23 internal coding auditor jobs found

Compliance Coding Auditor Performs a number of functions including those of physician education, internal auditing, coder education, management of AR queries/problems, and liaison with external auditors for corporate audits. The internal audit program assures optimal ethical reimbursement for Sentara's patients, and also assures that the coding practices fall within established compliance guidelines. Both ICD and CPT coding methodologies are used in the internal audit activity. The Auditor must exhibit competence in Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Conditionals Categories (HCC) and other federal payer policies, and is expected to achieve mastery in the MPFS payment methodology, including the impact on Relative Value Unit (RVU) value related to Non-Physician Practitioner (NPP) services, Provider Based Billing (PBB) locations, and all other complex coding protocols within one year. All queries arising from the audit process are...

***To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia*** The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility)...

About Integrated Management Strategies (IMS) LLC We are a women-owned small business and management consulting firm that provides an array of business and technical services. IMS is headquartered in the Washington, D.C. metropolitan area, with employees across 39 US states. What We Do We support the mission critical needs of federal agencies by leveraging our experience, talent and can-do attitude, and solve their strategic and operational challenges. How We Do It We earn our clients’ trust through our personalized approach and attention to detail, allowing us to collaborate and solve even the most complex problems. About the role Are you ready for your next career adventure? Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Medical Coding Auditor to join our healthcare consulting practice. The...

Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Job Summary Responsible for conducting internal audits and monitors to ensure that the organization’s processes and operations are in compliance with laws, corporate guidelines, best practices, and contractual agreements. Knowledgeable of general audit concepts and techniques, including the type of audits, the approaches and processes, and the subsequent activities as they relate to internal audits. Demonstrates the ability to interpret Federal rules and regulations. Demonstrates the ability to research regulation from various data sources. Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in Current...

United Cerebral Palsy of Georgia is seeking an Auditor/Educator for Inpatient Coding in Lynchburg, VA. This role involves performing internal coding audits and coordinating coder education within the Health Information Management department. The ideal candidate should have a minimum of 5 years of hospital Inpatient coding experience, an associate degree in health information management, and proficiency with ICD-10 coding systems. #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 healthcare organization in Lynchburg, Virginia, is seeking an experienced Auditor/Educator for Inpatient Coding. This role involves conducting internal coding audits, coordinating staff education, and ensuring compliance with coding guidelines. The ideal candidate will have at least five years of inpatient coding experience and strong knowledge of ICD-10 coding. Responsibilities include monitoring coder progress and developing training programs, while also being a resource for the coding staff. Competitive benefits are offered. #J-18808-Ljbffr

Become a part of our caring community The Medical Coder / Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As the Medical Coder / Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education, based on business needs Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and...

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

Job Title: Medical Biller (Medicaid & MCO - Behavioral Health) Full-time Office Address: 20116 Ashbrook Pl #100 Ashburn, VA Compensation: USD 25 - USD 28 - hourly Position Summary The Medicaid & MCO Biller is responsible for accurate and timely submission, tracking, and reconciliation of claims for services billed to DC Medicaid and Managed Care Organizations (MCOs). This role ensures compliance with District of Columbia Department of Health Care Finance (DHCF) regulations and payer‑specific billing requirements while supporting revenue cycle efficiency. Eligibility & Authorization Verification Verify Medicaid eligibility using systems such as DC Access System or other payer portals. Confirm MCO enrollment and service coverage prior to claim submission. Track and manage prior authorizations and limitations. Claims Submission & Processing Submit clean claims to DC Medicaid and MCOs (e.g., AmeriHealth Caritas DC, MedStar Family Choice DC, Wellpoint, HSCSN)....

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for 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...

Newport News, Virginia FOR APPLICATION REVIEW - PROVIDE YOUR CREDENTIAL OR AHIMA ID NUMBER ON YOUR APPLICATION OR RESUME This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Overview Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient or inpatient records. Performs audits on accuracy of APC or MSDRGs as well as on quality of medical record documentation needed for accurate coding. Works with DRG and CPT denials from commercial payers and writes appeal letters as indicated. What you will do Ensures coding compliance. Applies all coding guidelines and principles as defined in the Coding Clinic and leading authorities. Complies with standardized coding standards, conventions and regulations, corporate compliance standards and reimbursement policies. Identifies training needs and provides education to team members. May teach...

Inpatient Medical Coding Auditor – PPI Coding Disputes Reports to the manager and reviews DRG, ICD-10-CM, and PCS coding assignments for accuracy within the coding disputes team. The auditor consults and collaborates with coding professionals across departments to ensure timely, compliant, and high-quality coding dispute outcomes. Responsibilities Review DRG and ICD-10-CM/PCS coding assignments for accuracy. Ensure overall accuracy and compliance of coding dispute reviews by adhering to coding guidelines. Communicate dispute outcomes to providers in a professional and concise manner. Leverage auditing expertise to make coding decisions based on industry guidelines and best practices. Manage multiple priorities and collaborate with peers to ensure timely completion of inpatient coding disputes. Qualifications RHIA, RHIT or CCS certification held for at least four years. Minimum of three years performing inpatient coding reviews or audits in health insurance and/or...

Who You Are You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Your Role As a Lead CDI Coder you are responsible for partnering with physician offices within our established partnerships to assist in translating healthcare documentation into standardized codes, ensuring accurate coding and billing of patient encounters, as supported by the medical record. You serve as a subject matter expert in Coding and Documentation. Role...

Coding Specialist Newport News, Virginia This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Overview Responsible for maintaining coded data quality through ongoing quality review and assessment of outpatient or inpatient records. Performs audits on accuracy of APC or MSDRGs as well as on quality of medical record documentation needed for accurate coding. Works with DRG and CPT denials from commercial payers and writes appeal letters as indicated. What you will do Ensures coding compliance. Applies all coding guidelines and principles as defined in the Coding Clinic and leading authorities. Complies with standardized coding standards, conventions and regulations, corporate compliance standards and reimbursement policies. Identifies training needs and provides education to team members. May teach or coordinate coding huddles. Coaches and mentors staff. Performs focused reviews and quality...

Base pay range $30.00/hr - $37.00/hr Job Title: Remote Inpatient Medical Coder & Inpatient Team Lead Location: 100% Remote (Must reside in the Central Time Zone ) Schedule: Monday – Friday | 8:00 AM – 4:30 PM CT Employment Type: Full-Time Federal Contract Duration: Long-term Role Overview We are seeking experienced Inpatient Medical Coders and a high-performing Inpatient Team Lead for a high-volume facility within the VA healthcare system. These are fully remote positions requiring a high level of investigative accuracy and a deep understanding of complex inpatient documentation. Note: Previous experience within the VA, a University Medical Center, or a Teaching Hospital is mandatory. Core Responsibilities Medical Coding: Review complex inpatient medical records to assign accurate ICD-10-CM, ICD-10-PCS, and DRGs. Data Validation: Perform 100% data validation of assigned encounters to ensure diagnostic integrity. Provider...

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. Overview Reporting to the Manager, Medical Coding & Audit, as a Medical Coder II or III, this role will be a key member of the team responsible for ensuring that CodaMetrix meets—and exceeds—our customers’ coding quality expectations. The Medical Coder II or III will be responsible for leveraging 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...

3 days ago Be among the first 25 applicants About Performant At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Our mission is to offer innovative payment accuracy solutions that allow our clients to focus on quality of care and healthier lives for all. Medical Coding Auditor – Inpatient (Remote) Location: Remote. Full‑time. Salary: $70,000 – $85,000 per year. Key Responsibilities Audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD‑10, CPT, and HCPCS codes. Ensure coding practices comply with federal, state, and payer‑specific regulations and guidelines, including HIPAA and CMS standards. Detect...

Candidate should ideally be located in Norfolk, VA or Raleigh, NC Monro’s family of brands is one of the leading automotive service and tire dealers in the United States. We work on approximately five million vehicles a year, but with us, it is personal. Every guest is important, and every teammate is valued. That is our people-first approach.  Headquartered in our hometown of Rochester, New York, where our founder, Chuck August, opened his first store in 1957, we have grown to 1,115 auto repair shops and tire dealers in 32 states from coast to coast. Monro powers 16 highly respected tire and auto service brands, supporting each company’s regional strength and community connections. From big cities to small towns to rural crossroads, you will find us in neighborhoods of every shape, size, and color.  Under the Monro banner, we are united TEAM, and share the same mission to bring our guests the highest quality tire and auto service in the industry.  Do you have what it...

Under the direction of the Health Information Management Director, the Outpatient Coder I accurately determines ICD-10-CM diagnosis, ICD-10-CM, CPT and HCPCS procedure codes for all outpatient medical records, which may include Emergency Department (ED), outpatient laboratory, diagnostic imaging, minor outpatient procedures, infusion and injections, outpatient labor and delivery, recurring accounts and observation stays. POSITION RESPONSIBILITIES Abstract pertinent information from patient records within various outpatient types and assign appropriate ICD-10-CM, ICD-10 PCS, and HCPCS codes, creating ambulatory payment classifications (APC). Monitor and manage the discharged not final billed (DNFB) accounts within assigned patient types daily to meet financial goals and expectations. Meet coding productivity standards and accuracy rates as determined by company policy. Query clinical staff to achieve accuracy in coding. Educate, train and communicate with medical staff...

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...

Starts out onsite, then transitions to REMOTE 4 days/week. Job Summary: Required Services provide single path medical coding services and related medical records functions. Single path coding combines facility coding and professional coding and allows one coder to code facility and professional codes for the same patient utilizing a single coding platform. perform technically complex professional services coding for medical conditions and assign the correct International Classification of Diseases, ICD-10-CM, Procedure Coding System (PCS) Current Procedural Terminology (CPT), Health Care Financing Administration Common Procedure Coding System (HCPCS), and Evaluation and Management (E&M) codes for diagnosis, acuity of care and procedures for a wide range of medical specialties to include coding of complicated cases identified as difficult to classify such as treatment of burn injuries, combat related injuries, orthopedic surgery, cardiothoracic surgery, interventional...

Job Description - Coder II (7454-1498) Wythe County Community Hospital POSITION SUMMARY Under the direction of the Health Information Management Director, the coder II accurately determines ICD-10-CM diagnosis, and ICD-10-CM, CPT and HCPCS procedure codes for all patient types to include inpatient, observation, surgical day care, Emergency Department (ED) outpatient and recurring patients. POSITION RESPONSIBILITIES Abstract pertinent information from patient records within various inpatient and outpatient types. Assign International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) / International Classification of Diseases, Tenth Revision, Clinical Modification Procedural Coding System (ICD-10 PCS) codes or Healthcare Current Procedural Coding System (HCPCS) codes, creating ambulatory payment classification (APC) or diagnosis related group (DRG). Monitor and manage the discharged not final billed (DNFB) accounts within assigned patient types daily...