32 coding compliance auditor jobs found

CVS Health in Madison, Wisconsin is hiring a Certified Professional Coder (CPC) to conduct medical record reviews for the Special Investigations Unit, ensuring CPT/HCPCS alignment with documentation and compliance with state, federal, and company requirements. The role requires 3+ years of coding experience, CPC certification, knowledge of CPT/HCPCS, CMS 1500/UB04, and strong communication to articulate findings to investigators and leadership; travel may be required. #J-18808-Ljbffr

The Coding Auditor at ThedaCare performs coding quality audits of records to ensure appropriate code assignments in accordance with CMS guidelines. Provides ongoing feedback and education to coders and providers, and supports corporate compliance efforts. Located at ThedaCare Regional Medical Center in Appleton, this role emphasizes regulatory compliance, audit planning, and collaboration with physicians to clarify documentation for accurate coding. #J-18808-Ljbffr

Indigenous Pact PBC, Inc. is seeking a Senior Coding Quality Auditor who will lead coding research, audits, and education within the Compliance Department. This remote role requires about 25% travel to clinic locations in the Pacific Northwest, Wisconsin, and California to support coding quality and policy updates. You will review coding accuracy, respond to denials, and ensure alignment with tribal care programs and service launches. #J-18808-Ljbffr

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...

JOB REQUIREMENTS: Number of Openings: 1 Job Title: Inpatient Coding Auditor Occupational Category: Please choose the most appropriate choice based on the Job Title and Description. Duties and Responsibilties of Job: Summary Are you passionate about coding accuracy, compliance, and helping others succeed? We're seeking an Inpatient Coding Auditor to join a leading healthcare organization in a remote capacity. In this role, you'll play a key part in strengthening coding quality, supporting professional development within coding teams, and ensuring documentation and reimbursement practices align with industry standards. This is an excellent opportunity for an experienced inpatient coding professional who enjoys a blend of auditing, education, collaboration, and continuous improvement. About the Opportunity Join a highly respected healthcare organization that is committed to delivering quality patient care through operational excellence and regulatory integrity. As part of a...

JOB REQUIREMENTSDiscover. Achieve. Succeed. #BeHere Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility. This job is REMOTE. FTE: 1.000000 Standard Hours: 40.00 Shift: Shift 1 Shift Details: M-F business hours Holidays: Not required Weekends: Not requiredJob SummaryThe Inpatient Auditor supports the quality and development of the inpatient coding team through coding audits, education, and mentorship. This role has a primary focus on auditing coding accuracy, DRG assignment, and compliance while providing constructive feedback to coders. As proficiency is demonstrated, responsibilities expand to include onboarding, training, assisting with developing educational resources, and serving as a coding subject matter expert. The Inpatient Auditor collaborates with Coding Leadership, the Inpatient Trainer and Education Coordinator, and interdisciplinary teams to promote coding quality, regulatory compliance, and continuous improvement across the organization.EXPERIENCE...

Job RequirementsDiscover. Achieve. Succeed. #BeHere Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility. This job is REMOTE. FTE: 1.000000 Standard Hours: 40.00 Shift: Shift 1 Shift Details: M-F business hours Holidays: Not required Weekends: Not requiredJob SummaryJob Summary: The Inpatient Auditor supports the quality and development of the inpatient coding team through coding audits, education, and mentorship. This role has a primary focus on auditing coding accuracy, DRG assignment, and compliance while providing constructive feedback to coders. As proficiency is demonstrated, responsibilities expand to include onboarding, training, assisting with developing educational resources, and serving as a coding subject matter expert. The Inpatient Auditor collaborates with Coding Leadership, the Inpatient Trainer and Education Coordinator, and interdisciplinary teams to promote coding quality, regulatory compliance, and continuous improvement across the...

Froedtert is seeking an Inpatient Auditor to strengthen inpatient coding quality, DRG assignment accuracy, and regulatory compliance. The role emphasizes audits, education, and mentoring, with potential expansion to onboarding and resource development. Collaborating with Coding Leadership and interdisciplinary teams, you will promote continuous improvement across Froedtert Health while supporting a remote operating model from Milwaukee. #J-18808-Ljbffr

Froedtert Health in Milwaukee seeks an Inpatient Auditor to strengthen the inpatient coding team through audits, education, and mentorship. The role emphasizes DRG assignment accuracy, regulatory compliance, and constructive feedback to coders, with potential onboarding and training responsibilities as proficiency grows. Collaborating with Coding Leadership and interdisciplinary teams, you will drive coding quality and continuous improvement across the organization, supporting patient care #J-18808-Ljbffr

JOB REQUIREMENTS: Discover. Achieve. Succeed. #BeHere Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility. This job is REMOTE. FTE: 1.000000 Standard Hours: 40.00 Shift: Shift 1 Shift Details: M-F business hours Holidays: Not required Weekends: Not required Job Summary: The Inpatient Auditor supports the quality and development of the inpatient coding team through coding audits, education, and mentorship. This role has a primary focus on auditing coding accuracy, DRG assignment, and compliance while providing constructive feedback to coders. As proficiency is demonstrated, responsibilities expand to include onboarding, training, assisting with developing educational resources, and serving as a coding subject matter expert. The Inpatient Auditor collaborates with Coding Leadership, the Inpatient Trainer and Education Coordinator, and interdisciplinary teams to promote coding quality, regulatory compliance, and continuous improvement across the organization. EXPERIENCE...

Summary: The Lead Professional Coder is responsible for day-to-day operations of the Coding Unit. The Lead Professional Coder will be auditing, coordinating, and ensuring that optimal coding is associated with medical records, data integrity, and quality of documentation is met in accordance with Rogers Medical Staff by-laws, Joint Commission, Federal and State regulations, in addition to acting as a liaison between clinical and administrative teams such as medical staff, nursing, regulatory, compliance, patient financial services, etc. The Lead Professional Coder is an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Possesses comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. Interacts with all...

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...

Your Future Role At A GlanceLocation: RemoteDepartment: Revenue Cycle ManagementSchedule: Full-time | Day ShiftHow You'll Make An Impact In This RoleAbstract & Code Records: Abstract relevant medical information and assign accurate ICD, CPT, and HCPCS codes to establish DRG or APC assignments, including handling complex cases.Query & Collaborate: Query physicians to clarify ambiguous, incomplete, or unclear record documentation, and provide appropriate education to physicians and associates.Audit & Comply: Conduct internal coding and physician documentation audits while maintaining strict adherence to AHIMA's Standards of Ethical Coding and official guidelines.Perform & Stay Current: Maintain required productivity and quality standards while continually keeping up-to-date with evolving coding, compliance, and reimbursement rules.What Minimum Requirements You'll NeedLicensure / Certification / Registration:One or more of the following:Certified Coding Specialist...

Why ThedaCare?Living A Life Inspired!Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you...

Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we...

Required Skills & Experience Certified coder (CPC, CCS, CRC, CCA, or equivalent certification) Strong ICD-10-CM coding experience and medical record review background Knowledge of Risk Adjustment and HCC coding methodologies Experience reviewing physician documentation and assigning accurate diagnosis codes Strong understanding of medical terminology, anatomy, physiology, and disease processes Ability to interpret complex clinical documentation with high accuracy and productivity Familiarity with CMS guidelines and Medicare Advantage requirements Nice to Have Skills & Experience Medicare Advantage Risk Adjustment experience Experience working with CMS-HCC models CRC (Certified Risk Adjustment Coder) certification Experience with EMRs and coding software platforms Background in a health plan, physician practice, hospital, or revenue cycle environment Audit and quality assurance experience Job Description Insight Global is seeking Medical Coders specializing in Risk...

Title: Medical Coding/ Education Specialist Location: Remote, preferably in Texas Compensation: $65,000 - $75,000 per year Must have Post Acute Care Experience We are seeking an accomplished Medical Coding and Education Specialist to join our healthcare team, focusing on enhancing coding accuracy and compliance within our post-acute care facilities. This role involves reviewing medical records, assessing for accurate provider cpt and ICD-10 codes, and developing educational materials. Additionally, the specialist will collaborate closely with our technology and revenue cycle teams to optimize EMR processes, streamline documentation, and reduce coding denials. Responsibilities: Conduct regular coding audits and reviews to ensure compliance with coding guidelines, regulatory requirements, and reimbursement policies. Develop and deliver educational materials, training modules, and resources on coding guidelines, regulatory updates, and documentation...

Your future role at a glance Location: Remote Department: Revenue Cycle Management Schedule: Full-time | Day Shift How you’ll make an impact in this role Abstract & Code Records: Abstract relevant medical information and assign accurate ICD, CPT, and HCPCS codes to establish DRG or APC assignments, including handling complex cases. Query & Collaborate: Query physicians to clarify ambiguous, incomplete, or unclear record documentation, and provide appropriate education to physicians and associates. Audit & Comply: Conduct internal coding and physician documentation audits while maintaining strict adherence to AHIMA's Standards of Ethical Coding and official guidelines. Perform & Stay Current: Maintain required productivity and quality standards while continually keeping up-to-date with evolving coding, compliance, and reimbursement rules. What minimum requirements you’ll need Licensure /...

Major Responsibilities: This role will have all responsibilities of coder I, II and III in addition to: reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Responsible for coding high dollar and long length of stay cases for all patient types. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate. Serves as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government...

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...

Rogers Memorial Hospital, Inc. seeks a Lead Professional Coder to oversee the Coding Unit’s day-to-day operations, audit records, and ensure accurate documentation and coding in alignment with regulatory standards. The role acts as the coding SME, providing training, challenging documentation quality, and coordinating with clinical and administrative teams to support compliant reimbursement and data integrity. #J-18808-Ljbffr

Job Description Job Description Job Summary As a Billing & Coding Specialist, you are responsible for conducting the assigned billing department’s daily operations within the healthcare setting. This includes preparation and submission of claims to insurance companies, ensuring accuracy in billing processes, maintaining records, monitoring and conducting proper follow up with insurance companies, and all other duties as assigned. This position is critical to maintaining a healthy revenue cycle and providing excellent support to patients and providers. Responsibilities: Review medical records and documentation to assign appropriate ICD-10 (International Classification of Diseases, 10th Revision), CPT (Current Procedural Terminology), and DRG (Diagnosis-Related Group) codes for billing purposes Prepare and submit accurate claims to insurance companies using Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems Follow up on unpaid or denied...

ThedaCare seeks a Clinic Coding II to review and assign CPT/ICD-10-CM codes for primary and specialty services, ensuring accurate, compliant documentation. You will audit medical records, educate providers, and collaborate with clinical teams to improve coding quality and reimbursement. Based in Neenah, Wisconsin, this full-time, remote-friendly role offers 40 hours weekly, daytime hours, and opportunities for professional growth within ThedaCare's coding organization. #J-18808-Ljbffr

Department 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status Full time Benefits Eligible Yes Hours 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 Pay Range $33.05 - $49.60 Major Responsibilities reviews complex...