22 drg coding auditor jobs found

Experienced Associate, Healthcare Forensics The Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients. Job Duties Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance matters Contributes to forensic engagements related to medical coding and...

Experienced Associate, Healthcare ForensicsThe Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients.Job Duties:Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance mattersContributes to forensic engagements related to medical coding and...

Under general supervision of the Director, the Coder II provides consistency and efficiency in outpatient claims processing and data collection to optimize APC reimbursement and facilitate data quality in outpatient services. Reviews, audits, and reports on charge capture. Maintains patient confidentiality at all times. ESSENTIAL JOB FUNCTIONS Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position. Analyzes IP, OP, Recurring, & SDC records and appropriately codes per coding guidelines, ICD-10-CM and CPT rules and updates, creating APC or DRG group assignments. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate,...

Description Summary: Selected by CHRISTUS Health Coding Leadership, to focus coding skills and expertise on designated Inpatient or Outpatient high dollar or specialty account types. Specialty Coder is responsible for maintaining current and high-quality ICD-10-CM, ICD-10-PCS and/or CPT coding for the Inpatient and or/ Outpatient diagnoses and procedural occurrences, through the review of clinical documentation and diagnostic results, with a consistent coding accuracy rate of 95% or better. Specialty Coder will accurately abstract data into any and all appropriate CHRISTUS Health electronic medical record systems, verifying accurate patient dispositions and physician data, following the Official ICD-10-CM and ICD-10-PCS Guidelines for Coding and Reporting and AMA CPT Guidelines. Coder will work collaboratively with various CHRISTUS Health departments, including but not limited to the HIM and Clinical Documentation Specialists, to ensure accurate and complete physician...

Coder Lll - FT Days - CodingDHR Health - US:TX:McAllen - DaysSummary:POSITION SUMMARY:The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the Standards of...

Description Summary: Responsible for maintaining current and high-quality ICD-10-CM/PCS coding for all Inpatient diagnoses and procedural occurrences, through the review of clinical documentation and diagnostic results, with a consistent coding accuracy rate of 95% or better. Coder will accurately abstract data into any and all appropriate CHRISTUS Health electronic medical record systems, verifying accurate patient dispositions and physician data, following the Official ICD-10-CM and ICD-10-PCS Guidelines for Coding and Reporting. Inpatient coding is applicable towards all regional Inpatient encounters. Coder will work collaboratively with various CHRISTUS Health HIM and Clinical Documentation Specialists to ensure accurate and complete physician documentation to support accurate billing and reduce denials. Coder will also assist in other areas of the department, as requested by leadership. Coder will report directly to their Regional Coding Manager, with additional...

BO Coder FT CMMC South Campus - Floresville, TX 78114 Overview Position Type Full Time Job Shift Day Education Level High School Travel Percentage None Category Admin - Clerical Description Summary Under general supervision and according to established procedures, assigns diagnostic codes to medical record information. Codes charts under the ICD 9 CM and HCPCS System for statistical and DRG assignment purposes. Abstracts required data into hospital abstracting system. The outcome of information gathered is used to determine the hospital database and reimbursement of hospital claims. Essential Duties and Responsibilities include the following. Other duties may be assigned. Abstracts and codes diagnoses, operations, and procedures from health records by using appropriate classification systems, standards, and procedures. Prepares statistical reports required by applicable legal, accrediting, and/or licensing regulations and hospital policy. Assigns patient...

HIM Coder-Non-Exempt FT Main 499 - Floresville, TX 78114 Overview Position Type Full Time Job Shift Day Education Level High School Travel Percentage None Category Admin - Clerical Description Summary Under general supervision and according to established procedures, assigns diagnostic codes to medical record information. Codes charts under the ICD 9 CM and HCPCS System for statistical and DRG assignment purposes. Abstracts required data into hospital abstracting system. The outcome of information gathered is used to determine the hospital database and reimbursement of hospital claims. Essential Duties and Responsibilities include the following. Other duties may be assigned. Abstracts and codes diagnoses, operations, and procedures from health records by using appropriate classification systems, standards, and procedures. Prepares statistical reports required by applicable legal, accrediting, and/or licensing regulations and hospital policy. Assigns patient...

Inpatient Coder (Remote)Full-time • Work From HomeMust have CCS, RHIA, or RHIT certificationJob SummaryAs a Coding Integrity Specialist III WORK FROM HOME, you will review and evaluate hospital inpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM and ICD-10-PCS codes. A CIS III performs coding and/or code/DRG validation across multiple entities by applying all appropriate coding guidelines and criteria for code selections.Job QualificationsAssign, sequence, validate, and/or edit codes/DRGs and abstracted data (e.g., physician, discharge disposition, query tracking) for inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCSMaintain or exceed established accuracy standardsMaintain or exceed established productivity standardsUtilize the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGsUndergraduate (Associate's or Bachelor's) degree in HIM/HIT...

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. Responsibilities include auditing coding logic, validating E/M level selection, MS-DRG and APC assignments, and #J-18808-Ljbffr

Minimum Qualifications Bachelor’s degree or equivalent and at least four years of relevant experience. Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) required. Job Summary Utilize advanced skills necessary to audit documentation, coding, and reimbursement of professional, hospital/facility inpatient and outpatient billing. Ensure that documentation is complete and accurately reflects/supports the coded level of service. Audits will determine if the billed services are consistent with medical record documentation and in accordance with the appropriate third-party billing regulations and/or standards. Assist with the development and implementation of pre- and post-audit education as needed. Job Duties Utilizes auditing software to select and conduct random or focused audits of professional and hospital/facility inpatient and outpatient billing based on determined criteria. Conducts prospective and retrospective professional and...

Overview The Revenue Cycle Medical Billing Specialist is responsible for the overall account resolution of patient accounts within the revenue cycle management (RCM) process. Ensures timely billing of claims to payers and follow up of denials, appeals, recoupments and balance management. Ability to audit and provide feedback on the billing process and outcomes. Works cooperatively with other departments to ensure timely billing, reporting and patient account management. Supports the organization’s strategic plan and workplace inclusion initiatives. Abides by the organization’s mission in performing job duties. Demonstrates an understanding and commitment to PPGT’s culture of quality, safety and risk awareness. Responsibilities Reviews submission of claims by third party billing team to the clearinghouse to ensure accuracy. Processes reimbursements and payment adjustments with attention to detail, timeliness, and accuracy. Makes corrections and prepares appeals related to claim...

Your future role at a glance Location: Austin, TX | Remote Facility: Seton Family of Hospitals Department: Revenue Cycle Management Schedule: Full-time | Monday - Friday, 8:00 am - 5:00 pm Salary Range: $24.87 - $33.64 per hour Life at Ascension: Where purpose meets opportunity Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter. Benefits that help you thrive Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options Financial security & retirement: employer-matched 403(b), planning and hardship...

Remote Chicago - 550 Van Buren Michigan-Grayling Pennsylvania-Trappe Boro Pennsylvania-East Lampeter Twp Pennsylvania-Skippack Twp Pennsylvania-Bethel Twp (Armstrong) Pennsylvania-North Bethlehem Twp Pennsylvania-South Park Twp Pennsylvania-West Norriton Twp Pennsylvania-West Mifflin Boro Pennsylvania-Wilkinsburg Boro Pennsylvania-Cogan House Twp (Lycoming) Kentucky-Wolfe County Pennsylvania-Reading (Berks) Pennsylvania-Bensalem Twp Pennsylvania-Lower Salford Twp Ohio-Mentor Michigan-Lansing Pennsylvania-Clarks Green Boro Ohio-Lima Pennsylvania-Bethlehem Twp Pennsylvania-West Cornwall Twp (Lebanon) Pennsylvania-Edgeworth Boro Ohio-Rocky River Kentucky-Murray Pennsylvania-Kennedy Twp Pennsylvania-Moon Twp Ohio-Bay Village Ohio-Lakewood Ohio-Ashville Kentucky-Lakeside Park Pennsylvania-Lower Paxton Twp Ohio-Oxford Ohio-Bedford Pennsylvania-Ross Twp Pennsylvania-Newtown Twp Pennsylvania-Washington Twp...

Salary: $2,451.00 - $2,909.45 Biweekly Location : Houston, TX Job Type: Full Time Job Number: 39605 Department: Administration and Regulatory Affairs Opening Date: 09/18/2026 Closing Date: 9/24/2026 11:59 PM Central POSITION OVERVIEW Applications accepted from: ALL PERSONS INTERESTED Job Classification: BARC SHELTER SUPERVISOR (Medical Division) Posting Number: 39605 Department: Administration & Regulatory Affairs Division: BARC Animal Shelter and Adoptions Reporting Location: 2700 Evella St., Houston, TX Workdays & Hours: Sunday -Thursday 9AM - 6PM* *Subject to Change DESCRIPTION OF DUTIES / ESSENTIAL FUNCTIONS Supervises the operations and activities of the Medical Services, including the work of Senior Animal Care Technicians (Medical) in the humane care and sheltering of animals within the facility. Supervises section, schedules and reviews work, and trains and evaluates employees. Interviews job applicants, conducts...

About Us Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits,...

Brief Description The Harris Center for Mental Health and IDD, known as \"The HARRIS CENTER,\" is seeking an experienced Medical Coder to join our team. Under the direction of Director of Revenue Management, the Medical Coder utilizes knowledge of insurance regulations, health insurance contracts, and medical coding to perform a variety of revenue cycle support activities. Additionally, the medical coder is responsible for reviewing medical records to assure proper billing of the medical record, comparison of physician selected CPT and ICD-10 codes to the physicians' documentation to substantiate the level of coding, physician services to include identification of professional services and complete review of medical records to accurately optimize all professional services documented for billing. Your Role In Action Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and...

Company Overview Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women Children's Health Insurance Program (CHIP) for the children of low‑income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions. Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare...

We are hiring a part-time Medical Coder to assign procedure and diagnosis codes for insurance billing, review claims data, research and correspond with insurance companies in an effort to obtain accurate reimbursement for healthcare claims. Responsibilities Utilize specialized medical classification software to assign procedure and diagnosis codes for insurance billing. Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission. Conduct medical records research and correspond with insurance companies and healthcare professionals to resolve issues resulting from denied claims. Adhere to coding policies and procedures consistent with the industry standard guidelines for CPT, ICD-9 and ICD-10. Answer coding questions. Review clinical documentation to ensure it meets level of CPT codes and ICD-10 codes. Perform related duties, as requested. Uphold the Organization's...

Billing Coder IIIInform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform. Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike. Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel...

Job Description:Employment type:Contract (initial 3 months; likely extension) Schedule:Full-time, Monday“Friday (flexible daytime hours) Location:Remote (U.S. only) About the Role We're hiring an experiencedInpatient Medical Coderto support acute-care facility coding for a Level I Trauma Hospital. The ideal candidate is AHIMA-credentialed, highly accurate with ICD-10-CM/PCS and MS-DRG/APR-DRG assignment. Key Responsibilities Review inpatient medical records and assign ICD-10-CM/PCS codes with appropriate DRG assignment (MS-DRG/APR-DRG as applicable). Ensure compliance with AHIMA , AHA Coding Clinic , CMS , and facility guidelines. Query providers per policy to clarify documentation and support compliant code/DRG selection. Meet or exceed productivity and 95“98%quality standards. Collaborate with HIM/CDI teams to resolve discrepancies and optimize documentation integrity. Maintain HIPAA compliance and safeguard PHI in a remote work...

JOB SUMMARYSupport and provide coding and compliance training to clinical personnel, billing, and / or other client staff.Establish effective communication with clinical staff, and / or hospital staff to address documentation, coding, and reimbursement issues.Use knowledge of coding and compliance guidelines to identify potential billing / reimbursement issues.Participate in special audits and system administration as necessary.ESSENTIAL DUTIES AND RESPONSIBILITIESInclude the following.Others may be assigned.Performs diagnosis data submissions to Client, Vendors and internal StakeholdersDevelop monthly productivity and revenue projectionsResponsible for chart assignment oversight and monitoring accounts on holdPrepares data collection reports for leadershipMonitors diagnosis submission progress; Audit diagnosis submission files to ensure accuracyReviews, analyzes and oversight of prebill / post bill reviews and pending accountsWorks to resolve workflow, systems and complex matters...