4 policy coding auditor jobs found

Billing Compliance Reviewer  Dana-Farber Cancer Institute  Boston, MA  Full Time Overview Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk. The role evaluates the accuracy and integrity of hospital and professional billing practices to ensure compliance with federal and state regulations, payer requirements, national coding guidelines, and internal policies. The Billing Compliance Reviewer is responsible for developing clear findings, collaborating with clinical and administrative stakeholders to resolve issues, and supporting continuous improvement in charge capture, documentation, and coding processes. This role works collaboratively with Coding, HIS, Billing and other internal and external teams to evaluate complex billing issues and initiate...

Senior Billing Compliance Hospital Reviewer  Dana-Farber Cancer Institute  Boston, MA  Full Time Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing Compliance inpatient and ambulatory activities. The Senior Reviewer will provide oversight related to reviewing the accuracy and appropriateness of ICD-10-PCS procedure coding and assessing DRG assignment. The Senior Reviewer will assist in the development and execution of the annual Billing Compliance work plan. They will monitor federal and state regulatory requirements and industry developments and work to determine applicability and risk to both technical and operational aspects of the organization. Metrics will be developed and reported quarterly. The Senior Reviewer will be expected to pursue successful completion of multiple tasks collaborating effectively with many departments across the institute, Mass...

We are looking for a Medical Coder (Behavioral Health, E/M) to help define how automated and human-in-the-loop coding works at scale. In this role, you will serve as an internal authority on behavioral health E/M coding , partnering closely with Brellium's Customer Success, Product, and Engineering teams. You will help ensure that coding recommendations are accurate, defensible, and aligned with payer expectations — balancing appropriate revenue capture with audit-safe compliance. This is a highly impactful role for an experienced coder who enjoys shaping policy, improving systems, and applying clinical coding expertise in a modern, technology-driven environment. What You'll Do Own Coding Quality & Compliance Review and validate E/M coding for behavioral health encounters in a pre-bill workflow Ensure coding decisions align with documentation, payer guidance, and compliance best practices Define clear standards for when revenue capture is appropriate vs when...