460 outpatient coding compliance auditor jobs found

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to conduct audits of OPPS coding, ensuring accurate ICD-10-CM and CPT coding, modifiers, and E/M levels. The role monitors QA processes and communicates findings to stakeholders while aligning with applicable laws and regulations. You will analyze medical records, identify root causes of non-compliance, and support education based on audit results. Remote work within the U.S. is possible. #J-18808-Ljbffr

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines. Responsibilities: Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.Works closely...

Outpatient Coding Compliance AuditorOptum 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 Outpatient Coding Compliance Auditor performs audits of outpatient facility (OPPS) coding to ensure accurate assignment of ICD-10-CM diagnoses, CPT/HCPCS codes, modifiers, and facility E/M levels (ACEP or client-specific). This role reviews coding for alignment with medical record documentation and established guidelines, ensuring compliance with applicable laws,...

The Valley Health System in Ridgewood, NJ is seeking an Outpatient Coding Auditor to review outpatient records for compliance with coding guidelines and regulatory requirements. You will identify trends, educate staff, and collaborate with external vendors to implement industry best practices and improve overall audit results. Requires 5+ years in hospital auditing with ICD-10-CM, outpatient CPT-4, HCPCS coding experience; 3M Encoder experience and EPIC/Meditech/CERNER familiarity are preferred. #J-18808-Ljbffr

Emory Healthcare is seeking an Outpatient Coding Auditor to implement and maintain a compliance plan for outpatient coding and reimbursement, and to assist the Coding Manager with outpatient and emergency coding services. The role includes developing education programs, supervising HIM Compliance activities, and coordinating continual reviews and quality audits to ensure accurate APC assignment and reimbursement. Strong communication and organization are essential. #J-18808-Ljbffr

Valley Health System in Ridgewood, NJ is seeking an Outpatient Coding Auditor to review coded outpatient records for adherence to official coding guidelines, regulatory standards, and internal policies. The role drives education and process improvements through detailed case reviews and trend analyses. The incumbent will collaborate with external vendors and coding leadership to ensure accuracy and implement best practices in audit feedback and staff education. #J-18808-Ljbffr

Med-Metrix seeks a Coding Auditor to conduct inpatient and outpatient coding and auditing across specialties, preparing and presenting audit results. The role requires CPC or CCS certification, 5+ years coding and 2+ years auditing in multi-specialty settings, and strong communication skills. Responsibilities include education, HIPAA compliance, and collaboration with offsite auditors. #J-18808-Ljbffr

Job Description Job Description Compliance Auditor – To $67K – Cherry Hill, NJ – Job # 2929 Who We Are? BritePros Healthcare Staffing is completely committed to sourcing only the best administrative and clinical talent in the healthcare industry. Our pool of candidates within the world of healthcare is unparalleled. We simply want your healthcare organization running smoothly so you can focus on providing the best health services to your patients. Healthcare organizations from across the country rely upon BritePros Staffing to present only the most qualified talent for each specific job. Our unique application of the Behavior-based Interviewing Model allows BritePros Staffing to properly vet and evaluate talent relative to key technical and cultural markers for each unique job opening. The Position We seek to fill a Compliance Auditor role in the Cherry Hill, NJ area. The candidate will be responsible for supporting the corporate compliance program. The...

Professional Fee Coding AuditorAt NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials.This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization.PRIMARY JOB DUTIESAudit ResponsibilitiesPerforms routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee.Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer...

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...

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm’s private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker’s compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions. The Advisory Group is currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely. Principal duties and responsibilities: Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payors. Researching...

Itemized Bill Review Quality Auditor, Lead Associate- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for a Lead Associate, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized medical bill, and UB-04 forms to ensure accuracy, compliance, and proper billing practices. This role is responsible for conducting quality assurance audits and oversight of itemized bill review...

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Performs technical and administrative work reviewing, abstracting and assigning accepted medical CPT, HCPCS, and ICD-10 codes for professional services. Duties are performed in compliance with third party, state and federal regulations according to standardized procedures. Employees report to an administrative superior but independently handle assigned tasks. Responsibilities: 1. Assigns International Classification of Diseases (ICD-10-CM) diagnosis codes in an accurate and productive manner. 2. Assigns all diagnosis codes to chronic conditions documented that may impact Hierarchal Condition Categories (HCCs) or expected mortality. 3. Assigns Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in an accurate and productive manner. 4. Groups codes...

Job Description Job Description Registered Nurse PACU Medical Coding Auditor - Ambulatory Job Description: About Company: Since 1984, Professional Performance Development Group (PPDG) has been proudly Serving Heroes by connecting exceptional healthcare professionals with rewarding opportunities across military, federal, and commercial healthcare facilities. Guided by our core principles of excellence, integrity, and collaboration, we are dedicated to delivering high-quality staffing solutions that strengthen the delivery of patient care nationwide. Rooted in a culture of Linked Prosperity, PPDG values the success of our clients, employees, and partners alike—offering competitive compensation, comprehensive benefits, professional growth, and a cooperative workplace built on trust, respect, and service. As a proud Department of Defense Partner Employer and participant in the Military Spouse Employment Partnership (MSEP), PPDG remains committed to supporting our...

Physician Billing (PB) Coding Auditor And EducatorOur team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.The Physician Billing (PB) Coding Auditor and Educator is responsible for auditing and educating healthcare providers on related applicable clinical documentation. This work supports coding and billing regulations that ensure appropriate reimbursement, public reporting, and various initiatives as directed by the Hackensack Meridian Health (HMH) Network.A day in the life of an Physician Billing (PB) Coding Auditor and Educator at...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for...

Outpatient Coding AuditorThe Outpatient Coding Auditor is responsible for auditing coded outpatient medical records to ensure compliance with official coding guidelines, regulatory agencies, and internal policies. This role supports coding accuracy, education, and process improvement through detailed review of encounters, identification of trends and variances, and communication with coding staff and leadership. This position also collaborates with external vendors to monitor performance and incorporate industry best practices into audit feedback and education.EducationHigh school diploma or equivalent required.ExperienceMinimum of 5 years of experience in hospital auditing or education experience ICD-10-CM and Outpatient CPT-4, HCPCs coding experience required. Knowledge of Medical Necessity APC, OCE, LCD, and NCD edits required. 3M Encoder experience, Meditech, EPIC, or CERNER preferred.SkillsCCS or COC, CPC, RHIT, RHIA required. Knowledge of ICD-10-CM, CPT-4 and HCPCs coding,...

Sentara Health Plans in Norfolk, VA, is seeking a Compliance Coding Auditor to perform internal coding audits, physician education, and AR query management. The role requires expertise in CCI, NCD, and HCC guidelines, and mastery of MPFS impact on RVU for NPP services. Remote work is favored for VA/NC candidates. Ideal candidates have CPC/CCS certification and 4+ years of multi-specialty coding experience, including acute care outpatient coding and professional fee coding. #J-18808-Ljbffr

Colorado Psychiatric is seeking an experienced HIM Auditor to support audit of hospital outpatient and ProFee claims, focusing on coding accuracy, revenue integrity, and billing compliance. The role leverages proprietary software to analyze findings, develops client reports, and presents recommendations to healthcare clients in a remote setting. Ideal candidates will have 5+ years in hospital outpatient facility coding audits and AHIMA/AAPC certification. #J-18808-Ljbffr

Position Summary The Outpatient Coding Auditor is responsible for auditing coded outpatient medical records to ensure compliance with official coding guidelines, regulatory agencies, and internal policies. This role supports coding accuracy, education, and process improvement through detailed review of encounters, identification of trends and variances, and communication with coding staff and leadership. This position also collaborates with external vendors to monitor performance and incorporate industry best practices into audit feedback and education. Education High school diploma or equivalent required. Experience Minimum of 5 years of experience in hospital auditing or education experience ICD-10-CM and Outpatient CPT-4, HCPCs coding experience required. Knowledge of Medical Necessity APC, OCE, LCD, and NCD edits required. 3M Encoder experience, Meditech, EPIC, or CERNER preferred. Skills CCS or COC, CPC, RHIT, RHIA required. Knowledge of ICD-10-CM, CPT-4 and...

We are sharing a specialised consulting opportunity for experienced Medical Auditors with strong expertise in outpatient professional fee coding, coding audits, academic medical center workflows, audit-program management, and coding quality assurance to contribute to an advanced AI training and medical-coding evaluation project. Selected professionals will audit outpatient professional fee coding, review other coders' work, resolve complex coding cases, identify recurring quality issues, and provide structured feedback grounded in professional coding standards. No prior experience in AI is required. Key Responsibilities Coding Audit & Complex Case Review Audit outpatient professional fee coding for accuracy, compliance, and documentation support Review other coders' work and identify incorrect, incomplete, or inconsistent coding Evaluate complex or ambiguous cases and document well-supported determinations Apply coding guidance consistently across varied clinical...