35 physician coding auditor jobs found

## Compliance Coding AuditorApplyremote type: Remotelocations: Norfolk, VAtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR-104491**City/State**Norfolk, VA**Work Shift**First (Days)**Overview:**# Compliance Coding AuditorPerforms 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...

City/State Norfolk, VA Work Shift First (Days) Overview 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...

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...

The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and educations associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remains in compliance with all federal healthcare program rules, regulations, administrative requirements and guidance. MINIMUM QUALIFICATIONS EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ; Associate’s Degree AND Five (5) years experience in multi-specialty coding, E&M coding, procedural/surgical coding. Current certification in one of the following: Certified Professional Coder (CPC)through the American Academy of Professional Coders (AAPC) Registered Health...

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

The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and educations associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remains in compliance with all federal healthcare program rules, regulations, administrative requirements and guidance. MINIMUM QUALIFICATIONS EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ; Associate’s Degree AND Five (5) years experience in multi-specialty coding, E&M coding, procedural/surgical coding. Current certification in one of the following: Certified Professional Coder (CPC)through the American Academy of Professional Coders (AAPC) Registered Health...

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...

POSITION SUMMARY Conducts reviews and provides recommended corrections of billed services as it relates to clinical documentation for the VMG enterprise. Assists in the reviews and responses to payor and governmental audits of billed services. Assists the CBO in replying to payor denials and patient inquiries as it relates to services billed. Reviews and research new coding guidelines and codes. Assists the staff of the VHS corporate compliance. EDUCATION CPC (AAPC) required. Degree in Heath Services Management, Business or another related field preferred. Extensive knowledge of ICD-9-CM/ICD-10 CM and CPT coding principles and guidelines required. Extensive knowledge of reimbursement systems required. EXPERIENCE Eight to ten years’ experience (college degree can be substituted for years of experience) and expertise in ICD-9 CM/ICD-10 CM Coding. SPECIAL SKILLS Medical Terminology, ICD-9 CM/ICD-10 CM and CPT-4 Coding, Ability to relate to people and work closely with physicians...

GI Coder III Required Skills & Experience Must Haves: 5+ years of professional medical coding experience Coder III level experience Extensive GI coding experience Experience coding: Colonoscopies EGDs (Esophagogastroduodenoscopy procedures) Other GI surgical procedures Experience in: Endoscopy Suites Ambulatory Surgery Centers (ASCs) EPIC experience required Experience with coding encoders such as: Codify Encoder Pro Experience using ProVation Nice to Have Skills & Experience Nice to Haves: Academic medical center experience Experience supporting system conversions or EMR transitions Job Description The GI Coder III is responsible for reviewing and assigning accurate ICD-10, CPT, and HCPCS codes for a variety of gastroenterology procedures and services. This individual will analyze physician documentation, operative reports, endoscopy reports, and related medical records to ensure coding accuracy, compliance, and appropriate reimbursement. The ideal...

Responsibilities Atlantic Region CBO: The Atlantic Region Central Billing Office (“ARCBO”) or (“CBO”) provides business office services including billing, collections, cash posting, pre-access management, variance, and customer service to our affiliated Universal Health Services hospitals. https://jobs.uhs.com/atlantic-region-cbo The Atlantic Region CBO is seeking a dynamic and talented Inpatient Coder for our Appeals department. The primary responsibility of the DRG Coder is to analyze third party coding audits of paid claims, draft detailed appeal letters, evaluate clinical level of care and review denial trends. Key Responsibilities include: Perform DRG (Diagnosis Related Group) validation reviews in response to audits from third party payers. Review audit findings letters from third party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical / coding rationale. Analyze medical records to obtain supporting clinical documentation...

Job Title Newport News, Virginia $23.00 - $29.90/Hourly Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. 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 Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. What You Will Do Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits...

Job Title Essential Duties and Responsibilities These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned. Coordinate, supervise, and respond to third-party patient bill audits. Perform patient-requested audits in a timely manner. Perform random quality audits as schedule permits. Assist Patient Account personnel with patient questions about itemized charges. Maintain reporting systems for audit activities and identify patterns and trends in results. Act as a resource for all hospital departments regarding charging questions and issues. Routinely review inpatient and outpatient records for appropriate coding and charging. Provide educational sessions for revenue-producing departments regarding appropriate charging processes and procedures. Work cooperatively with the Patient Accounting staff and other healthcare professionals in obtaining correct HCPCS codes and modifiers. Assist the Health...

Become a part of our caring community Become a part of our caring community and help us put health first *** $5,000 SIGN-ON BONUS for new associates! $5,000 payable following 90 days employment. *** The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding...

Supervisor -Emergency Transport Job Code: SU2000 Full Time Days/Mid-shifts FLSA Status: Non -Exempt About Us We are welcoming a new era in healthcare where achieving good health is just the beginning. AtUVACommunity Health, we believe in caring for the whole person by getting to know - and making connections with - our patients. By combining the talent andexpertiseof our people, the breadth of capabilities across our system, and our commitment to helping our communities get better and stay healthy, we are improving the patient experience. As aUVACommunity Healthteam member, you will have a voice in patient care decisions, support the most advanced medicaltechnologiesand feela strong senseof satisfaction from making a difference in people's lives every day. Job Summary The Supervisor, Emergency Transport provides day-to-day operational and clinical oversight of ambulance and patient transport servicesfor assigned site specific areas. This roleis responsible forensuring safe,...

West Virginia University Health System is seeking an Enterprise Compliance Auditor/Educator to support ongoing auditing, monitoring, and education across WVUHS and affiliates. The role ensures provider organizations meet CMS, state, and payer regulations, with emphasis on documentation, coding accuracy, and medical necessity. The incumbent will lead audits, prepare comprehensive reports, and deliver education programs for physicians, APPs, and staff. #J-18808-Ljbffr

Location: Norfolk, Virginia, United StatesSalary: $92,880 - $160,218Company: Elevance HealthPosted: DRG Coding Auditor - MS-DRG and APR-DRGSign On Bonus: $1,500; paid in two installments: $500 at the time of hire and $1,000 after one year of service.Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high...

City/StateVirginia Beach, VAWork ShiftFirst (Days)Overview:Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!Hours: Monday - Friday, dayshift.This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week or must be able to do site visits. The role also includes travel as needed to support business objectives and team collaboration.OverviewPerforms compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories...

Summary With direction from the Director, the Nurse Auditor/ Senior Revenue Integrity Specialist is responsible for auditing itemized charges versus the patient medical record and other applicable hospital documentation, assigning modifiers to appropriate claims, researching edited claims for medical necessity, and advising the billing staff of appropriate HCPCS codes and modifiers. The Nurse Auditor/ Revenue Integrity Specialist works directly with revenue producing departments regarding lost charges, billing questions, and proper coding and charging. The nurse auditor reviews documentation on all Observation accounts for carve-out observation hours, the charge coding of ED Visits and Injection and Infusion charges. Essential Duties and Responsibilities Coordinate, supervise, and respond to third party patient bill audits. Perform patient requested audits in a timely manner. Perform random quality audits as schedule permits. Work and review a high volume of accounts assigned to...

Essential Duties and Responsibilities These duties and responsibilities represent the general tasks performed on a daily basis; other tasks may be assigned. Coordinate, supervise, and respond to third‑party patient bill audits. Perform patient requested audits in a timely manner. Perform random quality audits as scheduled. Assist Patient Account personnel with patient questions about itemized charges. Maintain a reporting system of audit activities and identify patterns and trends of results. Act as a resource for all hospital departments with charging questions and issues. Routinely review inpatient and outpatient records for appropriate coding and charging. Provide educational sessions for revenue‑producing departments regarding appropriate charging process and procedures. Work cooperatively with the Patient Accounting staff and other health‑care professionals in obtaining correct HCPCS codes and modifiers. Assist the Health Information Department with RAC requests,...

Chesapeake Regional Medical Group is seeking a Senior Coding Specialist to perform coding tasks across physician practices, including obtaining pathology and operative reports, assigning ICD and CPT codes, and ensuring accurate transmissions within the system. The role requires experience in hospital/medical office settings, CPC certification (or within one year), and strong computer skills. You will participate in audits, education, and go-live support across multiple locations. #J-18808-Ljbffr

DRG Coding Auditor - MS-DRG and APR-DRGSign On Bonus: $1,500; paid in two installments: $500 at the time of hire and $1,000 after one year of service.Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients....

West Virginia University Health System is seeking an Enterprise Compliance Auditor/Educator to support ongoing auditing, monitoring, and education across WVUHS and affiliates. The role ensures provider organizations meet CMS, state, and payer regulations, with emphasis on documentation, coding accuracy, and medical necessity. The incumbent will lead audits, prepare comprehensive reports, and deliver education programs for physicians, APPs, and staff. #J-18808-Ljbffr

Newport News, Virginia Hiring Range $23.00 - $29.90/Hourly. Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. 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 Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. Assigns diagnostic and procedure codes to simple record types up to highly complex record types. Contributes to the proper management of health information through consistent and accurate code assignment processes adhering to all regulatory coding principles, rules and regulations. What you will do Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. Audits for...

Riverside Health in Newport News, Virginia, is seeking a qualified Medical Coder to ensure accurate reimbursement by assigning ICD-10-CM and CPT codes to medical records. The role emphasizes chart reviews, data element coding, documentation audits, and collaboration with physicians and the Patient Financial Services team. Remote work eligibility is available for candidates in specified states; strong accuracy and adherence to coding standards are required. #J-18808-Ljbffr