35 inpatient coding auditor jobs found

Huron Consulting Group is hiring a highly organized Inpatient Coding Auditor to ensure DRG and coding accuracy for inpatient records. The role involves auditing coders and offshore auditors, using encoder software, and communicating findings to client teams and payers. Strong knowledge of ICD-CM/ICD-PCS and compliance guidelines is essential. Join a team focused on healthcare transformation, revenue-cycle optimization, and delivering high-quality audit results across multiple clients. #J-18808-Ljbffr

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare...

Humana Inc. is seeking an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role focuses on accurate ICD-10-CM, ICD-10-PCS, and DRG coding, with opportunities to improve payment accuracy and drive cost savings. Responsibilities include auditing inpatient records, validating codes, investigating disputes, and collaborating with teams. #J-18808-Ljbffr

Become a part of our caring community 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. Where you Come In 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 accuracy of...

A leading healthcare insurance company in Ohio is seeking a skilled professional to review inpatient hospital claims and manage disputes. Candidates must have RHIA, RHIT, or CCS Certification with 4+ years of experience, alongside expertise in MS-DRG coding and auditing. This role offers competitive salary, a comprehensive benefits package, and opportunities for professional growth in a supportive environment. Flexible remote work with occasional travel required. #J-18808-Ljbffr

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified 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 goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following: Review inpatient medical records and claims to ensure accurate coding and reimbursement Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes Audit coding quality and identify opportunities for...

Employer Industry: Healthcare Insurance Why consider this job opportunity: Salary up to $97,800 per year Eligible for a bonus incentive plan based on company and/or individual performance Comprehensive benefits package including medical, dental, vision, and 401(k) retirement savings plan Opportunities for professional development and career advancement within a Fortune 100 company Flexible remote work environment with occasional travel for training or meetings Supportive organizational culture focused on the well-being of employees and consumers What to Expect (Job Responsibilities): Review inpatient hospital claims to ensure proper reimbursement and handle provider disputes Assign appropriate procedural terminology and medical codes to patient records Analyze, enter, and manipulate databases for accurate claims payment and diagnosis-related group assignments Respond to internal requests for medical information and clarify discrepancies Make independent decisions...

Licking Memorial Health Systems is seeking a Compliance Auditor responsible for auditing and monitoring adherence to state and federal documentation and billing requirements across LMHS. This position reports to the VP of Financial Services and emphasizes collaboration with clinicians and administrators to improve processes. The role focuses on home care, patient-level care, and internal audits, ensuring compliance with CMS, OIG, ODH, ODM, and RAC standards. #J-18808-Ljbffr

Full-Time Days Two (2) years of work experience in a physician’s office or Out-patient/In-patient setting performing documentation review per compliance and Medicare/Medicaid Standards, diagnostic code sequencing and familiarity to Medical Terminology required. Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Medical Coder (CMC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) reqired. Summa Health Medical Group Akron, OH 44304 Full-Time Days Will work remote after training and orientation Two (2) years of work experience in a physician’s office or Out-patient/In-patient setting performing documentation review per compliance and Medicare/Medicaid Standards, diagnostic code sequencing and familiarity to Medical Terminology required. Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Medical Coder (CMC), Certified Professional Coder (CPC), Certified Professional...

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient medical records and DRG-based claims across lines of business. The role requires expert ICD-10 coding knowledge and sophisticated audit capabilities. You will work with management on criteria, perform secondary reviews, and identify opportunities for optimal recoveries. Hybrid work setup involves weekly in-office sessions and remote collaboration. #J-18808-Ljbffr

Location: This role enables associates to work virtually full-time, except for 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 if candidates reside within a commuting distance from an office. 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 accommodation is granted as required by law. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding...

Ensemble Health Partners seeks an Inpatient/DRG Validation Coding Auditor to review medical records and ensure accurate DRG assignment and documentation. You will identify discrepancies, educate coders, and help improve reimbursement accuracy for hospital clients. The role requires 5+ years of coding and 3+ years of facility audit experience, proficiency with EMR systems and encoders, and maintaining HIPAA compliance. #J-18808-Ljbffr

Location: This role enables associates to work virtually full-time, except for 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 if candidates reside within a commuting distance from an office. 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 accommodation is granted as required by law. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note:...

Medical Claims SpecialistThis position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts.Job Duties/ResponsibilitiesMaintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Job DescriptionUsing established policies and procedures; the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series, and emergency room cases) and may be called upon to code highly complex inpatient records (to include trauma, burns, open heart and transplant cases) based on experience and skill set.ResponsibilitiesCoding quality:Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRG's.Interprets health record content to ensure that all diagnoses and procedures coded are supported by physician documentation.Maintains a coding accuracy rating of at least 95% on records assigned.Queries physicians when necessary to ensure documentation supports the codes...

Overview Using established policies and procedures; the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series, and emergency room cases) and may be called upon to code highly complex inpatient records (to include trauma, burns, open heart and transplant cases) based on experience and skill set. Qualifications High school graduate required. Associate Degree preferred | Registered Health Information Technician (RHIT) preferred, (or RHIT eligible) | 2 years experience in Health Information Management or related health care/office experience . Responsibilities Coding quality - 40% - Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRGs. Interprets health...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We’re Looking For We’re looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

Medical Claims Specialist This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization's operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. Job Duties/Responsibilities Maintains a thorough understanding and education of federal and state regulations and payer specific policies and...

Job Description Using established policies and procedures; the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of inpatient, observation and outpatient cases (to include clinics, ancillary services, and ambulatory surgery, series, and emergency room cases) and may be called upon to code highly complex inpatient records (to include trauma, burns, open heart and transplant cases) based on experience and skill set. Responsibilities Coding quality: Reviews inpatients, ambulatory, observation, emergency and outpatient accounts to assign accurate ICD-10 and/or CPT codes and DRG's. Interprets health record content to ensure that all diagnoses and procedures coded are supported by physician documentation. Maintains a coding accuracy rating of at least 95% on records assigned. Queries physicians when necessary to ensure documentation supports...

Summa Health is seeking a Certified Coder / Audit Specialist in Akron, OH to audit medical records for compliance and coding accuracy. The role requires two years of relevant experience in physician offices or inpatient/outpatient settings and proficiency in medical terminology. Certifications CCS, CCS-P, CMC, CPC, CPMA are required. The position offers full-time days with remote work after training and orientation, along with Summa Health's competitive benefits package. #J-18808-Ljbffr

PURPOSE OF THIS POSITION This position is responsible for all medical claims including pre-billing and follow up activities for delayed claims by ensuring, through various activities, that claims are clean and should be paid promptly by insurers without requiring further intervention. This staff member performs all pre-claim submission activities, including verifying existing information is accurate, determining when additional data is needed, and collecting necessary details to ensure claims are complete. Additionally, this individual follows departmental productivity and quality control measures that support the organization’s operational goals. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, timely payer follow-up activities and collection of accounts. JOB DUTIES/RESPONSIBILITIES Duty 1: Maintains a thorough understanding and education of federal and state regulations and payer specific policies...

Job TitleJob DescriptionDutiesHelpsAssigns codes to documented patient care encounters (inpatient or outpatient) covering the full range of health care services provided by the VAACC.Applies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services.Selects and assigns codes from the current version of several coding systems to include current versions of the International Classification of Diseases-Clinical Modification (ICD-CM), Current Procedural Terminology (CPT), Diagnostic and Statistical Manual of Mental Disorders (DSM), and Healthcare Common Procedure Coding System (HCPCS).Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management (E&M) code to ensure ethical, accurate, and complete coding.Applies codes based...

Summary This position is in the Health Information Management (HIM) section of the Patient Business Services (PBS) at the Columbus VA Ambulatory Care Center. MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. Learn more about this agency Duties Help Assigns codes to documented patient care encounters (inpatient or outpatient) covering the full range of health care services provided by the VAACC. Applies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services. Selects and assigns codes from the current version of several coding systems to include current versions of the International Classification of Diseases-Clinical Modification...