Hcc auditor coder jobs | Healthcare Careers

Hybrid HCC QA Coder/Auditor — Risk Adjustment Expert

Blue Cross Blue Shield of Arizona Phoenix, AZ

A health insurance provider seeks a Quality Assurance Coder/Auditor based in Arizona to develop risk mitigation and education programs. Responsibilities include reviewing medical records, coding for accuracy, and educating providers on best practices. The position requires at least 5 years of coding experience, with proficiency in HCC coding, and certifications like CCS-P or CPC. This hybrid role promotes flexibility, allowing candidates to work both onsite and remotely within Arizona. #J-18808-Ljbffr

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Hybrid QA Coder/Auditor - HCC & Risk Adjustment

Blue Cross Blue Shield of Arizona Phoenix, AZ

A regional health insurance provider in Phoenix seeks a Quality Assurance Coder/Auditor to develop risk mitigation programs and educate providers. The candidate should have 5 years of coding experience with expertise in Hierarchical Condition Categories (HCC). Responsibilities include medical record reviews, coding analysis, and providing education to healthcare professionals. The position requires residency in Arizona and offers a hybrid work environment, enhancing work-life balance. #J-18808-Ljbffr

Full Time

Medical Coding and Billing Analyst

C2Q Health Solutions Hybrid (NY)

JOB PURPOSE: Responsible for supervising, evaluating, and consistently improving the day-to-day operations of Medical Practice. This role is responsible for accurate and timely billing of insurance claims and patient statements across multiple sites, implements accurate medical coding policies, and enhances operational processes. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing diagnosis data submission processes, presenting performance results to leadership, and supporting HCC/RAF optimization strategies. The role will also oversee the training of Medical Practice Assistants, Physician and IDT disciplines in ICD-9/ICD-10 guidelines. JOB RESPONSIBILITIES: Responsible to deliver accurate and timely billing of insurance claims and patient statements for all...

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Medical Coding Specialist

TEKsystems San Fernando, CA

*Description* The HCC Auditor/Coder's primary objective is to continually improve providers' reporting and documentation of chronic health care conditions. This is done through auditing providers' patient medical records and providing education on best coding practices. Code review super bills and patient medical records for proper use of diagnosis and procedure codes. * Works as an integral member of the Finance Department. * Code review super bills and patient medical records for proper use of diagnosis and procedure codes. * Interface effectively with physicians and office staff on coding issues. Research coding questions as needed. * Code review a wide variety of document types, i.e., Primary and specialty care medical records, mental health, substance abuse, in-patient, out-patient, non-submittals (lab), ancillary and pharmaceutical services for HCC values. * Perform both provider office audits and on-line audits via reviewing patient medical records. * Provide...

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Medical Coding and Billing Compliance Auditor

CommuniCare Health Services Blue Ash, OH

Medical Coding and Billing Compliance Auditor Location: Remote Division: Coding Compliance About the Role: The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have extensive knowledge of CPT coding, ICD-10-CM coding, E/M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access...

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Coding Auditor/Educator

Mysemg Alpharetta, GA

Job Title: Provider Coding Educator / Auditor Department: Revenue Integrity & Compliance Employer: Southeast Primary Care Partners / Southeast Medical Group, P.C. FLSA Status: Non-Exempt (Hourly) Position Summary The Provider Coding Educator/Auditor is responsible for driving accurate clinical documentation, compliant coding, and revenue integrity across Southeast Primary Care Partners’ ambulatory practices. The role combines prospective and retrospective E/M, procedural and risk‑adjustment auditing with in‑person and virtual provider education. Up to 50 % regional travel is required to meet with physicians on flexible schedules, including early‑morning huddles and occasional after‑hours sessions. This is an hourly, non‑exempt position governed by the Fair Labor Standards Act (FLSA) overtime provisions and subject to Occupational Safety and Health Administration (OSHA) workplace safety standards. Requirements Essential Functions Perform focused and random audits of...

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Coding Auditor/Educator

Southeast Primary Care Partners Alpharetta, GA

Job Type Full-time Description Job Title: Provider Coding Educator / Auditor Department: Revenue Integrity & Compliance Employer: Southeast Primary Care Partners / Southeast Medical Group, P.C. FLSA Status: Non-Exempt (Hourly) Position Summary The Provider Coding Educator/Auditor is responsible for driving accurate clinical documentation, compliant coding, and revenue integrity across Southeast Primary Care Partners' ambulatory practices. The role combines prospective and retrospective E/M, procedural and risk-adjustment auditing with in-person and virtual provider education. Up to 50 % regional travel is required to meet with physicians on flexible schedules, including early-morning huddles and occasional after-hours sessions. This is an hourly, non-exempt position governed by the Fair Labor Standards Act (FLSA) overtime provisions and subject to Occupational Safety and Health Administration (OSHA) workplace safety standards. Requirements Essential...

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Coding Auditor, Facility

Scout Exchange OR

Title - Coding Auditor Location - Clackamas, OR Job Type - Permanent Job Summary: To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP),...

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Permanent - Inpatient Facility Medical Coder

Healthcare Staffing Plus OR

JOB DESCRIPTION To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

UH

Sr Risk Adjustment Coder

University HealthCare Alliance Newark, NJ

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. What you will do: Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with other departments to address coding updates and support risk...

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Inpatient Facility Medical Coder (40h Day)

Softpath System OR

Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid...

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HCC Risk Adjustment Coder, Sr.

Regal Medical Group Los Angeles, CA

We are looking for experienced HCC Risk Adjustment Auditors/Coders to join our team! Position Summary: The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services. Essential Duties and Responsibilities include the following: Works as an integral member of the Finance Department. Code review super bills and patient medical records for proper use of diagnosis and...

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Quality Assurance Coder/Auditor - Hybrid

Blue Cross Blue Shield of Arizona United States

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service,...

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Coder I - MPG - FT - Days - MSS - Remote Eligible

Memorial Healthcare System United States

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Memorial is seeking an experienced Medical Coder with a strong background in professional billing for Radiation Oncology services. The ideal candidate will have in-depth knowledge of CPT, ICD-10, and HCPCS coding, with proven expertise in radiation oncology coding guidelines, documentation requirements, and payer-specific billing practices. Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities: For physician billing, collaborates with billing department to ensure all bills...

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Inpatient Facility Medical Coder

InstantServe LLC United States

Job Title : Inpatient Facility Medical Coder Location : Clackamas, OR, US Pay Rate : USD $27.26 - $39.37 / hr +Benefits JOB DESCRIPTION : Essential Responsibilities: Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as...

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QA Coder/Auditor (Hybrid) — Risk-Adjustment Expert

Blue Cross Blue Shield of Arizona Phoenix, AZ

A leading health insurance provider in Arizona seeks a Quality Assurance Coder/Auditor to develop risk management and provider education programs. This hybrid role requires 5 years of professional coding experience, with 3 years focused on HCC coding. The ideal candidate will ensure coding accuracy in medical records and provide training to healthcare providers. Applicants must have a high school diploma and relevant certifications, with a preference for those with Medicare Advantage experience. #J-18808-Ljbffr

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Compliance Auditor - MPG - FT - Days - MHS

Memorial Health Care System Fort Lauderdale, FL

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements. Responsibilities: Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify...

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Quality Assurance Coder/Auditor - Hybrid

Blue Cross Blue Shield of Arizona Phoenix, AZ

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer...

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Sr Risk Adjustment Coder

Stanford Health Care - ValleyCare Stanford, CA

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America)**This is a Stanford Health Care - University Healthcare Alliance job.** **A Brief Overview** The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. **Locations** Stanford Health Care - University Healthcare Alliance **What you will do****Education Qualifications*** High school diploma or GED equivalent.* Bachelor's Degree preferred.**Experience Qualifications*** 5+ years of work experience in a risk...

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Supervisor of Medical Group Coding Audit & Provider Education (REMOTE)

Trinity Health Livonia, MI

Purpose Frontline, department-based role that supervises daily functions of assigned area(s). Provides clear direction & manages / advances people, processes, structures & / or programs that support direct / indirect care. Demonstrates behaviors in alignment with culture & creates / supports comprehensive strategies & measures progress to achieve desired outcomes. Employment Type Full time Description Frontline, department-based role that supervises daily functions of assigned area(s). Provides clear direction & manages / advances people, processes, structures & / or programs that support direct / indirect care. Demonstrates behaviors in alignment with culture & creates / supports comprehensive strategies & measures progress to achieve desired outcomes. Note: “patients” refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our...

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Hospital Based Outpatient Coder II - HIM - FT - Days - MSS - Remote Eligible

Memorial Healthcare System Florida, NY

Location Miramar, Florida Summary Reviews medical record documentation to assign ICD‑10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance. Responsibilities For hospital encounters, routes billing charge entry errors and/or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing. Reviews chargemaster generated CPT/HCPCS codes when errors are found. Coding Management is notified to alert Charge Management to educate department making errors. For Professional Billing, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing. Enhances and maintains coding knowledge and skills for physician billing. Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements. Communicates with insurance...

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EMR CODING AUDITOR

Galen Medical Chattanooga, TN

EMR Coding Auditor Summary/Objective: The EMR Coding Auditor (ECA) facilitates improvement in the overall quality, completeness and accuracy of medical record documentation. The individual will perform medical record reviews based on CMS Quality Standards and validating active chronic problems for each patient and communicating with the physician to ensure Hierarchical Condition Coding is met, as well as accurate and up-to- date patient problem lists are documented in the EMR. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes. The ECA reports to the Population Health Manager. It is the obligation of each Galen associate to comply with and promote the Galen mission, core values, privacy and corporate/departmental/site policies (I.E. Dress code, Time and attendance, et al). Essential Functions: Coordinate...

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Inpatient Facility Medical Coder (40h Day)

Veracity United States

Inpatient Facility Medical Coder (40h Day) Remote Clackamas, OR Candidates must reside either in Washington or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding...

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Inpatient Facility Medical Coder

American IT Staff United States

Company Description Job Description To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional...

163 hcc auditor coder jobs found