37 coding compliance auditor jobs found

A healthcare service organization is seeking a Medical Coding and Billing Compliance Auditor to perform coding audits and ensure compliance with regulations. The role requires extensive coding knowledge, analytical skills, and a strong background in Microsoft Office applications. Applicants should have a current coding credential and a minimum of three years of outpatient coding experience. This is a full-time remote position. #J-18808-Ljbffr

Medical Coding and Billing Compliance Auditor Location: Remote Division: Coding Compliance About the Role: The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have extensive knowledge of CPT coding, ICD-10-CM coding, E/M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access...

Jobtailor seeks an experienced coding auditor to conduct regular audits of clinical documentation and coding, ensuring compliance with federal, state, and payer regulations. The role involves interpreting coding patterns, implementing compliant solutions, and training needs analysis. The ideal candidate holds a Bachelor's degree (or equivalent) with CPC/CCA/CCS/CCS-P or similar certification and at least 3 years of physician coding experience. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy and proper documentation across medical records, behavioral health, transportation and other services. You will audit records, provide detailed findings, and present results to investigators and leadership. Stay current with CPT/ICD-10 guidelines to detect errors, fraud, and savings opportunities. #J-18808-Ljbffr

Baylor Scott & White Health is seeking a Coding Auditor I to perform coding quality audits and provide feedback to coders. The role requires strong knowledge of ICD-10-CM/PCS, CPT, HIPAA, and data abstraction, with the ability to interpret health record documentation for accurate code assignment. Collaboration with clinical documentation specialists is essential. Candidates should have at least 5 years of coding experience and one of the listed certifications, with a minimum of 1 year as a #J-18808-Ljbffr

Licking Memorial Health Systems is seeking a Compliance Auditor responsible for auditing and monitoring adherence to state and federal documentation and billing requirements across LMHS. This position reports to the VP of Financial Services and emphasizes collaboration with clinicians and administrators to improve processes. The role focuses on home care, patient-level care, and internal audits, ensuring compliance with CMS, OIG, ODH, ODM, and RAC standards. #J-18808-Ljbffr

Providence is seeking a Compliance Auditor for a remote role focused on revenue cycle compliance and hospital auditing. The position involves evaluating adherence to federal and state laws, regulatory rules, and internal Providence policies across Rev Cycle, HIM Coding, RI, and related areas. The candidate should have a Bachelor's degree in business/healthcare/finance or 5 years of hospital billing auditing or coding experience. Certification in coding is preferred. #J-18808-Ljbffr

CVS Health is seeking a skilled medical records auditor to perform chart reviews and abstract ICD codes for CMS risk adjustment. You will ensure accuracy and compliance with state and federal regulations while supporting coding decisions with evidence from records. Responsibilities include applying guidelines, identifying active vs historical conditions, meeting tight deadlines, and conducting self-audits to maintain quality within our healthcare operations. Strong CPC/CCS-P credentials required. #J-18808-Ljbffr

Providence is seeking a Compliance Auditor to audit adherence to Federal and State laws, regulatory rules, and Providence policies. The role is remote and open to candidates in multiple US states, with audit focus across revenue cycle, HIM, coding, and related areas. You'll present findings collaboratively and work toward reducing risk within Providence as a system, supporting patient-focused care and maintaining compliance across departments. #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...

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...

LMHS Compliance Auditor Licking Memorial Health Systems (LMHS) is a leading, non‑profit healthcare organization, passionately dedicated to improving the health and well‑being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting‑edge facility provides a comprehensive spectrum of patient care services, from life‑saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness. When you join the LMHS team, you become a vital part of your local community hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well‑being of your friends, family, and neighbors, and the impact of your work extends beyond the hospital doors into the heart of our community. Position Description Under the general direction...

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....

Job Description Job Description Corporate Compliance LMHS Compliance Auditor Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness. When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where...

Ohio State University Physicians is seeking a Coding Specialist to ensure accurate CPT and ICD-10 coding, while maintaining compliance with billing rules. This role will involve training staff on coding practices and conducting audits on payer denials. The ideal candidate holds a high school diploma or GED along with coding certification and has experience in billing and reimbursement. Competitive pay and comprehensive benefits are offered. #J-18808-Ljbffr

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...

Job Description Interpret clinical documentation/records from patient records to ensure all diagnoses and procedures are documented and coded accurately. Ensure highest level of reimbursement practice efficiencies and compliance related to coding procedures. Provide feedback and support to physicians. Responsibilities Responsible for translating healthcare providers' diagnostic and procedural documentation into coded form, applying regulatory and organizational guidelines. Review patient reports and extract data necessary to apply appropriate ICD and CPT codes for billing, internal and external reporting, research and regulatory compliance. Utilize technical coding principals and reimbursement rule expertise to assign appropriate ICD diagnosis and CPT procedures as appropriate, with understanding of E/M coding elements. Collaborates with direct supervisor and or team lead prior to communication with assigned healthcare providers to ensure documentation and coding...

PURPOSE OF THIS POSITION This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization’s operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES Duty 1: Maintains a thorough understanding and education of federal and state regulations and payer specific policies...

SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 hours / Days Hybrid or Remote Join a mission‑driven health plan where precision and expertise protect both members and resources—we’re seeking a certified coder who can identify discrepancies others miss, analyze coding patterns with accuracy, and turn complex clinical data into clear, actionable insights; if you bring deep knowledge of coding standards, a sharp analytical mindset, and a passion for ensuring integrity in healthcare claims, this is your opportunity to make a meaningful impact and strengthen the quality of care delivery. Summary Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met. Makes recommendations to Medical Directors, Compliance, Internal...

Responsibilities Conducts regular audits of clinical documentation and coding to identify areas for improvement and ensure compliance with federal, state, and payer regulations Makes recommendations based on interpretations of identified coding patterns Implements compliant and accurate coding solutions Identifies patterns of incorrect coding Identifies training needs and develops educational materials Partners with providers to analyze and resolve complex coding inquiries Helps Coders stay informed on changes in coding regulations Works independently to assess coding accuracy Requirements Bachelor’s degree or equivalent combination of related experience and education Certification of CPC, CCA, CCS, CCS-P, or similar designation At least 3 years of experience related to coding for physician services #J-18808-Ljbffr

About PHOENIX PHOENIX Retail, LLC is a retail platform operating the Express and Bonobos brands worldwide. Overview About PHOENIX PHOENIX Retail, LLC is a retail platform operating the Express and Bonobos brands worldwide. About Express Express is a multichannel apparel brand dedicated to a design philosophy rooted in modern, confident and effortless style whether dressing for work, everyday or special occasions. Since its launch in 1980, the brand has embraced a design philosophy rooted in modern, confident and effortless style. Express ensures you look and feel your best, wherever life takes you. The Company operates over 400 retail and outlet stores in the United States and Puerto Rico, the express.com online store and the Express mobile app. About Bonobos Our Bonobos menswear brand is known for being a style instigator and offering perfect-fit risks through our innovative retail model and personalized experience. Launched online in 2007 with its signature line of chinos,...

Overview Looking to join our dynamic team at Ohio State University Physicians where excellence meets compassion? Who We Are With over 100 cutting‑edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth. Our culture At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community. Our Benefits We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing...

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...

Overview About PHOENIX PHOENIX Retail, LLC is a retail platform operating the Express and Bonobos brands worldwide. About Express Express is a multichannel apparel brand dedicated to a design philosophy rooted in modern, confident and effortless style whether dressing for work, everyday or special occasions. Since its launch in 1980, the brand has embraced a design philosophy rooted in modern, confident and effortless style. Express ensures you look and feel your best, wherever life takes you. The Company operates over 400 retail and outlet stores in the United States and Puerto Rico, theexpress.comonline store and the Express mobile app. About Bonobos Our Bonobos menswear brand is known for being a style instigator and offering perfect-fit risks through our innovative retail model and personalized experience. Launched online in 2007 with its signature line of chinos, Bonobos now offers a variety of styles available to order online and to try on at any one of our 50 Guideshop...