107 coding compliance auditor jobs found

Coding Compliance Auditor at Memorial Hermann Health System Job Summary Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Minimum Qualifications Education : High school diploma or GED, required. Licenses/Certifications : Inpatient: RHIT, RHIA, CCA, CCS, or CIC; AHIMA/AAPC certification required. Outpatient: RHIT, RHIA, or relevant coding certification; AHIMA/AAPC certification required. Experience / Knowledge / Skills : Four (4) years of relevant hospital coding or auditing experience required. Experience coding/auditing in a level 1 trauma facility/academic teaching facility strongly preferred. Extensive knowledge of ICD‑10‑CM and CPT coding principles and guidelines. Extensive knowledge of 3M Coding applications and resolving coding...

Central Health in Austin, TX is seeking a Healthcare Compliance Coding Auditor to conduct coding audits and communicate results to providers, staff and leadership. The role includes training, reviewing CPT/HCPCS and ICD-10 codes, and updating coding processes annually. Responsibilities include identifying coding discrepancies, guiding improvements, and ensuring compliance with Medicare/Medicaid and private payers. Collaboration across departments and ongoing education are required. #J-18808-Ljbffr

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Job Description Minimum Qualifications Education :  High school diploma or GED,...

Job Opportunity At Memorial Hermann At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Description Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Minimum Qualifications Education: High school...

The Texas Tech University Health Sciences Center is seeking a Documentation & Coding Auditor to conduct medical billing coding and documentation quality audits. In this role, you will provide essential feedback to coding specialists and work collaboratively within the team. This position requires strong problem-solving skills and an active professional coding certification. An ideal candidate will have at least five years of experience in medical billing coding and reimbursement, along with knowledge in CPT, ICD-CM, and related coding systems. You will also be responsible for participating in compliance symposiums and conducting annual risk assessments. #J-18808-Ljbffr

Las Palmas Del Sol Healthcare is seeking an Inpatient Coding Auditor to perform internal quality assessments on coding practices in a work-from-home setting. The role focuses on enhancing the accuracy and integrity of patient data and ensuring coding compliance with various guidelines. The ideal candidate will have strong experience in medical coding and auditing, preferably with at least 3 years in the healthcare field. The position also offers comprehensive benefits, including medical, dental, retirement plans, and educational support opportunities. #J-18808-Ljbffr

CVS Health is seeking a Program Integrity Auditor to review medical and behavioral health records to ensure accurate coding and documentation. The role involves audits across Medicaid lines, identifying FWA, and coordinating regulator reporting with a focus on compliance and education for providers. Qualifications include 3–5 years in claims data review and medical records, CPT/HCPCS/ICD-10 proficiency, and an active CPC/CCS/CPMA license. 40-hour workweek and comprehensive benefits offered. #J-18808-Ljbffr

Baylor Scott & White Health in Dallas is seeking a Coding Auditor I to perform coding quality audits, advise coders, and ensure accurate ICD‑10, HCPCS, and CPT coding. This role emphasizes collaboration with Clinical Documentation Specialists to improve documentation quality and compliance. The position requires 5 years of coding experience with at least 1 year as an auditor and certification in RHIA/RHIT/CCS/CCS‑P/CPC/COC/CIC/CIRCC. On-site role with comprehensive benefits plan. #J-18808-Ljbffr

HCA Healthcare is looking for a work-from-home Inpatient Coding Auditor to ensure compliance with national coding guidelines and company policies. You will lead quality reviews for inpatient and outpatient coding across multiple service centers, demonstrating expert knowledge in medical coding practices. The ideal candidate will have at least three years of coding experience and auditing background. We offer comprehensive benefits, including healthcare, retirement plans, and extensive educational support. #J-18808-Ljbffr

Job TitleThis position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff.This position will support the implementation of changes to the CPT, CDT, HCPCS, and ICD-10 codes on an annual basis.ResponsibilitiesEssential Duties :Conduct prospective and retrospective chart reviews (i.e.baseline, routine periodic, monitoring, and focused) comparing medical and / or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer / title / grant coding requirements.Identify coding discrepancies and formulate suggestions for improvement.Communicate audit results / findings to providers and / or ancillary staff and share improvement ideas.Work with the Office of the CMO and provider leadership to identify and assist providers with coding.Report findings and recommendations to Compliance...

Overview This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. Responsibilities Essential Functions: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements. Identify coding discrepancies and formulate suggestions for improvement. Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. Work with medical staff department to identify and assist providers with coding. Report findings...

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation across medical, behavioral health and transportation services. The role requires a CPC, 3+ years of medical coding or auditing experience, and proficiency with CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements. Will leverage Excel and Word and communicate findings clearly to investigators and leadership. #J-18808-Ljbffr

Baylor Scott & White Health in Texas seeks a Coding Auditor 1 to join our healthcare coding team. You will perform coding quality audits, review coder work, and provide actionable feedback to ensure accurate ICD-10-CM/PCS, HCPCS, CPT coding and proper DRG classifications. You will abstract data, collaborate with Clinical Documentation Specialists, and complete production coding as assigned by leadership. A strong knowledge of coding rules, HIPAA, and documentation standards is essential, with #J-18808-Ljbffr

Integrative Emergency Services, LLC seeks a Coding Specialist in Dallas, Texas to ensure accurate coding for surgical services. This role includes evaluating medical records for CPT, ICD-10-CM, and HCPCS Level II codes, supporting documentation integrity, and compliance with payer guidelines. With a focus on best practices in emergency care, IES offers a professional environment that values employees and supports optimal reimbursement through coding analysis. A minimum of five years in surgical coding is essential for this position. #J-18808-Ljbffr

Extended Job Title Documentation & Coding Auditor Position Description Performs medical billing coding and documentation quality audits; provides feedback to coding and reimbursement specialists, coders, and educates them. This job has no supervisory responsibilities. Requisition ID 42210BR Travel Required Up to 25% Pay Grade Maximum Compensation is commensurate upon the qualifications of the individual selected. Major/Essential Functions Current and active professional medical billing coding certification required from an accredited organization. Billing and coding experience in a multi-specialty group practice and/or academic practice setting is preferred. Five or more years of health care items/services. Managerial/supervisory and program management implementation experience strongly preferred. Ability to initiate administrative activities as necessary. Excellent oral and written communication skills. Ability to write and present ideas and information in a...

Documentation & Coding Auditor Performs medical billing coding and documentation quality audits; provides feedback to coding and reimbursement specialists, coders, and educates them. This job has no supervisory responsibilities. Travel Required: Up to 25% Pay Basis: Hourly Location: Amarillo Shift: Day Major/Essential Functions Current and active professional medical billing coding certification required from an accredited organization. Billing and coding experience in a multi‑specialty group practice and/or academic practice setting is preferred. Five or more years of health care items/services. Managerial/supervisory and program management implementation experience strongly preferred. Ability to initiate administrative activities as necessary. Excellent oral and written communication skills. Ability to write and present ideas and information in a concise manner. Ability to work collaboratively with all individuals. Professional bearing, sound business...

Description Summary: The Compliance Auditor II will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws. Conducts audit activities, reporting and communicates audit findings. Works in conjunction with Compliance Director on compliance work plans, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with VP/Senior/Manager/Director on...

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 Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Review medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines Utilize encoders and various coding resources Perform CPT Procedure reviews Maintain strict patient and physician...

Job Description Job Description Job Summary: Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.   Job Responsibilities/Duties: · Chart Analysis IP, 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). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or...

Job Summary (Par time-Potential for Fulltime) The Certified ER Medical Coding Auditor is responsible for auditing emergency department medical records to ensure accurate coding, compliance, and optimal reimbursement. This role also includes training and mentoring offshore coding teams to maintain high-quality standards and consistency across operations. Key Responsibilities Audit ER charts for accurate assignment of ICD-10-CM, CPT, and HCPCS codes Validate E/M level selection for emergency department visits Ensure compliance with payer guidelines and regulatory standards (CMS, HIPAA) Identify under coding, over coding, and documentation deficiencies Prepare detailed audit reports with corrective recommendations Provide education and feedback to coders and providers Train and mentor offshore coding teams on ER coding guidelines and audit findings Conduct regular quality review sessions and calibration meetings with offshore staff Develop and update...

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Position is responsible for leading multiple reviews / audits of healthcare coding, billing, documentation, operations, and related risk areas to support compliance with regulatory standards, internal policies and procedures, and other guidelines. Typically reports to Director, Corporate Compliance. Job Description Location : Memorial Hermann, Memorial City Status :...

Description Providence is calling for Compliance Auditor - Remote The Revenue Cycle Compliance Hospital Auditor conducts audits to evaluate compliance with a wide variety of Federal and State laws, regulatory rules & regulations, PSJH policies and procedures. Areas of audit focus for this position may involve clinical and non-clinical services, including but not limited to revenue cycle: Rev Cycle departments, Rev Cycle Billing Offices, External Vendor; HIM Coding, Revenue Integrity RI, Chargemaster CDM, EPIC, and Clinical Documentation CDT. This position works collaboratively with Case Management, Utilization Review, Revenue Integrity, our PB Professional Revenue Cycle Compliance Team, Clinical Risk, Internal Legal Affairs and Finance under the supervision of the Rev Cycle Compliance Senior Manager. The Revenue Cycle Compliance Hospital auditor navigates and analyzes data across both the Clinical EMR and Epic Billing systems. This includes reviewing...

Position Description The Documentation and Coding Auditor supports the billing compliance program by helping prevent, detect, and respond to billing, coding, reimbursement, and documentation risks. This role conducts proactive monitoring, auditing, education and risk assessment activities while also responding to identified concerns, audit findings, regulatory changes, and reported compliance issues. Major/Essential Functions Plan and perform proactive compliance activities, including risk-based audits, pre-bill or concurrent reviews, data monitoring, targeted education, policy or template reviews, and department consultations. Identify and address billing compliance risks before issues escalate by using audit trends, payer updates, denial patterns, regulatory changes, stakeholder feedback, and risk assessment results. Partner with departments before new services, workflows, locations, provider groups, or documentation tools are implemented to assess and reduce...