36 coding compliance educator jobs found

At Suvida Healthcare, we are not just caregivers; we’re compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well‑being of an underserved community and their families. Our multi‑disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare‑eligible Hispanic seniors. Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service‑centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos , to help achieve our Higher Purpose? What Makes Us Unique We are an empowered...

Become a part of our caring community The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Reviews medical records to report conditions that map to HCCs by reviewing medical record documentation and applying the appropriate ICD-10 diagnosis codes. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. Works on projects that may include making phone calls to providers. Works within broad guidelines with...

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 regulations. Maintain continuing education by attending...

Supervisor Of Waukesha Memorial Hospital Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together. This position is first shift Supervisor of Waukesha Memorial Hospital. This position is full-time, Monday - Friday, primarily covering the day hours for operations. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 5:00 am...

Job Description Job Description The Ambulatory Coding and Reimbursement Specialist is responsible for reviewing, analyzing, and accurately coding ambulatory and/or hospital-based encounters. This role performs initial charge review for E/M visits, diagnostic tests, and procedures across multiple specialty departments to determine the appropriate assignment of CPT, ICD-10, HCPCS codes, and modifiers for reporting physician services to third-party payers. The Specialist ensures all coding aligns with established coding standards, regulatory requirements, and reimbursement policies. Essential Duties and Responsibilities: Analyzes provider documentation to assure the appropriate Evaluation & Management levels are assigned using the correct CPT and current Evaluation and Management Guidelines Interprets outpatient office visit notes and charge documents to determine services provided and accurately assign CPT , Modifiers, and ICD-10 coding to these services. Performs...

Become a part of our caring community The 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 Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Job Opportunity at SSM Health St. Mary's Hospital - Madison It's more than a career, it's a calling. Worker Type: Regular Job Highlights: Monday to Friday, 8:00 to 4:30 (flexible), full-time (.9/36 hours). This is a new role supporting imaging and procedure lab charges and charge reconciliation. The individual will help define and build the role. The position supports St. Mary's and the WI region as needed. Job Summary Supports assigned department(s) as a subject matter expert for achieving operational efficiency, compliance, and exceptional patient care. Serves as a liaison between and resource for clinical and Revenue/Financial departments with strong understanding of both components. Job Responsibilities and Requirements PRIMARY RESPONSIBILITIES Serves as a resource and subject matter expert to the department for workflows, documentation, coding, charging, and software applications. Manages all work queues using subject matter expertise to investigate/correct errors...

Become a part of our caring community. Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will perform quarterly...

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. Minimum Qualifications Education: High school diploma or GED, required....

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 and recommendations...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based on documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

ThedaCare Coder (Clinic - III) The Coder (Clinic - III) performs coding review for surgical specialties for ThedaCare Physician Services to accurately reflect services rendered. Reviews and processes charges using industry standard methodologies (CPT, ICD-10-CM, HCPCS), abides by Standards of Ethical Coding (AAPC/AHIMA), and complies with official coding guidelines and other regulatory requirements. Audits medical record documentation and educates providers on documentation improvement opportunities and risks. Educates and trains new team members to department standards. Mentors and observes team members in department responsibilities. Upholds and demonstrates department expectations and accuracy in regards to coding responsibilities including payer denials and claim edits. Job Description: Schedule: Full time, benefit eligible 40 hrs/week Business hours (i.e 8:00am-5:00pm) Remote Position Preferred skill set and experience strong in surgical coding; Urology primarily to...

Supervisor Of Waukesha Memorial Hospital Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. This position is the evening & overnight Supervisor of Waukesha Memorial Hospital. The position is full-time, Monday - Friday, primarily covering the evening shift 3:00pm-11:00pm, and overnight shift 11:00pm - 7:00am. Our office is located at 725 American Ave, Waukesha, WI Primary Responsibilities: Investigates, resolves, and documents patient,...

Major Responsibilities This role will have all responsibilities of coder I, II and III in addition to reviewing 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. Serve as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations. Maintain continuing...

Position Summary Applies CPT-4 and HCPCS codes to medical records for the cardiovascular lab and interventional radiology departments based on physicians’ documentation. Adheres to strict federal coding rules and guidelines, achieving 95% coding accuracy while meeting billing deadlines. Essential Responsibilities Code surgical procedures performed by cardiologists and interventional radiologists. Verify supplies used during procedures. Use encoders and other reference materials effectively. Maintain appropriate non‑leading queries to physicians. Abstract services from physician documentation and procedure logs. Reconcile monthly surgical logs. Manage multiple job tasks daily (WQs, emails, surgical logs, census, etc.). Prepare Excel analysis, including V‑Lookups and pivot tables. Gather and compile data systematically, document assumptions, and validate accuracy to resolve inconsistencies. Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and...

Job Summary The Coding Specialist will provide CPT, HCPCS, and ICD‑10‑CM coding for Outpatient Facility Same‑Day Surgeries. The position requires 2-3 years of experience and observations experience. The role is remote; the employee must work from home and be independent in coding skills. Essential Duties and Responsibilities Provide various components of coding services to support clients. Calculate ProFee and/or Facility E/M levels using the company’s algorithm. Recognize critical care cases by patient acuity. Code surgical procedures typical of an ER setting to capture additional revenue when appropriate. Apply ICD‑10‑CM diagnosis codes at the highest level of specificity available. Accurately assign diagnosis and procedure codes using ICD‑10‑CM, ICD‑10‑PCS, CPT®, and HCPCS. Interpret coding guidelines for accurate code assignment. Assess the impact of documentation on code assignment and reimbursement. Act in accordance with AHIMA’s Standards of Ethical Coding and the Company’s...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. We’re looking for experienced and credentialed outpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the...

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 This role will comply with all departmental scheduling policies and expectations. Will support Inpatient Community Core - WI/IL division Schedule Monday - Friday 1st shift 40 hours a 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 $28.55 - $42.85 Major Responsibilities This role will have all responsibilities of coder I, II and III in addition to: reviews complex...

Position Summary Applies CPT-4 and HCPCS codes to medical records for the cardiovascular lab and interventional radiology departments based on physicians’ documentation. Adheres to strict federal coding rules and guidelines, achieving 95% coding accuracy while meeting billing deadlines. Essential Responsibilities Code surgical procedures performed by cardiologists and interventional radiologists. Verify supplies used during procedures. Use encoders and other reference materials effectively. Maintain appropriate non‑leading queries to physicians. Abstract services from physician documentation and procedure logs. Reconcile monthly surgical logs. Manage multiple job tasks daily (WQs, emails, surgical logs, census, etc.). Prepare Excel analysis, including V‑Lookups and pivot tables. Gather and compile data systematically, document assumptions, and validate accuracy to resolve inconsistencies. Evaluate and implement charge requests with appropriate CPT/HCPCS codes, revenue codes, and...

JOB SUMMARY: The primary purpose of the position is to review both procedural and diagnostic (ICD-10) coding to ensure appropriate billing and insurance regulations are met. This position will be staffed during clinic hours and is largely remote. Occasionally in-person meetings with providers will be required. Must live within reasonable traveling distance from Hudson, WI.CORE DUTIES AND RESPONSIBILITIES:Have in-depth understanding of coding and compliance rules and regulations.Responsible for reviewing provider documentation, coding and posting charges for healthcare services; including Primary Care, Lab/Pathology, Podiatry and more.Provide coding education and engage with assigned providers.Research and communicate governmental and payer-specific rules and regulations to ensure coding compliance.Identify and communicate best practices based on provider documentation, insurance payer medical policies and CMS guidelines.Review, code and post charges for hospital outpatient and...

Job Opportunity at SSM Health St. Mary's Hospital - Madison It's more than a career, it's a calling. Worker Type: Regular Job Highlights: Monday to Friday, 8:00 to 4:30 (flexible), full-time (.9/36 hours). This is a new role supporting imaging and procedure lab charges and charge reconciliation. The individual will help define and build the role. The position supports St. Mary's and the WI region as needed. Job Summary Supports assigned department(s) as a subject matter expert for achieving operational efficiency, compliance, and exceptional patient care. Serves as a liaison between and resource for clinical and Revenue/Financial departments with strong understanding of both components. Job Responsibilities and Requirements PRIMARY RESPONSIBILITIES Serves as a resource and subject matter expert to the department for workflows, documentation, coding, charging, and software applications. Manages all work queues using subject matter expertise to investigate/correct...

Western Wisconsin Health is looking for a full-time Medical Coding Specialist (0.8 FTE) to join the Health Information Management department. The Medical Coding Specialist is responsible for reviewing clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and CPT-4 codes for billing, internal and external reporting, research, and regulatory compliance. Under the direction of the HIM Director, accurately code inpatient, observation, outpatient diagnostic, therapeutic, consultative, emergency department services, ambulatory surgery (same day surgery), and clinic encounters, as assigned. Obtain appropriate reimbursement levels for professional services by reviewing and coding clinical diagnoses and procedures for physician visits and other services, conditions and procedures as documented in the ICD-10-CM and Official Guidelines for Coding and Reporting and CPT Coding Guidelines. Resolve errors associated with billing software...

Become a part of our caring community. Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will perform quarterly...

At Suvida Healthcare, we are not just caregivers; we’re compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well‑being of an underserved community and their families. Our multi‑disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare‑eligible Hispanic seniors. Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service‑centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos , to help achieve our Higher Purpose? What Makes Us Unique We are an empowered...