38 hospital coding auditor jobs found

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...

Inpatient/DRG Validation Coding Auditor The Inpatient/DRG Validation Coding Auditor performs documentation and coding audits for all acute inpatient services for clients. Identifies coding errors, compliance, and educational opportunities, and optimizes reimbursement by ensuring that the diagnosis/procedure codes and supporting documentation accurately support the services rendered and comply with ethical coding standards/guidelines and regulatory requirements. Performs independent reviews, interprets medical records, and applies in-depth knowledge of coding principles to determine billing/coding/documentation issues and quality concerns. Demonstrates high level of expertise in researching requirements necessary to make compliant recommendations. Has an extensive understanding of reimbursement guidelines, specifically related to DRG (MS, APR, Tricare, etc.) payment systems. Conducts DRG (ex. MS, APR, Tricare) coding and clinical reviews to verify the accuracy of coding, DRG...

Location: Virtual Employee PRIMARY PURPOSE Conducts audits of medical record coding to ensure compliance with established guidelines, provides results of audits, and assists with educational activities related to findings to promote adherence to state/federal laws and regulatory requirements. MINIMUM SPECIFICATIONS Education: - Must be a graduate of a Health Information Management program or must have successfully completed an approved Coding educational program. Experience - Must have six (6) years of proven coding experience in an acute care setting. Equivalent Education and/or Experience - May have an equivalent combination of education and experience in lieu of specified requirements. Certification/Registration/Licensure - Because of the lag in SCCE, HCCA, NCRA, and AHIMA updating the status of certifications, current employees whose certification is granted through one of these associations are allowed up to seven (7) calendar days, after expiration, to...

Job Posting Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials. Job Responsibilities/Duties: Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to Standards of...

Medical Coding Auditor UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico. This position requires extensive knowledge and experience with E/M coding. $2,000 Sign-on Bonus Minimum $56,173 - Midpoint $70,217 Salary is determined based on years of total relevant experience. Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes, medical...

DRG Coding Auditor Principal This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case...

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...

We are hiring a part-time Medical Coder to to assign procedure,diagnosis codes for insurance billing, review claims data, research and corresponds with insurance companies in an effort to obtain accurate reimbursement for healthcare claims. . Duties include but are not limited to: 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 Performs related duties, as...

Job Description Job Description Job Summary: Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.   Job Responsibilities/Duties: · Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or...

We've learned that what is best for patients is also best for employees. Learn more about why we are one of the Best Companies to Work for in Texas®. Job Summary The Healthcare Compliance Billing & Coding Auditor is responsible for performing independent audits of billing and coding practices across hospital departments and clinic providers to ensure compliance with organizational policies, federal and state regulations, and payer requirements. Reports to Chief Compliance Officer Job Specific Responsibilities 1.Conduct comprehensive audits of billing and coding documentation for accuracy and compliance in both hospital and clinic settings. 2.Identify discrepancies, potential compliance risks, and recommend corrective actions. 3.Develop audit reports and present findings to leadership. 4.Stay current with regulatory changes, coding guidelines (ICD-10, CPT, HCPCS), and compliance standards. 5.Collaborate with clinical and administrative teams to implement best...

Description Summary: Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The 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 Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an on-site position with a remote option. Responsibilities: Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk adjustment....

Job Description The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines...

Responsibilities HIM/Medical Records Analyst/Coding Specialist Opportunity West Oaks Hospital has provided psychiatric care to the Houston area and surrounding communities for over four decades. Our 176-bed acute care facility is fully accredited and included a 16-bed residential treatment center for adult chemical dependency. We offer a broad range of behavioral health programs for children, adolescents and adults. Treatment is offered at multiple levels of care including inpatient, partial hospitalization and intensive outpatient. We are available 24 hours a day, seven days a week to assist you and answer your questions about treatment options and insurance coverage. The hospital is easily accessible off the Southwest Freeway near the Galleria. Visit us online at: https://westoakshospital.com/ West Oaks Hospital is seeking a dynamic and talented HIM/Medical Records Coding Specialist to join our team of compassionate, dedicated professionals. The HIM/Medical...

Medical Coder Multi-Specialty (Hospital & Clinic) Location: Kingwood-Hybrid Employment Type: Full-Time Reports To: Revenue Cycle Manager Position Summary We are seeking a highly skilled, detail-driven, and high-producing Certified Medical Coder with multi-specialty experience to join our growing healthcare organization. This role requires strong proficiency in both hospital and outpatient clinic coding, with specialty expertise in: Cardiology Urology Dermatology General Surgery Pulmonology The ideal candidate has 2+ years of coding experience, maintains current certification (AAPC or equivalent), and consistently demonstrates accuracy, productivity, and strong clinical understanding across multiple service lines. This is a high-impact role within a performance-driven, collaborative organization focused on compliance, precision, and revenue integrity. Core Responsibilities Coding & Documentation Review Accurately assign ICD-10-CM, CPT, and HCPCS Level...

POSITION SUMMARY This position is responsible for accurately coding at least one main outpatient work type accounts (Observation, Same Day Surgery, and/or ER) as well as assisting with the coding of other outpatient work types as needed. All accounts should be completed within 5 days following discharge. POSITION REQUIREMENTS Minimum Education Required: Completion of college level course work in Medical Terminology and Anatomy and Physiology. Preferred: Minimum education level of Associates Degree. Minimum Work Experience Required: A minimum of two (2) years coding experience in an acute care hospital. Required Licenses/Certifications Required: CCA credentials (Certified Coding Associate) or CPC credentials (Certified Professional Coder) Required Skills, Knowledge, and Abilities Required: A through working knowledge of Medicare billing rules, regulations and local medical review policies as they impact reimbursement under APCs and DRGs. Preferred Qualification...

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...

Business, Managerial & Finance UTMB Health Minimum Qualifications: Two years of medical billing or related experience, or related training from a non-accredited program or accredited agency. Preferred Qualifications: Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology and medical abbreviations. Required Licenses, Registrations, or Certifications: One of the following: CCA Certified Coding Associate (AHIMA) or CCS Certified Coding Specialist (AHIMA) or CCS-P Certified Coding Specialist Physician Based (AHIMA) or RHIA Registered Health Information Administrator (AHIMA) or RHIT Registered Health Information Technician (AHIMA) or CIC Certified Inpatient Coder (AAPC) or COC Certified Outpatient Coder (AAPC) or CPC Certified Professional Coder (AAPC) or CPC-A Certified Professional Coder Apprentice (AAPC) or CRC Certified Risk Adjustment Coder (AAPC) Job Summary: Properly codes and/or audits...

Registered Nurse Clinical Coder DRG Audit Our client is seeking an experienced Registered Nurse Clinical Coder to support DRG audit activities for one of their major healthcare partners. This role focuses on reviewing inpatient medical records, validating DRG assignments, and ensuring coding accuracy from an insurance and payer-side perspective rather than the provider side. This is an excellent opportunity for an RN with coding experience who enjoys analytical work, documentation review, and collaborating with audit teams. Key Responsibilities: Perform DRG audits on inpatient medical records to validate ICD-10 coding accuracy and DRG assignment. Review clinical documentation to ensure compliance with payer guidelines and audit standards. Identify discrepancies, trends, and opportunities for coding improvement. Communicate audit findings clearly and professionally through written reports and outbound calls as needed. Collaborate with internal teams to support audit...

Overview Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many...

Hours of Work : 8 AM -4:30 PM Days Of Week : M-F Work Shift : Job Description : Your Job: In this highly technical and fast-paced position, you will collaborate with multidisciplinary team members to provide the very best care for our patients. The Coder 3 performs pre-bill (secondary) audits on inpatient, ambulatory care and observation records to ensure accurate ICD10-CM, ICD10 PCS and/or CPT codes for optimal reimbursement and provide data and clinical information to management, medical STAFFnd various hospital departments. The reviewer also codes and abstracts inpatient, ambulatory and observation records for diagnosis and procedures to determine optimal reimbursement. Your Job Requirements: • Associate's degree in Health Information Management or Certification as a Coding Specialist; Bachelor's degree in Health Information Management preferred • RHIA, RHIT, or CCS preferred • Minimum of 3 years of DRG-based coding experience in an acute care hospital...

Coding Specialist This position is responsible for accurately coding at least one main outpatient work type accounts (Observation, Same Day Surgery, and/or ER) as well as assisting with the coding of other outpatient work types as needed. All accounts should be completed within 5 days following discharge. Position Requirements Minimum Education Required: Completion of college level course work in Medical Terminology and Anatomy and Physiology. Preferred: Minimum education level of Associates Degree. Minimum Work Experience Required: A minimum of two (2) years coding experience in an acute care hospital. Required Licenses/Certifications Required: CCA credentials (Certified Coding Associate) or CPC credentials (Certified Professional Coder) Required Skills, Knowledge, and Abilities Required: A thorough working knowledge of Medicare billing rules, regulations and local medical review policies as they impact reimbursement under APCs and DRGs. Preferred Qualification Preferred:...

Coder 3 Hours of Work: 8 AM - 4:30 PM Days Of Week: M-F Work Shift: Job Description: Your Job: In this highly technical and fast-paced position, you will collaborate with multidisciplinary team members to provide the very best care for our patients. The Coder 3 performs pre-bill (secondary) audits on inpatient, ambulatory care and observation records to ensure accurate ICD10-CM, ICD10 PCS and/or CPT codes for optimal reimbursement and provide data and clinical information to management, medical staff and various hospital departments. The reviewer also codes and abstracts inpatient, ambulatory and observation records for diagnosis and procedures to determine optimal reimbursement. Your Job Requirements: Associate's degree in Health Information Management or Certification as a Coding Specialist; Bachelor's degree in Health Information Management preferred RHIA, RHIT, or CCS preferred Minimum of 3 years of DRG-based coding experience in an acute care hospital with...

Medical Coder - Multi-Specialty (Hospital & Clinic) Location: Kingwood-Hybrid Employment Type: Full-Time Reports To: Revenue Cycle Manager Position Summary We are seeking a highly skilled, detail-driven, and high-producing Certified Medical Coder with multi-specialty experience to join our growing healthcare organization. This role requires strong proficiency in both hospital and outpatient clinic coding, with specialty expertise in: • Cardiology • Urology • Dermatology • General Surgery • Pulmonology The ideal candidate has 2+ years of coding experience, maintains current certification (AAPC or equivalent), and consistently demonstrates accuracy, productivity, and strong clinical understanding across multiple service lines. This is a high-impact role within a performance-driven, collaborative organization focused on compliance, precision, and revenue integrity. Core Responsibilities Coding & Documentation Review • Accurately assign...

DHR Health - US:TX:McAllen - Days Summary: 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 Ethical Coding as set...