63 internal coding auditor jobs found

Medical Compliance Auditor We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Think you've got what it takes? Job Duties & Responsibilities Assess the treatment plan, clinical information, and medical necessity of all requested services Utilizes established criteria to appropriately review billed services within established timeframe required. Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate....

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Position is responsible for leading multiple reviews / audits of healthcare coding, billing, documentation, operations, and related risk areas to support compliance with regulatory standards, internal policies and procedures, and other guidelines. Typically reports to Director, Corporate Compliance. Job Description Location : Memorial Hermann, Memorial City Status :...

Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Job Description. Minimum Qualifications. Education: High school diploma or GED, required. Licenses/ Certifications:Inpatient - Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), or Certified Inpatient Coder (CIC) Coding Certification(s) from American Health Information Management Association (AHIMA) or American Association of Professional Coders (AAPC) required. Outpatient - Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or relevant Coding Certification(s) from American Health Information Management Association (AHIMA) or American...

## CPC-A Certified Coder RepresentativeApplylocations: San Antonio, Texas, USA - Remotetime type: Full timeposted on: Posted Todaytime left to apply: End Date: August 31, 2026 (30+ days left to apply)job requisition id: R\_2606\_7783**About TaskUs:** TaskUs is a provider of outsourced digital services and next-generation customer experience to fast-growing technology companies, helping its clients represent, protect and grow their brands. Leveraging a cloud-based infrastructure, TaskUs serves clients in the fastest-growing sectors, including social media, e-commerce, gaming, streaming media, food delivery, ride-sharing, HiTech, FinTech, and HealthTech.The People First culture at TaskUs has enabled the company to expand its workforce to approximately 45,000 employees globally. Presently, we have a presence in twenty-three locations across twelve countries, which include the Philippines, India, and the United States.It started with one ridiculously good idea to create a different...

Become a part of our caring community The 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 Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

About CLS Health CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians! Summary Assigns and aligns predefined codes, tabulates the data into the computer system, generates new codes, resolves edits and denials, and maintains proper records in accordance with CLS guidance and procedures. Conducts regular reviews to ensure billing is timely, accurate, and in compliance. Job Description Assist with implementing and maintaining system-wide billing and coding quality audits. Understands, interprets and applies coding guidelines for coding audits. Review of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including...

Senior Profee Coding Auditor Insight Global is seeking a Senior Profee Coding Auditor to support a healthcare consulting organization that partners with providers nationwide to improve coding accuracy, compliance, and revenue integrity through auditing and education services. This individual will perform physician-side (profee) coding audits within EMR systems, ensuring compliance with CMS, OIG, and industry standards. This is a high-level, production-driven consulting role requiring strong critical thinking, independent decision-making, and the ability to clearly explain audit findings and rationale to clients. The ideal candidate has extensive experience across multi-specialty profee coding and auditing and can confidently operate in a fast-paced, autonomous environment. The annual salary for this role ranges from 85k-93k depending on the candidates years of experience. Key Responsibilities: Perform profee coding audits (CPT, ICD-10, HCPCS) in EMR systems to ensure accuracy...

Description Summary: The Compliance Auditor II will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws. Conducts audit activities, reporting and communicates audit findings. Works in conjunction with Compliance Director on compliance work plans, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with VP/Senior/Manager/Director on...

Job Description Insight Global is seeking a Senior Profee Coding Auditor to support a healthcare consulting organization that partners with providers nationwide to improve coding accuracy, compliance, and revenue integrity through auditing and education services. This individual will perform physician-side (profee) coding audits within EMR systems, ensuring compliance with CMS, OIG, and industry standards. This is a high-level, production-driven consulting role requiring strong critical thinking, independent decision-making, and the ability to clearly explain audit findings and rationale to clients. The ideal candidate has extensive experience across multi-specialty profee coding and auditing and can confidently operate in a fast-paced, autonomous environment. The annual salary for this role ranges from 85k-93k depending on the candidates years of experience. KEY RESPONSIBILITIES: Perform profee coding audits (CPT, ICD-10, HCPCS) in EMR systems to ensure accuracy and...

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Review medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines Utilize encoders and various coding resources Perform CPT Procedure reviews Maintain strict patient and physician...

Details Client Name Parkland Health Job Type Travel Offering Nursing Profession RN Specialty Compliance Auditor Job ID 18433625 Job Title Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX Weekly Pay $2538.14 Shift Details Shift 5 Day Shifts X 8 Hrs Scheduled Hours 45 Job Order Details Start Date 06/22/2026 End Date 09/21/2026 Duration 13 Week(s) Job Description Candidates living within 60 miles of the facility will have a local rate of $72 Monday-Friday, start time between 7am-8am. The initial orientation will require more on-site days for onboarding, but a specific schedule can be negotiated with the individual. After onboarding, periodic on-site is needed, but we can accommodate a hybrid/flexible schedule! The Compliance Nurse Auditor is responsible for conducting audits to ensure the clinical documentation contained within the patient medical record supports the reasons for treatment,...

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...

Where Compassion Meets Innovation And Technology And Our Employees Are Family Thank you for your interest in joining our team! Please review the job information below. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required. Always maintains utmost level of confidentiality. Adheres to hospital policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Reviews the medical record and assigns the appropriate ICD and CPT...

Outpatient Coder Location: US:TX:Irving | Medical Coding | Full Time Description Summary: Responsible for maintaining current and high-quality ICD-10-CM and CPT coding for all Outpatient diagnoses and procedural occurrences, through the review of clinical documentation and diagnostic results, with a consistent coding accuracy rate of 95% or better. The 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 Guidelines for Coding and Reporting and CPT Guidelines. Outpatient coding is applicable towards clinical, provider office visits, therapeutic, laboratory, recurring, emergency department, outpatient observation, and ambulatory surgery patient encounters. Coder will work collaboratively with various CHRISTUS Health departments (Admitting, Charging, Patient Financial Services, HIM, etc.) to resolve charging issues, denials, and...

Medical Coder Multi-Specialty (Hospital & Clinic) Location: Kingwood or Remote 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...

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Position responsible for ensuring the accuracy and completeness of clinical coding resulting in the appropriate reimbursement and data integrity and validation of the coded information for external and internal affairs. This position typically reports to the Coding Compliance Manager. Job Description Minimum Qualifications Education : High school diploma or GED,...

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...

Summary About the Position: This position is located at Brooke Army Medical Center, Fort Sam Houston, Texas. A recruitment or relocation incentive may be authorized. Salary negotiation may be available for those candidates who are new to Federal service. This is a Direct Hire Solicitation Learn more about this agency Duties Help Perform internal audits of inpatient, outpatient, and ambulatory encounters to ensure coding accuracy and compliance. Trains coders, providers, and other staff on documentation, coding guidelines, and regulatory updates. Identify coding issues, reports non-compliance, and creates corrective action plans to resolve documentation or coding problems. Maintains and updates program templates based on ICD-10, CPT, and HCPCS changes or clinic practice updates. Direct and evaluate coding auditors, assign workload, provide training, and manage performance. Requirements Help Conditions of employment Appointment may be subject to a suitability or fitness...

Job Number: 180041, Job Title: Risk Adjustment Coder II, Salary: $27.69 - $34.62 JOB SUMMARY The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborating with multiple departments across the organization. JOB SPECIFICATIONS AND CORE COMPETENCIES Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions,...

Key Responsibilities Conduct detailed audits of patient medical records to ensure clinical documentation supports quality care, medical necessity, and accurate billing practices. Identify documentation, coding, billing, and compliance discrepancies and develop corrective action recommendations. Prepare comprehensive audit reports and communicate findings to leadership and operational teams. Monitor compliance risks related to Medicare, Medicaid, and other federal healthcare programs. Provide consultative guidance regarding healthcare compliance regulations and best practices. Assist with responses to government audits, investigations, and regulatory inquiries. Review potential refund and repayment obligations related to federal healthcare programs. Support policy and procedure development based on regulatory updates and audit findings. Monitor changes in healthcare laws, regulations, and compliance requirements. Collaborate with clinical, revenue cycle, finance, legal,...

Medical Coder - Multi-Specialty (Hospital & Clinic) Location: Kingwood or Remote 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...

Overview Bonus Potential! Monthly and Quarterly Bonus Incentives! Through our evidenced based medicine approach, Concentra’s goal is to provide quality patient care while treating everyone with friendliness, skill, and respect. We strive daily to promote a diverse environment of acceptance and compassion for our colleagues and cultivate a welcoming atmosphere where our patients can heal. As we’ve grown, we’ve expanded into urgent care, wellness services, administration, onsite health and wellness centers, and telemedicine. All these services together make achieving health easier and more accessible for our patients, clients, colleagues, and all provide you with unmatched support, education, career advancement opportunities, and benefits. The Associate Director of Medical Operations position involves providing direct patient care and leading by example to ensure an exceptional patient experience. The role includes identifying and communicating opportunities for clinical quality...

Outpatient Professional Medical Coder Greenberg-Larraby, Inc. (GLI) is actively seeking a skilled Outpatient Professional Medical Coder to join our dynamic healthcare team based in Temple, TX This position is onsite in Temple, TX. In this role, you will be responsible for reviewing and coding outpatient medical records, ensuring adherence to coding standards and guidelines. Your expertise will play a vital role in ensuring accurate billing and compliance, contributing to the overall quality of patient care at GLI. You'll collaborate effectively with healthcare providers to clarify clinical documentation and ensure that all coding assignments align with the latest coding practices. If you are a detail-oriented professional ready to excel in a collaborative environment, we invite you to apply! Requirements Minimum Requirements: One active coding credential required: RHIT, RHIA, CCS, CCS-P, or CPC At least three (3) years of outpatient or professional...

Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: 2. HEDIS 3. Medical Record Reviews (Accreditation) 4. And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities Abstract pertinent information from patient medical records. Assign appropriate...