21 compliance coding auditor jobs found

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...

Physician Compliance Auditor Grady Health System offers many career paths for experienced professionals. Whether you have many years of experience or are in the early stages of your career, you can find a rewarding career at Grady! Location: Atlanta, GA Job Type: FTE Shift/Schedule: Days This is a remote role, but the ideal candidate will be required to come into the office occasionally to meet with the providers. The Physician Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, the appropriateness of treatment setting, HIPAA matters, and other compliance issues as directed by the Physician Coding Director, Compliance Director. This position requires effective communication with internal...

A healthcare organization in Wisconsin is seeking a coding auditor to conduct billing and coding audits, provide training, and ensure compliance with regulations. The ideal candidate has extensive experience in procedural and diagnostic coding, with relevant certifications. Strong attention to detail and communication skills are essential. This position offers a chance to work within a collaborative environment focused on compliance and accurate reporting. #J-18808-Ljbffr

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...

Join our team which is committed to the delivery of the highest quality healthcare service. We are seeking a full-time Certified Professional Coder who is self-motivated, energetic, and a take-charge individual. JOB RESPONSIBILITIES: 1. Review, abstract, and code clinical data such as diseases, operations, procedures, and therapies into computer system for billing and data collection within the established time frame 2. Assigns appropriate ICD-9, ICD-10, CPT, HCPCS and modifiers to accurately report and support the need for each physician service 3. Identifies physician services provided, but not adequately documented in the medical record. Advises coding auditor/educator or Manager of deficiencies 4. Codes and abstracts patient care records to provide information for insurance/billing and to establish accurate working indices 5. Perform void/re-enter of charges and changes to insurance as indicated by the medical record and insurance nuances 6. Comply with the...

Join our team at Sixteenth Street Community Health Centers! We are dedicated to the highest quality health care. JOB RESPONSIBILITIES: Review, abstract, and code clinical data such as diseases, operations, procedures, and therapies into computer system for billing and data collection within the established time frame. Assign appropriate ICD-10, CPT, HCPCS and modifiers to accurately report and support the need for each physician service. Identify physician services provided but not adequately documented in the medical record. Advise coding auditor/educator or Manager of deficiencies. Code and abstract patient care records to provide information for insurance/billing and to establish accurate working indices. Perform void/re-enter of charges and changes to insurance as indicated by the medical record and insurance nuances. Perform follow-up claim duties as required and assigned. Comply with the Sixteenth Street TB Control Plan including PPD testing. Perform...

Inpatient Coding Auditor (PRN) Join Our Award-Winning Team and Work with the Best! We are thrilled to share that UASI has been recognized as a Top Workplace by the Cincinnati Enquirer in 2022, 2023, and 2024! With over 40 years of experience and enduring partnerships with our valued clients, we are proud of the stability we've built and the long-term success of our dedicated team. We are currently seeking an experienced facility inpatient Coding Auditor to join our team on a PRN basis. The Coding Auditor will perform inpatient coding audits and review services to client sites remotely from a home office. Additional responsibilities include: Work with clients performing coding audit and/or review services on a variety of Inpatient facility record types Identify trends based on coding audit and review findings and formulate recommendations for corrective action plans Perform necessary research to provide to the client to support findings. Examples of this research include...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Join our team at Sixteenth Street Community Health Centers! We are dedicated to the highest quality health care. Job Responsibilities Review, abstract, and code clinical data such as diseases, operations, procedures, and therapies into a computer system for billing and data collection within the established time frame. Assign appropriate ICD-10, CPT, HCPCS and modifiers to accurately report and support the need for each physician service. Identify physician services provided but not adequately documented in the medical record and advise the coding auditor/educator or manager of deficiencies. Code and abstract patient care records to provide information for insurance/billing and to establish accurate working indices. Perform void/re-enter of charges and changes to insurance as indicated by the medical record and insurance nuances. Perform follow-up claim duties as required and assigned. Comply with the Sixteenth Street TB Control Plan including PPD testing. Perform other...

Join our team at Sixteenth Street Community Health Centers! We are dedicated to the highest quality health care. Job Responsibilities Review, abstract, and code clinical data such as diseases, operations, procedures, and therapies into the computer system for billing and data collection within the established time frame. Assign appropriate ICD-10, CPT, HCPCS and modifiers to accurately report and support the need for each physician service. Identify physician services provided but not adequately documented in the medical record and advise coding auditor/educator or Manager of deficiencies. Code and abstract patient care records to provide information for insurance/billing and to establish accurate working indices. Perform void/re-enter of charges and changes to insurance as indicated by the medical record and insurance nuances. Perform follow‑up claim duties as required and assigned. Comply with the Sixteenth Street TB Control Plan including PPD testing. Perform other...

A healthcare organization in Kenosha seeks a Physician Coder/Auditor responsible for auditing provider documentation and ensuring compliance with coding standards. The role requires a minimum of 1-3 years of relevant experience and certification as a CPC, CCS, or equivalent. Candidates must have strong knowledge of CPT and ICD-10 codes, as well as proficiency in Microsoft Office. Excellent communication skills and the ability to interpret clinical documentation are essential. The position is on-site in Kenosha, Wisconsin. #J-18808-Ljbffr

Medical Coder Job Duties: Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications. Researches and analyzes data needs for reimbursement. Analyzes medical records and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff. Reviews and verifies documentation supports diagnoses, procedures and treatment results. Identifies diagnostic and procedural information. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines. Follows coding conventions. Serves as coding consultant to care providers. Identifies discrepancies, potential quality of care, and billing issues. Researches, analyzes, recommends, and facilitates plan of action...

Join UnitedHealthcare At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The key challenge of this role centers around your ability to work quickly, accurately, and independently. You'll be challenged with daily production goals as well as maintaining a high accuracy rate to achieve your quality goals. Extensive use of electronic medical records in an ICD-10 environment is also required. Hours: This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 5am - 5pm. We offer 2-3 weeks of paid training. The hours during...

This position is full-time and will work 40-hours per week. It is full-time benefit eligible. Remote and/or hybrid can be an option after 6-months of on-site training. Coder Certified Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care. Job Summary The Certified Coder is responsible for accurately translating medical records and patient services into standardized numerical codes for billing and reimbursement purposes. This role ensures compliance with federal, state, and organizational regulations, while maintaining the highest standards of patient confidentiality. The Certified Coder works...

POSITION PURPOSE Areas of emphasis will include inpatient and outpatient coding of provider charges as well as documentation reviews and audits. Secondary responsibilities will include assisting Physicians Billing staff and clinic staff with coding questions. SITE(S) Kenosha Campus Urgent Care Physicians Billing Service MINIMUM EDUCATION REQUIRED High School or Equivalent (GED) MINIMUM EXPERIENCE REQUIRED 1-3 years Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P) MINIMUM EXPERIENCE PREFERRED LICENSES / CERTIFICATIONS REQUIRED Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P). SUPERVISES N/A KNOWLEDGE, SKILLS & ABILITIES REQUIRED Knowledge of CPT and ICD-10 codes Ability to accurately audit provider documentation to ensure all CPT codes and ICD-10 codes are accurately assigned...

Overview Title: Medical Biller & Coder (Cross-Trained in Registration & Education Support) Department: Revenue Cycle / Business Office Reports To: Business Office & Billing Operations Manager FLSA Status: Non-Exempt Location: Rural Critical Access Hospital / Multi-Clinic Health System Position Summary The Medical Biller & Coder is responsible for accurate and compliant coding, charge review, claim preparation, and follow-up to ensure timely reimbursement for hospital and clinic services. This position also plays a critical role in identifying trends, documentation gaps, coding issues, and new regulatory or payer updates—and communicating these findings through staff education. This position works under the direct supervision of the Business Office & Billing Operations Manager, who provides oversight, training, and direction for all billing, coding, registration cross-training, and revenue cycle improvement efforts. Because rural hospitals require team...

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 regulations. Maintain continuing...

Major Responsibilities Acts as a resource and role model to team members, which includes training/orienting, providing day‑to‑day work direction, and giving input on performance. Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues. Codes routine to complex procedures and diagnoses including hospital‑based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers. Meets or exceeds department quality and production standards. Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy. May assist with provider education/orientation regarding policy requirements of federal and state government agencies. Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding...

Medical Billing Specialist – Mile Bluff Medical Center **Schedule**: Full‑time, 80 hours per pay period (Monday – Friday, 8:00 am – 4:30 pm). Position is not eligible for remote work; must report on‑site daily. **Weekend rotation**: None *Holiday rotation*: None Position Summary The Medical Billing Specialist accurately prepares, submits, and follows up on medical claims to insurance companies and patients. The role ensures timely reimbursement, compliance with healthcare regulations, and effective communication with providers, payers, and patients. Responsibilities Prepare, submit, and transmit clean medical claims to commercial, Medicare, and Medicaid payers (electronic and paper). Review and resolve accounts and pre‑claim edits. Verify patient insurance coverage and benefits. Review documentation and charges for accuracy and compliance. Monitor accounts receivable and follow up on outstanding balances. Follow up on unpaid, denied, or rejected claims and resolve billing...

Experienced Multi-Specialty Surgery Coder The experienced multi-specialty surgery coder is responsible for daily coding, denial management, charge hold, RAI resolution and abstraction. The coder is responsible for escalation of coding questions and requests for coding guidance to the Coding Coordinator and/or Supervisor. Participate in internal QA audits and provide feedback in the compliance QA process. Hours: Monday - Friday, working 40 hours a week Location: Fully Remote - U.S You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Provide coding and abstraction of physician or professional records Provide communications to Coordinator, Supervisors and Managers Complete RAI's, denials, charge hold reports, and coding edits Assist on special coding projects as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear...

General Information Job title: Medical Billing Specialist Schedule: Full‑time, 80 hours per pay period; Monday - Friday, 8:00am - 4:30pm Position is not eligible for remote work. Must report on‑site daily. Weekend rotation: No Weekends Holiday rotation: No Holidays Position Summary The Medical Billing Specialist is responsible for accurately preparing, submitting, and following up on medical claims to insurance companies and patients. This role ensures timely reimbursement, compliance with healthcare regulations, and effective communication with providers, payers, and patients. Position Responsibilities Prepare, submit, and transmit clean medical claims to commercial, Medicare, and Medicaid payers (electronic and paper) Review and resolve accounts and pre‑claim edits Verify patient insurance coverage and benefits Review documentation and charges for accuracy and compliance Monitor accounts receivable and follow up on outstanding balances Follow up on unpaid, denied, or...