21 internal coding auditor jobs found

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...

If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-22463 Facility: LOC0006 - 780 Main Street780 Main StreetWeymouth, MA 02190 Department Name: SHS Compliance Status: Part time Budgeted Hours: 32 Shift: Day (United States of America) The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Compensation Pay Range: $73,000.00 - $104,400.00 Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit)...

Coding & Compliance Auditor The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Compensation Pay Range: $73,000.00 - $104,400.00 Job Responsibilities Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC's, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify...

What We're Looking ForWe'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 you to help shape the future of healthcare from your own workspace!What You Will DoAssign diagnostic and procedural codes using ICD-9-CM, ICD-10-CM, and ICD-10-PCS codesAccurately sequence and abstract medical codes from patient records, ensuring precision and adherence to documentationOversee and audit the work of Level 1 & 2 Coders, where applicableChampion documentation improvement opportunities and coding issues, facilitating resolution with relevant stakeholdersUphold an overall 95% coding accuracy rate and a 95% accuracy rate for MS-DRG assignmentsMaintain a minimum production of 1 chart per hour or site-specific productivity benchmarksFoster professional communication...

Title: Certified Risk Coder Reports to: Manager, Risk Coding Classification: Individual Contributor Location: Boston (Remote) Job description revision number and date: 2.0, 01.06.2025 Organization Summary Community Care Cooperative (C3) is a 501(c)(3) non‑profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast‑growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. Job Summary The Certified Risk Coder will be a part of an emerging coding team and coding service that performs...

Position Summary Conducts CPT and ICD-10 coding reviews by detailed examination of each line item in the physician medical record and charge session. Performs chart audits to ensure correct coding and charge capture have been applied appropriately. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers. Position Physician Practice Coder Department BUMG Corporate PBO Schedule 40 hours Essential Responsibilities / Duties Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures. Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems. Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing. Sequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital...

Medical Billing Specialist job at Entyre Inc. Boston, MA. Our Mission Serve Families. Our Method: Relentless Speed. Entyre Care radically supports family caregivers with financial, emotional, and expert resources. We operate with urgency, focus, and a commitment to delivering “insanely great” outcomes for families. Position Overview We are seeking a highly organized and detail-oriented Billing Specialist to join our accounting team. The Billing Specialist will be responsible for supporting the daily operations of the accounting department, ensuring the accuracy of the medical billing. This role requires a strong understanding of billing, excellent problem-solving skills, and the ability to work collaboratively across departments. Key Responsibilities Prepare and post journal entries, ensuring accuracy and compliance with company policies. Maintain and reconcile general ledger accounts. Assist with month-end, quarter-end, and year-end closing processes. Review and process...

Community Behavioral Health Center Clinical Supervisor (Adult) job at Boston Medical Center. Boston, MA. Position Summary The Clinical Supervisor oversees and supervises master's level clinicians who are responsible for evaluating, treating, and providing behavioral health services for patients of BMC Department of Psychiatry. Responsibilities will include: overseeing daily onsite clinical activities, providing regular clinical and programmatic supervision to clinicians, providing clinical back-up and support to the teams as needed; performance management of Master’s level clinicians; payroll and timekeeping for program staff; and reviewing cases and documentation to ensure staff are compliant with approved protocols and procedures. In addition, the Clinical Supervisor also provides direct clinical care through individual, group, couples, and family psychotherapy using an anti-oppression and health equity lens. The position consults with, collaborates, and communicates with a wide...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Under the general supervision of the Facility Outpatient (OP) Coding Manager and OP Coding Supervisor, the Facility OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The facility OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. Job Description: Essential Duties & Responsibilities including but not limited to: Hospital Coding: •...

Title: Certified Risk Coder Reports to: Manager, Risk Coding Classification: Individual Contributor Location: Boston (Remote) Job description revision number and date: 2.0, 01.06.2025 Organization Summary: Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. Job Summary: The Certified Risk Coder will be a part of an emerging coding team and coding service that...

Medical Coding Specialist Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Responsible for ensuring proper coding compliance, documentation accuracy, and adherence to coding guidelines and regulations. Essential Functions Assign appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other relevant information. Ensure compliance with coding guidelines, including those outlined by the American Medical Association (AMA), Centers for Medicare and...

Senior Medical Coding Analyst CodaMetrix is revolutionizing Revenue Cycle Management with its AI-powered autonomous coding solution, a multi-specialty AI-platform that translates clinical information into accurate sets of medical codes. CodaMetrix's autonomous coding drives efficiency under fee-for-service and value-based care models and supports improved patient care. We are passionate about getting physicians and healthcare providers away from the keyboard and back to clinical care. Reporting to the Senior Manager, Medical Coding & Audit, as a Senior Medical Coding Analyst, this role will be a key member of the team responsible for ensuring that CodaMetrix meets—and exceeds—our customers' coding quality expectations. They will leverage their strong background in coding, billing, and auditing across service lines to review, analyze, and enhance coding processes, both internally and externally. They will play a pivotal role in improving the quality and efficiency of coding...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the general supervision of the Facility Outpatient (OP) Coding Manager and OP Coding Supervisor, the Facility OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The facility OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing. Job Description: Essential Duties & Responsibilities including but not limited to: Hospital Coding: ·...

Responsible for ensuring proper coding compliance, documentation accuracy, and adherence to coding guidelines and regulations. Essential Functions -Assign appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other relevant information. -Ensure compliance with coding guidelines, including those outlined by the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other regulatory bodies. -Analyze medical records, including physician notes, laboratory results, radiology reports, and operative reports, to extract pertinent information for coding purposes. -Maintain a high level of accuracy and quality in coding assignments to ensure proper reimbursement and minimize claim denials. -Utilize coding software, encoders, and electronic health record systems to facilitate the coding process. -Support coding compliance efforts by participating in coding...

JOB SUMMARY The Certified Coder is responsible for applying accurate diagnostic and procedural codes (ICD-10-CM, CPT, HCPCS) to patient health records to optimize reimbursement and ensure claims are submitted correctly. They are also responsible for managing and maintaining patient accounts as assigned by the Accounts Receivable Manager. This position works closely with internal and external customers to resolve unpaid claims, insurance discrepancies, and patient balances through timely and accurate follow-up. The goal of this role is to maximize reimbursement, ensure correct insurance payments, and uphold the principles of the "Flawless Reimbursement" system. RESPONSIBILITIES Coding Review patient records for completeness, documentation accuracy, and proper signatures. Apply ICD-10-CM, CPT, and HCPCS codes to ensure accurate claims and optimal reimbursement. Analyze provider documentation to assign correct Evaluation & Management (E&M) levels; query physicians when...

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary The Coder manages the day to day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic data base and or excel spread sheets. The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medial record. Our Investment In You Full-time remote work Competitive salaries Excellent benefits Responsibilities Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. Ability to code government and state models. This includes code...

Director, Billing Compliance  Dana-Farber Cancer Institute  Boston, MA  Full Time  Overview Reporting to the VP, Chief Compliance Officer with a dotted line reporting relationship to the VP, Revenue Performance Management, the Director of Billing Compliance is a strategic leader and subject matter expert responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization. The Director provides constructive oversight and mentorship to the Billing Compliance team. This role leads the development and execution of a robust billing compliance program focused on hospital technical and professional fee billing in compliance with internal policies and state, federal and local rules. The Director serves as a key 'second line of defense' in support of accurate and compliant operational processes. The Director works as a cross functional leader, partnering with clinical, administrative, and financial teams and participating in...

Billing Compliance Reviewer  Dana-Farber Cancer Institute  Boston, MA  Full Time Overview Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk. The role evaluates the accuracy and integrity of hospital and professional billing practices to ensure compliance with federal and state regulations, payer requirements, national coding guidelines, and internal policies. The Billing Compliance Reviewer is responsible for developing clear findings, collaborating with clinical and administrative stakeholders to resolve issues, and supporting continuous improvement in charge capture, documentation, and coding processes. This role works collaboratively with Coding, HIS, Billing and other internal and external teams to evaluate complex billing issues and initiate...

Senior Billing Compliance Hospital Reviewer  Dana-Farber Cancer Institute  Boston, MA  Full Time Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing Compliance inpatient and ambulatory activities. The Senior Reviewer will provide oversight related to reviewing the accuracy and appropriateness of ICD-10-PCS procedure coding and assessing DRG assignment. The Senior Reviewer will assist in the development and execution of the annual Billing Compliance work plan. They will monitor federal and state regulatory requirements and industry developments and work to determine applicability and risk to both technical and operational aspects of the organization. Metrics will be developed and reported quarterly. The Senior Reviewer will be expected to pursue successful completion of multiple tasks collaborating effectively with many departments across the institute, Mass...

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...

Exemption Status: Non-Exempt Hiring Range: $25.83 - $43.91 Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations . Schedule Details: Monday through Friday Scheduled Hours: 7:00am-3:30pm Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 99940 - 5458 Coding Services Union: SHARE (State Healthcare and Research Employees) This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as...