21 manager quality system compliance auditor jobs found

Coding AuditorAllCare Health | Quality Department | Grants Pass, Oregon Summary of the Position The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members. This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes. Essential Duties Ensures the accuracy and correlation of diagnosis codes, dates of service, medical record documentation, and other information used to support risk adjustment. Identifies, analyzes, and communicates trends related to coding accuracy and documentation quality. Develops and supports...

**Job Description:**Medical-Surgical Clinical EducatorProvides clinical education, staff development, orientation, competency validation, and clinical coordination for the Medical-Surgical Unit. Serves as a clinical resource and mentor while partnering with the Nurse Manager, Nursing Education, and interdisciplinary teams to support evidence-based practice, quality improvement, patient safety, efficient daily operations, and compassionate patient- and family-centered care.**EXPECTATION FOR ALL EMPLOYEES**Support the organization’s mission, vision and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all laws and regulations affecting Bay Area Hospital. Be familiar with and adhere to the Bay Area Hospital Code of Conduct and Compliance Program. Effective communication skills and the ability to work effectively with people from various backgrounds are critical. **POSITION SUMMARY**Provides clinical education, staff development, orientation, competency...

Department/Unit:Health Information Management Work Shift: Day (United States of America) Salary Range: $64,972.00 - $97,458.00 The Remote Senior Professional Coder will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding/charging/denials follow-up. Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes. Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines. Provide education, instruction and training to providers and coding staff. Act as an expert for the HCC/Risk adjustment coding. This position is remote but does require onsite education to providers as needed. Essential Duties and Responsibilities Review, analyze, and validate CPT and ICD-10 diagnosis codes and charges applied by...

Primary Duties And Responsibilities The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Verify that all ICD-10-CM codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings. Performs other duties as assigned. Medical Coding - Hoag Hospital In addition to the above, the coder resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing productivity...

Company Description WHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Job Description The Clinical Compliance Auditor II is responsible for ensuring Guidehealth's clinical operations, utilization management activities, and delegated services comply with regulatory requirements, client contractual obligations, and internal clinical standards. This role serves as a senior clinical...

This is a remote based position. Applicants can be located nationwide Outpatient Coding Auditor #2972 United States Remote/Nationwide Position Description About You You are a person who enjoys ensuring coding accuracy and solving documentation and compliance challenges. We need someone who demonstrates skills in organization, prioritization, professionalism, and coaching others. In the role of Outpatient Coding Auditor, you will be responsible for quality reviews and audits and coordinating with department managers to ensure standards are met in accordance with department and organization policies. Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you. About The Position Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), Procedural Coding System (PCS), Current Procedural Terminology (CPT-4 and Healthcare Common Procedure Coding System...

Signature Performance, Inc. is seeking an Outpatient Coding Auditor to ensure accurate medical coding and compliant documentation across multiple client systems. You will lead quality reviews, perform audits, and collaborate with department managers to uphold policies and standards. Ideal candidate has advanced ICD-10-CM/PCS, CPT-4/HCPCS knowledge, and 5+ years in professional coding. You will provide education to coders and identify documentation gaps, driving ongoing improvement and payer #J-18808-Ljbffr

About Us Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member.This position is REMOTE within...

About Us At Alteva RCM, we're dedicated to helping healthcare providers thrive through expert revenue cycle management, strategic insight, and innovative solutions. We're always looking for passionate, driven professionals who want to make a meaningful impact, grow their careers, and be part of a collaborative team committed to excellence. Position Summary The Professional Coder is responsible for accurately reviewing clinical documentation and assigning diagnosis codes, CPT codes, and other required codes for professional services across the Neurosurgery and Spine specialties. This role applies official coding guidelines, regulatory requirements, and payer-specific rules to ensure accurate code selection, clean claim submission, and timely reimbursement. By ensuring coding accuracy and compliance, the Professional Coder plays a critical role in optimizing revenue cycle performance, reducing claim denials and audit risk, supporting regulatory compliance, and contributing to the...

Our Benefits Comprehensive Health Coverage: Medical, dental, and vision plans to keep you and your family healthy. Competitive Pay & Full Benefits: A salary and package designed to reward your expertise and dedication. Paid time off Flexible scheduling Future Security: 401(k) with matching. Job Summary The Inpatient Coder is responsible for accurately assigning ICD-10-CM and ICD-10-PCS codes to inpatient medical records, ensuring compliance with coding guidelines, reimbursement policies, and corporate standards. This role supports Health Information Management (HIM) Central Services and works to review inpatient documentation, apply accurate codes, and collaborate with clinical documentation integrity (CDI) teams to optimize coding accuracy and financial integrity. Essential Functions Performs remote inpatient coding for CHS-supported hospitals, reviewing electronic medical records (EMR) and provider documentation to assign accurate diagnosis and procedure codes. Ensures...

Department Name: Coding AmbulatoryWork Shift: DayJob Category: Revenue CycleA rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you're looking to leverage your abilities - you belong at Banner Health.In this Physician Coder Quality Associate position, you bring your 5 years of Ambulatory Physician coding experience to a team who resolves complex denials, identifies trends, and provides solutions to help support mid-revenue cycle.This is a Quality position, not a day-to-day coding production role, but does require coding proficiency and recent Physician Ambulatory/Professional Coding experience. This position is task-solution-oriented ensuring quality in the Ambulatory Coding department and allows opportunity for coaching fellow coders through different aspects of Ambulatory Coding and denial prevention. Requirements 5 years current experience in Ambulatory...

Essential Job Functions Assist with new hire orientation and training inclusive of Client-specific information. Assist with system problems by answering field employee questions or directing questions to the appropriate party. Manage workflow and productivity, as requested. Perform coding functions, as necessary. Communicate with the designated point-of-contact(s) at Omega and Client; provide information on progress, actions, and issues in a timely manner. Perform quality reviews utilizing Omega’s review/audit tools, as needed, under the oversight of an Omega Compliance Manager. Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. Key Success Indicators/Attributes Ability to prioritize and multi-task in a fast-paced, changing environment. Demonstrate ability to work in all work types and specialties. Demonstrate ability to self-motivate, set goals, and meet deadlines. Demonstrate...

Overview Be inspired. Be valued. Belong. At Emory HealthcareAt Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more LOCATION:Remote This position is remote; however, applicants must be physically located and authorized to work in one of the following states: Alabama, Arkansas, Florida, Georgia, Illinois, Louisiana, Michigan, New Hamsphire, North Carolina, Ohio, Pennsylavnia, South Caroline, Tennessee, Texas, Virginia, Wisconsin Description This position ensures the accuracy, completeness, and compliance of medical coding and clinical...

50 states. Multiple environmental regulations. One auditor who knows how to see the big picture — and get the details right. Leidos is looking for an experienced Environmental Compliance Auditor to help lead and grow our environmental auditing programs across the country, supporting federal agencies and commercial clients with complex environmental compliance challenges. Across Leidos, we help government and commercial organizations navigate environmental regulations, manage risk, and improve operational performance. In this role, you’ll take that expertise directly to facilities nationwide — evaluating environmental compliance, identifying risks, advising clients, and helping organizations strengthen their environmental programs. This isn’t a role where you’ll simply work through an audit checklist. You’ll lead multimedia environmental compliance audits from start to finish — researching regulatory requirements, evaluating facility operations, identifying deficiencies, and...

DescriptionAt VMG Health, we're more than just a team of experts; we're trusted partners in the business of healthcare. Backed by a team of over 300 professionals and a history of more than 70,000 engagements since 1995, we bring experience, deep and wide, to every project. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. Our solutions-oriented approach to client needs is bolstered by our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients' valuation, strategic, and compliance needs.? Position Summary VMG Health is seeking an experienced Ophthalmic Compliance Auditor to join its Coding Audit and Compliance (CAC) team. The Ophthalmic Compliance Auditor will provide auditing, compliance, education, and consulting services to a broad range of healthcare clients, including...

Coding Auditor AllCare Health | Quality Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members. This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes. Essential Duties Ensures the accuracy and...

Job Details Sr. Coder Professional Billing Job Description REMOTE Professional Billing Sr. Certified Coding Medical Records : Review patient medical records and assign appropriate codes using systems like ICD-10-CM, CPT, and HCPCS for diagnoses and procedures. Claims Processing: Prepare and submit claims to insurance companies, ensuring compliance with regulations and accuracy in coding to facilitate reimbursement. Collaboration: Work closely with healthcare providers, billing specialists, and other staff to clarify documentation and ensure accurate coding practices. Auditing and Compliance: Conduct audits of medical records to ensure coding accuracy and compliance with federal regulations and insurance standards. Training and Support: Provide training and support to healthcare staff on coding practices and documentation requirements. Required Qualifications Certification: Must hold a certification from recognized organizations such as AAPC (CPC) Experience: Typically requires a...

Department/Unit:Health Information ManagementWork Shift: Day (United States of America)Salary Range: $59,066.00 - $88,599.00The Remote Professional Coder will review, analyze, and validate CPT and ICD-10 diagnosis codes and charges applied by providers to assure compliant with federal and state regulations and insurance carrier guidelines. Perform accurate and compliant coding of CPT and ICD-10 DX codes. This position is remote. Essential Duties and Responsibilities Effectively reviews, analyzes, and validates CPT, ICD-10 diagnosis codes, HCPCS, modifiers and charges applied by providers to assure compliant with federal and state regulations and insurance carrier guidelines. Perform accurate and compliant coding of CPT and ICD-10 diagnosis codes. Understands National Correct Coding Initiative (NCCI) edits and relative value units as appropriate for the role. Ensure established productivity and quality standards are met. Review denials, research and respond appropriately and...

$2,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start  Caring. Connecting. Growing together. The  C&S Coding Clinical Analyst  is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and...

$2,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS The M&R Clinical Investigator  is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and UHC/Client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation on a daily basis to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible to investigate, review and provide clinical and/or coding expertise in a review of pre-payment claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are...

Job Description Oracle Health is a comprehensive suite of healthcare technology solutions designed to help organizations advance patient care, improve operational efficiency, and enhance caregiver experiences. Building on Oracle’s global expertise in cloud technology, data management, and analytics, Oracle Health delivers integrated electronic health records (EHR), population health tools, and data-driven insights for hospitals, clinics, and health systems. By connecting data and workflows across the continuum of care, Oracle Health empowers providers to make informed decisions, streamline processes, and drive better health outcomes. The Senior Compliance Specialist provides guidance to cross-functional teams on medical device quality system compliance, with a focus on quality system support for CE marking processes and requirements under the EU Medical Device Regulation (EU MDR). Responsibilities The Senior Compliance Specialist will provide quality system support through...