15 coding documentation compliance auditor jobs found

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...

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...

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...

Medical Claims Specialist 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 Maintains a thorough understanding and education of federal and state regulations and payer specific policies...

Medical Claims Specialist 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 Maintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Overview Looking to join and lead a 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...

Scope of Position The Associate Director of Outpatient Coding Services performs at an expert level sustaining responsibility for timely and accurate coding of all facility outpatient visits and outpatient coding audits for The Ohio State University Wexner Medical Center (OSUWMC) including James Hospital. This position oversees the operations of denials, claim edits, and charge capture for reimbursement purposes. In this role, the Associate Director of Outpatient Coding Services serves as a liaison and coordinator for special projects regarding the coding of medical records. This position develops and implements policies and procedures to achieve organizational goals; and assists in the development of operational strategy. This position also re-evaluates processes to keep staff engaged and to assist in meeting department and organizational goals for OSUWMC. This position is critical to the financial and legal standing of the hospital for compliance and legal purposes. The director...

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 will 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...

Certified Coder, Special Investigations Unit (SIU) (Job ID: 59225) 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....

Become a part of our caring community The Senior Market Consultation / Partnership Professional (Nurse Medical Coder) supports Clinical Support Team (CST) initiatives by promoting accurate, compliant, and complete documentation and coding practices that enhance the quality and measurement of programs across risk adjustment. Work assignments involve moderately complex to complex issues where analysis of clinical documentation, coding accuracy, and risk adjustment data requires evaluation of multiple variable factors. Key Responsibilities Perform detailed medical record reviews to ensure accurate ICD-10-CM coding, risk adjustment capture, and alignment with CMS-HCC (e.g., V24/V28) models Validate diagnosis coding and ensure documentation meets compliance standards Identify and escalate coding trends and documentation gaps Serve as a coding subject matter expert supporting CST workflows, including PDV, chart review prioritization, and provider outreach...

WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION Coder MAIN FUNCTION: The Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT and DRG codes as needed to all patient charts/accounts. Assists the revenue cycle team by performing audits to detect, assess and resolve re-imbursement and revenue compliance concerns. Involved in the charge capture process. RESPONSIBLE TO: System Director of Revenue Cycle MUST HAVE REQUIREMENTS: Previous coding experience / knowledge. Ability to follow written and verbal directions. Knowledge of state and federal coding regulations. Knowledge of Anatomy, Physiology, Disease Processes, and Medical Terminology. RHIT/RHIA/CCS/ or CCA eligible. If not credentialed at time of hire, then applicant must become credentialed in one of the four areas within 12 months of hire to remain employed. Ability to operate computer on a daily basis and perform basic office procedures. No written disciplinary action within the last...

Job Description Aultman Medical Group/Professional-Senior Billing Specialist Position Summary The primary responsibility of this position is to review, analyze and/or assign ICD-10 Diagnosis and CPT Codes for all E & M, procedural and/or surgery codes for professional billing. Also, should be able to code for Professional Inpatient vs Observation status. Other responsibilities include revenue integrity functions including charge capture, timely charge entry, revenue improvement initiatives and compliant documentation review. Job function include communicating with practice leaders, providers and CBO leadership on areas of concern or opportunity including open encounters and zero charges. Candidate may also be expected to assist in performing other administrative task as assigned as well as assisting other areas of the Revenue Cycle or Clinical divisions as necessary. Primary Responsibilities Proficiently assign ICD-10, HCPCS, CPT codes and modifiers to all...

Certified Coder, Special Investigations Unit (SIU) 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...

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...

Purpose of This Position This position is responsible for all medical claims including pre‑billing and follow‑up activities for delayed claims, ensuring that claims are clean and paid promptly by insurers without requiring further intervention. The staff member performs all pre‑claim submission activities, verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. The individual follows departmental productivity and quality‑control measures that support the organization’s operational goals, promotes revenue integrity, and ensures timely and accurate billing and payer follow‑up activities and collection of accounts. Job Duties / Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer‑specific policies and requirements to promote compliant claims submission practices. Adheres to HIPAA related privacy, security and transaction & code set...