64 physician coding compliance auditor jobs found

divh2Coder Quality Auditor/h2pThe Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties./ppJob Responsibilities:/pulliQuality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess...

Coding Compliance Auditor In accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant. The Coding Compliance Auditor will also provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics Re: coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems...

Job Description Shared Services: Compliance- (Full-Time, Day Shift) - Job Summary: The Compliance Auditor-Physician monitors and audits established mechanisms and controls to ensure compliance with regulations. Audits the activities of various departments for compliance with plans, policies and procedures prescribed by management. Prepares and submits reports on the results of audits, recommending improvements in policies and procedures. Cooperates with outside auditors in any undertaking that may expedite their work. Performs other duties as needed. Conducts full range of physician-based audits/projects and develops partnerships with internal and external customers. Performs other duties as needed. Education and Experience: Bachelor's Degree required. Master's Degree preferred. Minimum three years of experience in auditing within healthcare, compliance, regulatory oversight agency, quality management, quality assurance or business analysis. Knowledge and Skills:...

Job Type Full-time Description About Us Simply put, our purpose at Accelerated Urgent Care is to get you quality care when you need it. We aim to foster a supportive environment where our team members can develop their careers. To promote this goal, we've built a diverse and driven team of employees who are all eager to learn from one another and reach Accelerated Urgent Care's mission of delivering exceptional healthcare to the patients and communities that we are privileged to serve. We are ... a fast-growing company that doubles in size year after year since 2012! Recognized as Kern County's Top Urgent Care center 6 years in a row! Dedicated to our employees' career growth; 65% of our Administration and Management team members have been internal candidates! 16 clinics strong across 5 regions in California and growing! Our Core Values: Friendliness, Competence, Respect, Teamwork, Compassion, Hard work, Integrity, Humility, Dedication! Job Summary The Certified...

Facility: System Services City San Diego Department Job Status Regular Shift Day FTE 1 Shift Start Time Shift End Time Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate; Other; Certified Health Care Compliance (CHC) - Compliance Certification Board Hours : Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $49.700 - $64.130 - $71.820 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.? The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other...

We are looking for HCC Risk Adjustment Auditors/Coders to join our team! Position Summary: The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services. Essential Duties and Responsibilities include the following: Works as an integral member of the Finance Department. Code review super bills and patient medical records for proper use of diagnosis and procedure...

Job Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Works independently performing program, compliance, and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions through an action plan. Responsible for coordinating, developing, and conducting educational training based on audit...

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick, birthday, and vacation time as well as a 410k matching plan. Additional employee paid coverage options available. Job Purpose The Medical Claims Coding Auditor supports the Managed Service Organization (MSO) by performing detailed medical claims reviews to ensure accuracy, compliance, and appropriate reimbursement across Medicare,...

A healthcare provider in San Diego is seeking a Coding Auditor to conduct audits and ensure compliance with coding standards. The role requires strong knowledge of CPT and ICD-10 codes, exceptional communication skills, and the ability to train clinical staff. The ideal candidate has 3 years of experience in a healthcare setting and holds a CPC or CCS-P certification. Competitive hourly rate offered. #J-18808-Ljbffr

Job Title: Medical Biller II Salary: $25hr-$28hr DOE Location: Tustin, CA Openings: 1 Position Purpose: The Medical Billing Specialist II supports the revenue cycle team by independently performing a broad range of billing functions with moderate complexity. This role is responsible for accurate insurance verification, charge entry, claim submission, payment posting, and resolution of routine denials to ensure compliance with payer requirements and timely reimbursement. Core Duties and responsibilities, include but are not limited to: Insurance & Eligibility Verification Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO). Research and resolve discrepancies in patient coverage or eligibility. Document eligibility outcomes in the EHR/PM system. Charge Entry & Coding Support Perform charge entry and apply CPT, ICD-10, and HCPCS codes. Review encounter forms for accuracy; flag missing or incorrect...

Internal Reference Number: R1049162 Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! This open position is within one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial...

Coding Educator (Temp-to-Hire, 13 Weeks) Location: Within Sutter Health Footprint (Hybrid - Mostly Remote with Local Travel) Type: Contingent / Temp-to-Hire Overview Sutter Health is seeking experienced Professional Fee (Pro Fee)-focused Coding Educators to support large-scale chart review, coding accuracy validation, physician education, and documentation improvement initiatives. These roles are high-visibility and require strong communication and presentation skills to engage directly with clinicians and support Sutter's revenue cycle, audit, and education functions. Candidates must live within the Sutter Health geographic footprint and be available for occasional on-site work and local travel. Positions are structured as 13-week temp-to-hire with conversion opportunities. Key Responsibilities Coding Education & Training Deliver physician and coder education for assigned groups, with emphasis on Pro Fee (ASC, surgery, outpatient) environments....

Medical Coding Auditor UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico. This position requires extensive knowledge and experience with E/M coding. $2,000 Sign-on Bonus Minimum $56,173 - Midpoint $70,217 Salary is determined based on years of total relevant experience. Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes, medical...

Overview Coding Educator (Temp-to-Hire, 13 Weeks) – Location: Within *** Footprint (Hybrid – Mostly Remote with Local Travel). Type: Contingent / Temp-to-Hire. is seeking experienced Professional Fee (Pro Fee)–focused Coding Educators to support large-scale chart review, coding accuracy validation, physician education, and documentation improvement initiatives. These roles are high-visibility and require strong communication and presentation skills to engage directly with clinicians and support Sutter's revenue cycle, audit, and education functions. Candidates must live within the *** geographic footprint and be available for occasional on-site work and local travel. Positions are structured as 13-week temp-to-hire with conversion opportunities. Key Responsibilities Coding Education & Training: Deliver physician and coder education for assigned groups, with emphasis on Pro Fee (ASC, surgery, outpatient) environments. Facilitate individual and group training sessions; must...

Medical Record Coder 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. Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding. Submits daily productivity report to HIM manager by defined deadline. Meets and maintains HIM coding quality and...

Hospital/Facility Revenue Cycle Manager Trajectory RCS joined the MedHQ family in the beginning of 2024 after enjoying 10 years as a well-established revenue cycle company with an annual growth rate of 40% to 50% and 150 employees. Together they now serve small hospitals, physician groups, ambulatory surgery, and outpatient centers nationwide by optimizing healthcare cash flow through teamwork and collaboration. MedHQ, LLC, is a fast growing, leading provider of consulting and technology enabled expert services for outpatient healthcare. With a 97% client retention rate spanning over 20 years, MedHQ serves Ambulatory Surgery Centers (ASCs), Surgical Hospitals, Physician Practices, and Hospital and Healthcare Outpatient Facilities nationwide. MedHQ, LLC, is a 2022 Becker's Top 150 Places to Work in Healthcare company. The MedHQ LLC service line offerings have grown organically over the years, beginning by providing high quality traditional human resource, accounting, and staff...

Overview We are seeking experienced Professional Fee (Pro Fee)–focused Coding Educators to support large-scale chart review, coding accuracy validation, physician education, and documentation improvement initiatives. These roles are high-visibility and require strong communication and presentation skills to engage directly with clinicians and support our revenue cycle, audit, and education functions. Candidates must live within the designated geographic footprint and be available for occasional on-site work and local travel. Positions are structured as 13‑week temp‑to‑hire with conversion opportunities. Key Responsibilities Coding Education & Training Deliver physician and coder education for assigned groups, with emphasis on Pro Fee (ASC, surgery, outpatient) environments. Facilitate individual and group training sessions; must be comfortable presenting to clinicians. Address provider and coder questions related to documentation standards, audit findings, and coding...

Job Description Job Description Job Summary Medical Biller The Medical Biller reports to the Billing Manager in person at our office in Ontario, CA and is responsible for the accurate, compliant, and timely billing of clinical laboratory services, including blood testing, microbiology/culture testing, and toxicology services. This role requires strong expertise in Medicare Part A vs Part B billing, skilled nursing facility (SNF) workflows, and commercial payer laboratory billing rules. The Medical Biller manages claims from Pending Review through payment resolution while ensuring full compliance with Medicare, Medicaid, and commercial payor regulations. NO remote work available Supervisory Responsibilities None Essential Duties and Responsibilities Laboratory Billing & Claims Management Review laboratory patient demographics, insurance, ordering provider, and facility information. Prepare, review, and submit insurance claims for...

Job Description Job Description Description: We are seeking a detail-oriented and knowledgeable Medical Biller to join our medical practice. The ideal candidate will be responsible for managing billing processes, ensuring accurate coding and submission of claims, and maintaining medical records. This role is crucial in facilitating the financial operations of our medical office while ensuring compliance with healthcare regulations. Requirements: Responsibilities Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues Follow up on claims using...

Job Description Job Description Position Purpose: The Certified Medical Coder plays a crucial role in the Billing Department by ensuring precise and compliant coding of medical services. Under the guidance of the Billing Department Supervisor, the Coder will assign appropriate diagnosis and procedural codes for services provided by JWCH physicians, adhering to industry standards and legal requirements. This position involves validating and auditing coding practices to guarantee accuracy in billing, supporting optimal reimbursement, and maintaining adherence to regulatory guidelines. Duties and Responsibilities: Serve as the primary liaison between providers and the Billing Department, effectively communicating to clarify diagnoses, procedures, coding, and documentation requirements. Recommend appropriate ICD-10-CM, CDT diagnosis codes, CPT codes, and HCPCS codes. Regularly review diagnosis and procedure coding within NextGen to ensure optimal billing accuracy....

Job Description Job Description South Los Angeles based FQHC looking for onsite Certified HCC coder . *This is not a remote position Conduct the necessary audits of medical record to verify the physicians have appropriately documented the diagnoses then code these diagnoses in ICD-10 for Medicare Risk Adjustments/Medicare Advantage. Evaluate medical information (Outpatient/Inpatient) documentation from a clinical standpoint for evidence of the possibility of additional medical conditions that may not have been documented in the past, and ensure accurate coding of the encounter data and recommend processes for accurate coding practices. This process involves a very strong understanding of medical coding. Ascertain that medical record documentations have accurate diagnoses and conditions to assure not to up-code, fraudulently or misrepresent the patient condition and ensure compliance to prepare for random CMS medical records audit HEDIS coding and record collection...

Medical Coding Auditor UNM Medical Group, Inc. is hiring for a Medical Coding Auditor to join our Compliance Team. This opportunity is a remote, full-time, day shift opening located in Albuquerque, New Mexico. This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico. This position requires extensive knowledge and experience with E/M coding. $2,000 Sign-on Bonus Minimum $56,173 - Midpoint $70,217 Salary is determined based on years of total relevant experience. Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM Medical group billing systems procedures to provide a review of evaluation and management codes, medical...

divh2Coding Specialist/h2pResponsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment./ppstrongMinimum Qualifications:/strong/pp1. Graduate of Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience./pp2. Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), COC (Certified Outpatient Coder), CCS...

Inpatient Coding Specialist In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non-Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Perform other coding...