49 compliance analyst jobs found

A medical group in Jacksonville is seeking a Physician Billing Compliance Analyst to conduct audits on physician coding and documentation. The role involves analyzing audit findings, coordinating training, and assisting in compliance development. Candidates need a high school diploma, coding certifications, and years of experience in medical billing and auditing. The position offers a chance to ensure adherence to billing regulations in a dynamic healthcare environment. #J-18808-Ljbffr

All the benefits and perks you need for you and your family :Benefits from Day One - Paid Time Off from Day One - Career Development - Whole Person Wellbeing Resources - Mental Health Resources and SupportOur promise to you :Joining AdventHealth is about being part of something bigger.Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit.AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ.Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team.All while understanding thattogetherwe are even better.Schedule :Full TimeThe role you'll contribute :The Coder Analyst I, under general supervision of the Outpatient Coding Supervisor is responsible for Assigning codes to ER and Outpatient ancillary medical records, using ICD-10-CM and CPT codes via the 3m Encoder and Dolbey Computer...

Become a part of our caring community and help us put health first 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. 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...

Orlando Family Physicians, LLC Responsible for providing coding services on all diagnosis and maintains a professional relationship with the Managers and Providers. Responsibilities: Audits records to ensure proper submission of services prior to billing on pre-determined charges Receives proper progress notes to properly bill provider services for services provided to patients Supplies correct ICD-10 CM diagnosis codes on all diagnosis provided Supplies correct HCPCS code on all procedures and services performed Supplies correct CPT code on all procedures and services performed Coding claims 100-150 a day Contacts providers to train and update them with correct coding information Remain current on coding issues Accurately follows coding guidelines and legal requirements to ensure compliance with federal and State regulatory bodies Determines the final diagnosis and procedures stated by the physician are valid and complete Qualitative analysis- evaluates the record...

Orlando Family Physicians, LLC It's fun to work in a company where people truly believe in what they're doing! We're committed to bringing passion and customer focus to the business. Responsible for providing coding services on all diagnosis and maintains a professional relationship with the managers and providers. Responsibilities: Audits records to ensure proper submission of services prior to billing on pre-determined charges Receives proper progress notes to properly bill provider services for services provided to patients Supplies correct ICD-10 CM diagnosis codes on all diagnosis provided Supplies correct HCPCS code on all procedures and services performed Supplies correct CPT code on all procedures and services performed Coding claims 100-150 a day Contacts providers to train and update them with correct coding information Remain current on coding issues Accurately follows coding guidelines and legal requirements to ensure compliance with federal...

Essential Duties and Responsibilities: - Abstract and code clinical data. - Audit medical records to ensure compliance with the organization's coding procedures and standards. - Accurately enter coded data in a system and validate data entered. - Research correct coding practices, clearly document and share findings with others. - Review denials and recommend billing corrections. - Train staff members on the coding process. Minimum Requirements - High School diploma or equivalent with 0 - 2 years of experience. - Additional clinical licensure may be required based on project. - Must be a Certified Medical Coder, Certified Professional Coder, or a Certified Coding Specialist. - Knowledge of Medical Billing and Coding Systems such as CPT and HCPCS is essential. - Ability to work a schedule between the hours of 8:00am - 5:00pm EST Monday - Friday required. Additional Skills and Experience: - Familiarity with retrospective payment reimbursement highly preferred....

Medical Records Technician (Coder Inpatient/Outpatient) MRTs are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. These coding practitioners analyze and abstract patients health records and assign alphanumeric codes for each diagnosis and procedure. ** This is an on site position, you must live within or be willing to relocate within a commutable distance of the duty location. ** Duties of the Medical Records Technician (Coder) In/Outpatient include, but not limited to: Assigns codes to documented patient care encounters (outpatient and/or inpatient professional services) covering the full range of health care services provided by the VAMC. Selects and assigns codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common...

Coder Physician Under limited supervision the Coder Physician reviews medical records and performs coding on all diagnoses, procedures, DRG/APC, and charge codes. The Coder Physician uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient's treatment. The Coder Physician will be charged with maintaining the confidentiality of patient records and procedures. Essential Job Functions Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee, and clinical medical records. Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing. Utilizes technical coding principals and DRG/APC reimbursement expertise to assign...

Billing and Coding Auditor Banyan Treatment Centers is seeking a detail-oriented and experienced Billing and Coding Auditor to support the accuracy and compliance of our billing practices across our behavioral health services. This critical role ensures the integrity of our claims processes and supports continuous quality improvement, staff education, and adherence to payer regulations. As a nationally recognized provider of addiction and mental health care accredited by The Joint Commissionwith 18 locations, robust Telehealth services, and backed by TPG's Rise Fund since 2023our 1,600+ employees are dedicated to delivering compassionate, high-quality care that transforms lives. Positions Details Location: Flexible | On-site (Pompano Beach, FL), Hybrid or Remote (USA) Reports to: Auditing Manager & Director of RCM Schedule: Full-time Key Responsibilities Conduct regular audits of behavioral health billing and claims for accuracy and compliance. Review coding of all...

Job Requirements POSITION SUMMARY To be fully engaged in providing timely, complete, and accurate code assignment and data collection for quality clinical analysis and revenue enhancement. PRIMARY ACCOUNTABILITES Uphold regulatory compliance by assigning and sequencing accurate ICD 10 codes to inpatient medical records as per coding guidelines demonstrating behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities. Validates the accuracy of codes assigned by the computer assisted coding software, recognizing inappropriate application of clinical coding regulations/guidelines, and revising the codes assigned based on expert subject matter knowledge and provider documentation. Literacy and proficiency in computer technology, particularly related to health information and coding applications utilized for daily job performance, are essential. Interpret clinical documentation to ensure...

Job Description Job Description Hybrid-Sunrise, Florida Position Summary: The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities: Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud...

A healthcare provider in Florida is seeking a Medical Office Supervisor for a full-time position to oversee practice operations, recruit and develop staff, and ensure compliance with policies. Candidates must have at least one year of experience in healthcare management, strong interpersonal skills, and be bilingual in Spanish. This role requires effective communication and the ability to analyze and improve operational workflows. Benefits include medical, dental, vision, and paid time off, making it a rewarding opportunity for dedicated professionals. #J-18808-Ljbffr

Medical Coder Educator - USFTGP RCO Serves as the coding reviewer and documentation educator for USFTGP Revenue Cycle Operations. Collaborate extensively with compliance; utilizing approved coding industry tools and approved internal documentation. This position is responsible for providing coding literacy and awareness using adult methodologies to revenue cycle, coding professionals, department managers, medical staff and others, ensuring proficiency is accurate and within compliant coding practices for billing. Analyze and report review findings indicating documentation gaps reimbursement and data internation, inpatient, outpatient and professional service coded. Report to compliance focused areas of improvements, recommendations and actions taken to improve medical staff knowledge and coding accuracy. Conduct individual and group coding and documentation support instructions as assigned and acts as an internal coding expert resource. Qualifications Required: High School...

Risk Adjustment Nurse/Coder AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! Full-time permanent position (40 hours) Standard working hours: 8am to 4:30pm EST, M-F This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories...

Review E/M services under 2021+ guidelines MUST RESIDE IN TEXAS AND HAVE CODING AND AUDITING EXPERIENCE. Counter Affidavit as well as Testimony experience is preferred. Requirements We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support including deposition and testimony services when needed. The ideal candidate must have strong Texas based coding experience and a thorough understanding of medical necessity, documentation compliance, and payer audit defense. Counter Affidavit experience is preferred. Responsibilities Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS) Conduct utilization reviews to determine medical necessity and documentation compliance Review and prepare demand packages and audit response materials Analyze records for payer disputes and recoupmentsPrepare written audit findings and defensible reports Provide expert...

Medical Biller and Coder, Orthopedics This individual is responsible for all aspects of the revenue medical billing cycle including claim submission, appeals, collections, and analytics Individual must: have strong attention to detail and problem solving skills; be organized, self-motivated, and able to multi-task; work independently but also work well as a team; have strong oral and communication skills; have the ability to adapt well to changes with their daily responsibilities Individual will need to provide their own transportation to and from work Responsibilities: Data entry and patient demographics verification Ensure authorizations are obtained as necessary for upcoming appointments, surgeries, and therapy Handle payment posting and charge entry for physical therapy and physician charges Submit electronic and paper claims to insurance companies Daily reconciliation of billing and reimbursements Ensure that all coding is compliant with current...

Certified Medical Coder Status: Non-Exempt Department: Coding Reports To: Coding Director Work Location: Remote Position Summary The Certified Coder is responsible for performing accurate and compliant coding of inpatient (IP) and outpatient (OP) medical records to support timely billing and maximize revenue integrity. This role ensures correct diagnostic and procedural coding in accordance with ICD-10-CM, CPT, HCPCS, CMS guidelines, and payer-specific requirements. The Certified Coder works closely with billing teams, clinical staff, and auditors to support clean claim submissions, reduce denials, and promote optimal reimbursement while maintaining the highest standards of coding compliance and data integrity. Key Responsibilities Review, analyze, and accurately assign ICD-10-CM, CPT, and HCPCS codes for inpatient and outpatient encounters, including surgeries, ancillary services, ER, observation, and clinic visits. Validate documentation to ensure it...

Quality Control Lead - Arcadia, FL Location: Arcadia, FL Pay Range: $55,000 - $60,000 Let's Be Blunt Cannabis isn't just an industry - it's a movement. Mint Cannabis is proud to serve Florida's medical cannabis patients with compassion, innovation, and unmatched service. Everything we do is about elevating the experience for everyone. Whether you're a seasoned patient or just discovering the benefits of medical cannabis, Mint is about connection, growth, and good vibes only. The Quality Control Lead plays a critical role in ensuring product quality, regulatory compliance, and consistency across production operations at Mint Cannabis's Florida facilities. This role supports the company's Compliance team by overseeing GMP adherence, managing supplier quality documentation, and assisting with BioTrack reporting. The ideal candidate is detail-oriented, collaborative, and comfortable working in a fast-paced, highly regulated manufacturing environment. Ready to grow...

Quality Control Lead - Arcadia, FL Location: Arcadia, FL Pay Range: $55,000 - $60,000 Let’s Be Blunt  Cannabis isn’t just an industry — it’s a movement. Mint Cannabis is proud to serve Florida’s medical cannabis patients with compassion, innovation, and unmatched service. Everything we do is about elevating the experience for everyone. Whether you’re a seasoned patient or just discovering the benefits of medical cannabis, Mint is about connection, growth, and good vibes only. The Quality Control Lead plays a critical role in ensuring product quality, regulatory compliance, and consistency across production operations at Mint Cannabis’s Florida facilities. This role supports the company’s Compliance team by overseeing GMP adherence, managing supplier quality documentation, and assisting with BioTrack reporting. The ideal candidate is detail-oriented, collaborative, and comfortable working in a fast-paced, highly regulated manufacturing environment. Ready to grow...

Banyan Treatment Centers is seeking a detail-oriented and experienced Billing and Coding Auditor to support the accuracy and compliance of our billing practices across our behavioral health services. This critical role ensures the integrity of our claims processes and supports continuous quality improvement, staff education, and adherence to payer regulations. As a nationally recognized provider of addiction and mental health care accredited by The Joint Commission—with 18 locations, robust Telehealth services, and backed by TPG’s Rise Fund since 2023—our 1,600+ employees are dedicated to delivering compassionate, high-quality care that transforms lives. Positions Details Location: Flexible |On-site (Pompano Beach, FL), Hybrid or Remote (USA) Reports to: Auditing Manager & Director of RCM Schedule: Full-time Key Responsibilities Conduct regular audits of behavioral health billing and claims for accuracy and compliance. Review coding of all services...

Benefits: 401(k) matching Bonus based on performance Company parties Dental insurance Employee discounts Health insurance Opportunity for advancement Paid time off Parental leave Training & development Vision insurance The Medical Billing Specialist is responsible for the billing and collection of office visits, procedures, nurse procedures, and all other billing events as a result of practice activities. Additional responsibilities include keeping up to date with coding and billing regulations as well as maintaining an understanding and compliance with all Skin Wellness Physicians policies and procedures. Essential Duties and Responsibilities As assigned, but not limited to the following: Develops and implements, with the Practice Administrator, procedures for all aspects of the billing process including charge entry, day end balancing, claims submission and edit, insurance follow up, patient balance follow up, denials, transfers to patient balance,...

Clinical Coder III - Department of Neurosurgery Job no: 532862 Work type: Staff Full-Time Location: Main Campus (Gainesville, FL) Categories: Office/Administrative/Fiscal Support, Veteran's Preference Eligible, Health Care Administration/Support Department: 29190000 - MD-NEUROLOGICAL SURGERY Classification Title: Clinical Coder III Job Description: The Department of Neurosurgery is seeking an experienced surgical coder to perform highly specialized diagnosis and procedural coding for all operative procedures and inpatient consulting services performed by the faculty of the Department of Neurological Surgery including those performed in Gainesville and at Halifax Regional Medical Center. The ideal candidate will have a thorough knowledge of anatomy, surgical and medical terminology coding, a working knowledge of the billing requirements of insurance carriers, and the operating procedures of the department and the hospital(s). The Lillian S. Wells...

Job Requirements ** Candidate to be considered must reside in the state of Florida. This is a work from home opportunity with majority being remote work** Position Summary To be fully engaged in providing timely, complete, and accurate data collection for quality clinical analysis and revenue enhancement. PRIMARY ACCOUNTABILITES 1. Uphold regulatory compliance by assigning and sequencing accurate ICD 10 and CPT 4 codes to reference lab, ancillary, emergency room, endoscopy, ambulatory surgery, observation, and other outpatient records as per coding guidelines demonstrating behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities. 2. Validate accuracy of codes assigned by the computer assisted coding software, recognizing inappropriate application of clinical coding rules/guidelines, and revising the codes assigned based upon expert subject matter knowledge and provider...

Position Details Under the direction of the Ambulatory Coding Quality Manager, reviews clinical documentation and diagnostic results, as appropriate, to extract data and apply appropriate ICD-10-CM, CPT, and/or HCPCS codes, and modifiers to clinic encounters and hospital-based services for reimbursement and statistical purposes. Assures that the provider and clinicial staff documentation in the medical record supports any information provided in the claims. Communicates with providers or other hospital team members as needed to obtain optimal documentation to meet coding and compliance standards. Abstracts clinical and demographic information in ICD-10 CM, CPT, and HCPCS codes and modifiers into the computerized patient abstract. Participates in ongoing continued education to assure knowledge and compliance with annual changes. Work Hours per Biweekly Pay Period: 80 Location : 210 South Florida Avenue Lakeland, FL Pay Rate : Min $24.02 Mid $30.03 Position...