8 outpatient coding auditor jobs found

Job Description The Patient Safety DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem. The role generates highly complex audit findings recoverable claims for the benefit of the Company across all lines of business. The position focuses on very complex coding cases paid through various DRG methodologies such as APS-DRG, APR-DRG, AP-DRG, MS-DRG, or TRICARE, with findings that may be reviewed only by other DRG Coding Audit Principals or Executives. Responsibilities Analyzes and audits claims by integrating advanced medical chart coding principles found in Official Coding Guidelines, Coding Clinics, and the ICD-10 Alphabetic and Tabular Indices, as well as complex clinical guidelines, maintaining objectivity in audit activities. Draws on extremely advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate sophisticated...

Registered Nurse - Diagnosis Related Group Coding Auditor Principal – Carelon Payment Integrity Location: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical records and attending physician’s statements provided by acute care hospitals on paid DRG,...

The Professional Coder provides timely and accurate clinical coding and abstraction of inpatient and outpatient services as appropriate to facilitate compliant and optimized reimbursement, research, and PI initiatives. The Professional Coder is responsible for the coding, abstraction, and charge entry (as applicable) of one or more of the following: professional and facility services which may include evaluation and management services, ancillary/diagnostic services, and behavioral health services. Essential Functions and Responsibilities Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health’s values Coding and Abstracting: Identifies and assigns the appropriate diagnosis, procedure, and evaluation and management (E&M) codes in accordance with coding guidelines and departmental standards; audits notes from providers to ensure the provider is coding in a...

Radiology Medical Coder Radiology Medical Coder Job Description Client Profile - An Indiana based Independent Physician-Owned radiology practices founded in 1967. Job Summary - The Radiology Coder is responsible for coding and charge submission activities, including abstracting CPT Professional Fee Coding and inpatient/outpatient coding and billing. This involves reviewing medical records and assigning appropriate ICD, CPT, and HCPCS codes. Job Duties Review and analyze medical records ensuring the correct assignment of ICD-10, CPT and HCPCS codes. Accurately code diagnostics imaging, interventional radiology procedures and other radiological services Ensure that documentation supports the assigned codes and matches physician orders and radiology reports Abstract relevant data such as procedural dates, providers, and patient demographics for billing and reporting. Collaborate with radiologists and other medical professionals to clarify diagnoses and procedures when...

Overview Responsible for ensuring accuracy and quality coding assignments for all records requiring DRG and/or APC coding; ensures optimal and timely reimbursement. Responsibilities Principal Duties and Responsibilities (*Essential Functions) Performs comprehensive pre-billing coding audits, through the use of eValuator, to ensure claims are accurately coded and charged in compliance with coding and regulatory standards. Performs comprehensive pre-billing coding data quality reviews on inpatient and/or outpatient records to ensure proper coding guidelines have been followed and appropriate DRG (MS/APR) or APC assignments have been made for appropriate reimbursement. Responsible for completion of reviews within 72 hrs of import date to include new reviews of up to or exceeding 12 to 15 per day for inpatients and/or completion of reviews within 48 hrs of import date including up to or exceeding 50 per day for outpatient accounts. Maintains an audit response turnaround time of 24...

Job Details Job Location: Valparaiso, IN 46383 Purpose Reporting to the Billing Team Supervisor, the professional coder is responsible for reviewing clinical documentation to abstract and/or validate CPT and ICD-10 coding for office based and outpatient professional services. Accountabilities and Job Activities Ensure that medical coders are trained, knowledgeable and consistently adhering to key responsibilities relevant to job description Train new employees Perform ongoing training and education as needed Conduct audits to ensure the accuracy of the coding team and re‑train and/or initiate coaching if necessary Monitor daily workload to ensure that claims are created in a timely manner Ensure that professional and facility service claims are created on a daily basis without interruption Responsible for alerting proper parties if any interruptions are discovered Analyze office progress notes, procedural and operative records to identify and independently assign accurate ICD and...

Overview Job Title: Medical Coder (Junior Level) | Location: Downtown Indianapolis, IN (Local candidates strongly preferred; occasional onsite presence required) We are looking for a detail-oriented Junior Medical Coder to support a healthcare client engagement. You will be responsible for reviewing clinical documentation, assigning accurate medical codes, and ensuring compliance with payer and regulatory guidelines to support clean and timely billing operations. Responsibilities Review and analyze clinical documentation to assign appropriate ICD-10-CM, CPT, and HCPCS codes Ensure all coding is compliant with CMS, payer-specific, and internal guidelines Identify and resolve coding discrepancies and documentation gaps in collaboration with clinical staff Support the revenue cycle team in maintaining accurate and timely billing submissions Stay current with coding updates, regulatory changes, and payer policy revisions Requirements Required Qualifications CPC, CCS, or equivalent...

Join CommunityThe Innovative Healthcare Collaborative of Indiana (IHCI) is a joint venture between Community Health Network and Deaconess Health system.Its goal is to support our sponsors and partners in their strategic evolution to positively impact and improve the healthcare delivery system.Make a DifferenceReporting to the Clinical Documentation Integrity Manager this role performs patient chart reviews to ensure the appropriateness andcompleteness of diagnostic coding with evidence based on CMS HCC standards.The Risk Adjustment Coder is responsible for :Timely accurate and complete review of patient charts following patient encounters utilizing a variety of technical platforms to completeworkflowsValidating diagnosis codes representing patient conditions along with necessary MEAT documentationEnsuring coding is consistent with guidelines from regulatory entitiesConducting audits to meet compliance with ACA standardsCreating post-visit queries with follow upCollaborating with...