29 compliance coding auditor jobs found

JOB SUMMARY: The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. KEY RESPONSIBILITIES: Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. Identify unsupported diagnoses, over coding, under-coding, and documentation gaps. Provide detailed audit findings and recommendations to coding teams, providers, and leadership. Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards. Track and...

DRG Coder, Registered Nurse Remote | Full-Time | Healthcare | Clinical Documentation & Coding About the Role We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records. This role is critical in ensuring accurate DRG assignment, strong clinical documentation support, and compliance with Medicare and CMS regulations. The ideal candidate is highly analytical, clinically strong, and comfortable working independently in a production-driven audit environment. You will play a key role in improving coding accuracy, reimbursement integrity, and regulatory compliance while providing clear, defensible audit findings. Key Responsibilities DRG Validation & Chart Review Perform in-depth DRG quality audits of inpatient medical records. Validate DRG assignments against clinical documentation and coding guidelines. Identify missed opportunities, discrepancies, and documentation gaps impacting...

JOB SUMMARY: The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. KEY RESPONSIBILITIES: • Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. • Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. • Identify unsupported diagnoses, over coding, under-coding, and documentation gaps. • Provide detailed audit findings and recommendations to coding teams, providers, and leadership. • Monitor compliance with CMS Risk Adjustment Data Validation (RADV)...

Coding Auditor And Educator Join our team as a day shift, full time, hybrid, Coding Auditor and Educator at INTEGRIS Health in Oklahoma City, OK. INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives. Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more. Take the first step toward growing your career by joining us. Qualifications REQUIRED QUALIFICATIONS 4+ year coding experience EDUCATION: High School Diploma or GED LICENSE/CERTIFICATIONS: AHIMA-RHIA (Registered Health Information Administrator) OR AHIMA-RHIT (Registered Health Information Technician) OR AHIMA-CCS (Certified Coding Specialist) OR AAPC-CIC (Certified Inpatient Coder) OR AAPC-CPC (Certified Professional...

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....

JOB SUMMARY: This position is responsible for reviewing a patient's medical records after a Clinic visit and translating the information into codes that insurers use to process claims for patients. Duties include confirming treatments with medical staff, identifying missing information, and submitting information to insurers for reimbursement. RESPONSIBILITIES (ESSENTIAL FUNCTIONS): Accurately assigns and sequences codes (ICD-10-CM, CPT, HCPCS/modifiers as necessary) for each patient encounter, following proper coding guidelines and legal requirements to ensure compliance with federal and state regulations. Ensures professional/physician billing CPT codes/ICD-10 codes are assigned correctly and sequenced appropriately as per government and insurance regulations. Queries providers or other Clinic team members when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Assigns and enters...

Medical Records Technician Coder V-Supervisor Koniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Technician Coder V-Supervisor to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Leadership Matter. Koniag Advisory Business Solutions (KABS) is seeking an experienced, highly skilled, and mission-focused Medical Records Coder V (Supervisor) to lead a coding team supporting a large-scale healthcare mission serving hospitals and clinics. This is a critical leadership role supporting coding and billing for more than 300,000 patient visits, where...

Indian Health Service is seeking a Medical Records Technician to review and code patient records, ensuring accuracy and compliance with current guidelines. The role focuses on documentation adequacy, coding accuracy, and proper sequencing of diagnoses and procedures to support high-quality patient care. The position requires knowledge of coding standards, ability to audit records, and adherence to privacy regulations. A CPC is preferred and federal employment processes apply. #J-18808-Ljbffr

Summary Join the Indian Health Service and make a meaningful impact in Native communities. In this role, you will support vital healthcare operations that ensure patients receive timely, high-quality care. If you're looking for a rewarding career where your work directly supports patient services and community well-being, we encourage you to apply. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021). Duties Total Compensation Package Check out IHS's outstanding total compensation package for this job: Medical Records Technician Total Compensation | Pay (ihs.gov) Reviews medical records for completeness, including required identifiers, signatures, dates, and reports associated with services rendered. Evaluates documentation for accuracy, consistency, medical necessity, and appropriate modifier usage; verifies that final diagnoses accurately reflect care provided. Reviews provider documentation to ensure appropriate Evaluation and Management...

Basic Function HF Sinclair Midstream is seeking a Compliance Auditor Lead. The position is open to Dallas, TX; Tulsa, OK; Artesia, NM or Salt Lake City, UT. The Compliance Auditor Lead ensures compliance with regulations and conducts moderate to complex regulatory compliance and auditing assignments for assigned areas under general supervision. Job Duties Reviews, interprets, and ensures compliance with applicable federal, state, and local regulatory requirements for all assigned locations. Plans, conducts, and leads regulatory compliance and operational risk‑based audits, including evaluations and review of internal policies and procedures of the company operations. Serves as the primary liaison to regulatory agencies and as the Company's point of contact for general inquiries, audits, and on‑site evaluations. Leads and coordinates follow‑up activities associated with regulatory inspections, audits, and enforcement actions by tracking corrective actions, conducting gap...

Job Purpose The Lead Coder will code all patient types as needed; inpatient, swing bed, same‑day surgery, ancillary, ambulatory and provider‑based clinics, and will mentor, train, and assist coding staff, including newly hired staff. They must review documentation to assign appropriate CPT/HCPCS and ICD‑10‑CM‑PCS diagnosis codes and procedures for hospital and physician (professional) services for inpatient and outpatient records based on knowledge of coding systems. Essential Functions Ensures that coding compliance initiatives are met with all record types. Conducts regular internal coding audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures and education as needed. Assists with productivity reporting and reducing DNFC. Coding complex outpatient or inpatient accounts utilizing encoder software and references in the assignment of ICD‑10‑CM/PCS, CPT/HCPCS codes, DRG, POA assignments, APC assignment and...

Labela is seeking certified U.S. medical coders for high-level coding and documentation consulting. You will serve as a subject matter expert to validate, refine, and audit the coding logic and documentation reasoning of frontier AI models. This is a flexible, remote role designed for practicing coders and auditors to influence the accuracy and compliance of medical AI at scale. In this role you will audit AI outputs for ICD-10-CM/PCS, CPT, and HCPCS, provide expert-level validation for full #J-18808-Ljbffr

Koniag Advisory Business Solutions seeks a Medical Records Coder V (Supervisor) to lead a coding team in a large healthcare mission serving hospitals and clinics. This senior role oversees the Coder IV Lead and Coder III staff, ensuring accurate coding, audits, and compliance for reimbursement. Hybrid position based in Oklahoma City; on-site for onboarding, with potential telework. Candidates need strong leadership, coding expertise, and a drive for quality and integrity in high-volume #J-18808-Ljbffr

Certified Medical Coder Edmond, OK | Full‑Time $20-$26/hour DOE | Pay: Competitive Schedule: Monday – Thursday: 8:00 AM – 5:00 PM Friday: 8:00 AM – 1:00 PM Are you a detail-oriented Certified Medical Coder looking to join a fast‑paced specialty clinic where your work truly matters? We are seeking a motivated CPC‑certified professional to become part of a supportive team focused on accuracy, collaboration, and exceptional patient care. Certified Medical Coder – Must‑Have Requirements Certified Professional Coder (CPC) certification required High School Diploma or GED required Minimum of 2 years of medical coding experience preferred Strong knowledge of CPT, ICD‑10, and HCPCS coding Experience with medical billing, insurance verification, authorizations, and collections preferred Knowledge of Medicare and third‑party payer guidelines Experience using EMR/EHR systems and coding software Strong attention to detail and organizational skills Excellent communication and problem‑solving...

Surg/Op CoderFully Remote • Home Office - Oklahoma City, OK 73134OverviewPosition Type Full Time Job Shift Day Education Level Certification Travel Percentage Occasional Category Health Information Management (HIM)DescriptionJOB PURPOSE: This position is for an Outpatient Coder with Emergency Dept and Ambulatory Surgery coding experience. The coder will code Surgery, Emergency department, and Ancillary records. Emergency Dept coding includes injection & infusion coding as well as the assignment of the E&M Professional fee. Coder will demonstrate competency by meeting productivity standards and achieving an accuracy rate of 95% on all chart types coded.Will abstract and code every account compliantly, accurately, and completely, to ensure accurate and timely reimbursement and reporting. Verifies, reviews, analyzes, and abstracts medical information; researches missing clinical information; assigns accurate codes; appropriately queries physicians when required; elevates...

Medical Records Technician Coder IV-LeadKoniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Technician Coder IV-Lead to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more.Join Our Team Where Precision, Integrity, and Expertise Matter. Koniag Advisory Business Solutions (KABS) is seeking highly skilled, self-directed Medical Records Coder IV (Lead) professionals to support a large-scale healthcare mission serving hospitals and clinics. This is an opportunity to bring your expertise to a team responsible for coding and billing more than 300,000 patient visits, where accuracy, compliance, sound...

Job Description Posted Monday, August 17, 2026 at 4:00 AM Koniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Technician Coder V-Supervisor to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid Vacation, paid sick leave and more. including health, dental and vision insurance, 401K with company matching, paid holidays, paid Vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Leadership Matter. Koniag Advisory Business Solutions (KABS) is seeking an experienced, highly skilled, and mission-focused Medical Records Coder V (Supervisor) to lead a coding team supporting a large-scale healthcare...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. The Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Conduct a...

Job DetailsJob Location: Home Office - Oklahoma City, OK 73134Position Type: Full TimeEducation Level: CertificationTravel Percentage: OccasionalJob Shift: DayJob Category: Health Information Management (HIM)JOB PURPOSE: This position is for an Outpatient Coder with Emergency Dept and Ambulatory Surgery coding experience. The coder will code Surgery, Emergency department, and Ancillary records. Emergency Dept coding includes injection & infusion coding as well as the assignment of the E&M Professional fee. Coder will demonstrate competency by meeting productivity standards and achieving an accuracy rate of 95% on all chart types coded. Will abstract and code every account compliantly, accurately, and completely, to ensure accurate and timely reimbursement and reporting. Verifies, reviews, analyzes, and abstracts medical information; researches missing clinical information; assigns accurate codes; appropriately queries physicians when required; elevates documentation issues...

Oklahoma Arthritis Center Billing SpecialistOklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.Job Summary:Reviews billing data from medical office or hospital records to ensure amounts and account numbers are accurate, responsible for account posting, collections, and verifying patient benefits. Responsible for accurate diagnose and procedure coding. Responsible for insurance pre-certifications, pre-authorizations, pre-determinations and other required insurance notifications for procedures performed in the clinic.Essential Functions:Review and analyze patient records and physician documentation for completeness and accuracy, focusing on areas such as radiology reports, neurological procedures, office visit notes, and laboratory results.Assign precise CPT, ICD-10, HCPCS (and when applicable,...

Medical Records Technician Coder III Koniag Advisory Business Solutions LLC, a Koniag Government Services company, is seeking a Medical Records Technician Coder III to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Expertise Matter. Koniag Advisory Business Solutions (KABS) is seeking detail-oriented, highly capable, and motivated Medical Records Coder III professionals to support a large-scale healthcare mission serving hospitals and clinics. This is an opportunity to contribute to a team responsible for coding and billing more than 300,000 patient visits, where accuracy, compliance,...

Join the Indian Health Service in El Reno, Oklahoma, as a Medical Records Technician, where you will support vital healthcare operations that ensure high-quality patient care. You will conduct reviews of medical records for completeness, accuracy, and compliance with coding standards. Your responsibilities will include assigning ICD and CPT codes, providing guidance to clinical staff, and participating in performance audits. Candidates should have experience in medical coding and are preferred to have a Certified Professional Coder (CPC) designation. #J-18808-Ljbffr

Summary Join the Indian Health Service and make a meaningful impact in Native communities. In this role, you will support vital healthcare operations that ensure patients receive timely, high-quality care. If you're looking for a rewarding career where your work directly supports patient services and community well-being, we encourage you to apply. Duties Reviews medical records for completeness, including required identifiers, signatures, dates, and reports associated with services rendered. Evaluates documentation for accuracy, consistency, medical necessity, and appropriate modifier usage; verifies that final diagnoses accurately reflect care provided. Reviews provider documentation to ensure appropriate Evaluation and Management (E/M) levels and correct CPT code assignment. Assigns and sequences ICD, CPT, HCPCS, CDT, and DSM codes based on documented diagnoses and procedures. Ensures diagnostic and procedural terminology aligns with current medical nomenclature and...

The Indian Health Service is seeking a Medical Records Technician in Wewoka, Oklahoma. This role is pivotal in ensuring accurate medical coding and compliance with health regulations. You will impact Native communities positively by supporting healthcare operations, ensuring patients receive high-quality care. In this position, candidates should have proven expertise in reviewing medical records, assigning appropriate codes, and assisting in coding audits. A CPC certification will enhance your application. #J-18808-Ljbffr