivable collection activities timely and accurately including prioritizing subtasks. Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days. Accurately post all insurance payments by line item. Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely* Collects...

Department: 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Will support : A mix of inpatient community and academic coding. Includes service lines such as cardiology, neurology, and oncology. Schedule : Full-time, Monday-Friday 40hrs with a standard schedule of Monday through Friday, 8 hours per day, totaling 40 hours each week. Certification required : Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY...

Job ID: 56162Positions Location: Lansing, MIDescription:Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes Optum CAC in accordance with established workflow. Follows University of Michigan Medicine – Sparrow policies and procedures and maintains required quality and productivity standards.Essential Duties:This job description...

Job Opportunity Positions Location: Lansing, MI Job Description General Purpose of Job: Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes Optum CAC in accordance with established workflow. Follows University of Michigan Medicine – Sparrow policies and procedures and maintains required quality and productivity standards....

Job Details POSITION SUMMARY : The HIM Coding Specialist, Outpatient, is responsible for the timely and accurate coding of outpatient, ambulatory surgery, observation, recurring, rehabilitation, and skilled care accounts. This role supports optimal reimbursement and regulatory compliance through the application of ICD-10-CM, CPT-4, APC assignment, NCCI edits, modifiers, and coding guidelines while maintaining productivity, quality, and turnaround standards. EMPLOYMENT TYPE: Direct- Hire WORK LOCATION : Remote SCHEDULE : Monday-Friday | 40 Hours Per Week SYSTEMS EMR, Outlook, VitalWare, Lawson, Encoder Software, Excel START DATE COMPENSATION: $22.49 - $34.25/hour, based on coding experience and years of acute care outpatient coding experience. ONSITE REQUIREMENTS (PLEASE REVIEW CAREFULLY) Although this is a remote position, limited onsite attendance is required. Candidates must attend one full week of onsite orientation and training at Covenant...

Highmark Inc. is seeking a remote HCC coding specialist to support risk adjustment initiatives for MA and ACA programs. You will translate physician documentation into ICD-10 codes and HCC categories, ensuring compliance with CMS guidelines and Highmark policies. In this role you will collaborate with physicians, Quality, Compliance, and leadership to improve documentation, accuracy, and audit readiness, while handling multiple coding projects across retro and prospective models. #J-18808-Ljbffr