15 manager quality compliance auditor jobs found

Job Type Full-time Description University Health Network is seeking a Full-Time Coding Auditor. This role requires normal business hours Monday-Friday and is a remote position with occasional on-site meetings. Candidate must be able to maintain HIPAA privacy requirements when working from home. Candidate must be located in the Knoxville, TN region. UHN Auditor provides superior customer experience by educating internally and externally of errors and opportunities for improvement discovered during routine auditing. This individual will work closely with management to implement benchmarks, establish acceptable thresholds, and effective quality assurance programs. The UHN Auditor performs duties in a professional manner while exercising good judgment and ethical standards, interacts effectively and builds respectful working relationships across the organization, and demonstrates integrity by adhering to high standards of personal and professional conduct. This...

Job Description Job Description   PYA is seeking an experienced Inpatient/Outpatient Facility Coding Auditor to join our nationally recognized  Revenue and Compliance Advisory team. As a trusted advisor to leading healthcare organizations, you will apply your expertise in coding, reimbursement, compliance, and documentation to help clients improve revenue integrity and reduce risk. WHAT YOU'LL DO Perform inpatient and outpatient facility coding audits and reimbursement reviews, including:  ICD-10-CM/PCS, CPT, and HCPCS coding validation MS-DRG and APC validation Charge capture and revenue integrity reviews Clinical documentation improvement (CDI) assessments Third-party payer compliance evaluations Deliver high-quality client reports, recommendations, and presentations  Manage multiple engagements while maintaining exceptional quality and compliance standards  Collaborate with PYA's consulting, compliance, and executive teams to deliver comprehensive...

Job Description Job Description   PYA is seeking an experienced Inpatient/Outpatient Facility Coding Auditor to join our nationally recognized  Revenue and Compliance Advisory team. As a trusted advisor to leading healthcare organizations, you will apply your expertise in coding, reimbursement, compliance, and documentation to help clients improve revenue integrity and reduce risk. WHAT YOU'LL DO Perform inpatient and outpatient facility coding audits and reimbursement reviews, including:  ICD-10-CM/PCS, CPT, and HCPCS coding validation MS-DRG and APC validation Charge capture and revenue integrity reviews Clinical documentation improvement (CDI) assessments Third-party payer compliance evaluations Deliver high-quality client reports, recommendations, and presentations  Manage multiple engagements while maintaining exceptional quality and compliance standards  Collaborate with PYA's consulting, compliance, and executive teams to deliver comprehensive...

Ranked one of Tennessee’s top places to work, MHC is a rare and special place where outstanding company culture is intentional. Where clients and associates are treated the same, as equals. Mental Health Cooperative, Inc. (MHC) was formed in 1993 to serve individuals with severe and persistent mental illness. Since then, we have expanded our services to children and adolescents with severe emotional disorders across Middle and East Tennessee. Our sole purpose is to support and treat those challenged with serious mental illness and poverty. Although based out of Nashville, we serve several communities across middle and East Tennessee with satellite offices in Antioch, Gallatin, Dickson, Columbia, Cleveland, Murfreesboro, Clarksville, Cookeville, Chattanooga, and Memphis. If you are interested in joining a team that is caring, collaborative, innovative and energizing this might be a great place for you! Job Title: Compliance Auditor Department: Compliance Reports To: Director of...

Hospital Auditor The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team's broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement integrity, ultimately contributing to improved patient care and organizational compliance. Responsibilities Conducts comprehensive record reviews to identify documentation gaps and best-practice process improvement opportunities. Performs high-level secondary case reviews to ensure accurate, complete, and compliant provider documentation. Assesses documentation alignment with ICD-10-CM/PCS, MS-DRG/APR-DRG, and payer guidelines, identifying missed or...

Overview Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states. Position Summary The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team’s broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement...

Experienced Associate, Healthcare Forensics The Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients. Job Duties Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance matters Contributes to forensic engagements related to medical coding and...

Coder AnalystAnalyzes documentation in the medical record to obtain information necessary for the appropriate sequencing and assignment of ICD-10-CM and CPT-4 codes. Abstracts and codes procedures in conjunction with the provider to code services rendered with correct coding initiatives. Abstracts and enters data from the medical records in order to maintain a database for statistics and reporting. Assists the Billing Department in timely billing and rebilling of patient information.ResponsibilitiesReviews documentation in the medical record to determine ICD-10 CM and CPT-4 coding that is needed to comply with billing and reimbursement guidelines set forth by government entities.Verifies data in the medical record and accurately abstracts pertinent information for charge entry.Appropriately utilizes CPT-4 and ICD-10 current procedural coding standards in assisting the provider with proper selection and assignment of the principal procedure(s) and related diagnosis.Edits unbilled...

Coder Analyst Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Medical Group Overview: Covenant Medical Group is the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee. With more than 300 physicians and advanced practice providers in 20 communities, our team delivers expertise across a broad spectrum of specialties from primary care and walk-in clinics to preventive medicine and advanced surgical and subspecialty services. We are committed to offering coordinated, patient-centered care that spans the continuum of health needs, ensuring access to exceptional providers close to home. Position Summary: Analyzes documentation in the medical record to obtain information necessary for the appropriate sequencing and assignment of ICD-10-CM and CPT-4 codes. Abstracts and codes procedures in conjunction with the provider to code services rendered with correct coding initiatives. Abstracts and...

Physician Coder III, RemoteErlanger Health hires employees for telecommuting/remote positions in the following states: AL, AZ, GA, FL, IN, KY, LA, MD, MI, MS, MO, NC, NV, OH, PA, SC, TN, TX, VA, WI, WYJob Summary: The Physician Coder III is responsible for coding of physician and/or mid-level provider professional services. Recognizes and completes a high-volume workload accurately and in a timely manner, with minimal direct supervision. Follows set procedures to achieve goals. Displays professional office skills and ability to navigate a practice management system. Functions as liaison between management, the physician practices and employees working within physician practices. Coder will provide CPT, HCPCS and ICD-10-CM coding a minimum of 1-4 specialties. Specialties could include UR, Podiatry, Plastics, Pediatrics, OB, Pain Management, Ortho, Addiction, General Surgery, Internal Medicine, Urgent Care, Pulmonary, or ED. Facility Chart types could include OT, PT, Urgent Care, ED,...

Senior Outpatient Coder Position Details: Full-Time Remote Reports to Coding Operations Manager You must reside in one of these states to be eligible for this position: Arkansas California Kentucky Massachusetts Nevada New Mexico Oregon Utah Tennessee Texas Wyoming Job Summary: The Senior Coder supports assigned inpatient and/or outpatient coding operations through day-to-day workflow leadership and may provide oversight of coding quality, coding edits, auditing, and staff education. Assigned functions may include inpatient, observation, emergency department, ambulatory surgery, ancillary, clinic, and other hospital-based coding services. The position supports Revenue Cycle Operations with special projects, including denial review, appeals, discharge-not-final-billed management, regulatory and payer edit review, and process improvement efforts designed to meet organizational goals while promoting accurate, complete, and compliant coding and billing....

Position Summary The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions. Duties & Responsibilities Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions Evaluates the quality of medical coding and notifies management of discrepancies, as needed. Conducts internal audits of medical record reviews performed by colleagues Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines Supports continuous improvement and quality initiatives...

Remote Chicago - 550 Van Buren Michigan-Grayling Pennsylvania-Trappe Boro Pennsylvania-East Lampeter Twp Pennsylvania-Skippack Twp Pennsylvania-Bethel Twp (Armstrong) Pennsylvania-North Bethlehem Twp Pennsylvania-South Park Twp Pennsylvania-West Norriton Twp Pennsylvania-West Mifflin Boro Pennsylvania-Wilkinsburg Boro Pennsylvania-Cogan House Twp (Lycoming) Kentucky-Wolfe County Pennsylvania-Reading (Berks) Pennsylvania-Bensalem Twp Pennsylvania-Lower Salford Twp Ohio-Mentor Michigan-Lansing Pennsylvania-Clarks Green Boro Ohio-Lima Pennsylvania-Bethlehem Twp Pennsylvania-West Cornwall Twp (Lebanon) Pennsylvania-Edgeworth Boro Ohio-Rocky River Kentucky-Murray Pennsylvania-Kennedy Twp Pennsylvania-Moon Twp Ohio-Bay Village Ohio-Lakewood Ohio-Ashville Kentucky-Lakeside Park Pennsylvania-Lower Paxton Twp Ohio-Oxford Ohio-Bedford Pennsylvania-Ross Twp Pennsylvania-Newtown Twp Pennsylvania-Washington Twp...

Experienced Associate, Healthcare ForensicsThe Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients.Job Duties:Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance mattersContributes to forensic engagements related to medical coding and...

Servpro Industries, LLC in Gallatin is seeking a Jr. Compliance Auditor to manage franchise audits and optimize processes. You will guide audit staff, provide training, and maintain quality standards while conducting audits. The ideal candidate should have 2+ years in franchise auditing or a related field and possess a Bachelor's degree in accounting. The role promises excellent benefits and a supportive work environment. #J-18808-Ljbffr