2 documentation coding auditor jobs found

Duties include performing audits of health status by performing primary source validation comparison of medical record documentation to the corresponding paid claim to ensure all risk adjusted diagnosis in the medical record and on the claim align and originate from a valid source.  Core duties and responsibilities include the following: Performs quality reviews on records to validate coding according to the International Classification of Diseases Manual (ICD-10) for diagnoses and coding guidelines. Review medical records to validate diagnosis on the claim are supported by the medical record documentation Review medical records to ensure all relevant diagnosis for a date of service were documented by the provider on the corresponding claim. Works individually and/or within a team to validate the health status which determines the risk score and HCC for health plan members including: Service Code Accuracy (CPT/HCPCS) Diagnosis Codes Accuracy for codes...

Position Summary    The Medical Coding Manager provides operational leadership for coding activities across assigned specialties and service lines. This role ensures coding accuracy, productivity, and compliance with applicable regulatory and payer requirements, while partnering with billing, clinical, and compliance teams to support clean claim submission, reduce denials, and protect revenue integrity.   Key Responsibilities    Team Leadership & Development     Lead, coach, and develop coding staff (in-house and outsourced resources) to support accuracy, consistency, and accountability Support recruiting, onboarding, training, and competency validation for new and existing team members Establish clear performance expectations and conduct regular evaluations aligned to quality and productivity standards Address performance gaps through structured coaching and corrective action plans as needed   Operational Oversight...