22 policy coding auditor jobs found

HCSC is seeking a skilled professional for a telecommute position focused on Reimbursement Policy review, creation, and publication. The role requires collaboration with multiple departments to ensure accurate documentation and policy updates. Ideal candidates will have a Bachelor's degree, relevant experience, and strong communication skills. Responsibilities include coordinating annual reviews and ensuring adherence to claims processes. The position offers a competitive salary in the range of $55,900.00 - $123,500.00. #J-18808-Ljbffr

Compliance Auditor, Billing and Coding Compliance The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and...

Become a part of our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

Position Description Performs medical billing coding and documentation quality audits; provides feedback to coding and reimbursement specialists, coders, and educates them. This job has no supervisory responsibilities. Major/Essential Functions Current and active professional medical billing coding certification required from an accredited organization. Billing and coding experience in a multi-specialty group practice and/or academic practice setting is preferred. Five or more years of health care items/services. Managerial/supervisory and program management implementation experience strongly preferred. Ability to initiate administrative activities as necessary. Excellent oral and written communication skills. Ability to write and present ideas and information in a concise manner. Ability to work collaboratively with all individuals. Professional bearing, sound business judgment and persuasive skills. Strong problem-solving skills, self-starter, ability...

Position Description Provides day-to-day supervision and support to the coding team responsible for outpatient, in-patient, and clinic-based services across Texas Tech Physician clinics. This role ensures coding accuracy, compliance with regulatory requirements, and timely encounter completion to support revenue cycle integrity and organizational goals. The supervisor serves as a working leader who performs coding and/or auditing functions while supervising team members, monitoring productivity and their quality performance. This position works collaboratively with the Coding Manager, Compliance, and Revenue Cycle teams to implement policies, resolve coding-related issues, and promote consistent application of coding standards across multiple specialties and oversees a staff. Major/Essential Functions Supervise daily operations and employees on your team of the centralized ambulatory coding team, ensuring timely and accurate coding of outpatient encounters. Monitor...

Job Description Insight Global is seeking a Senior Profee Coding Auditor to support a healthcare consulting organization that partners with providers nationwide to improve coding accuracy, compliance, and revenue integrity through auditing and education services. This individual will perform physician-side (profee) coding audits within EMR systems, ensuring compliance with CMS, OIG, and industry standards. This is a high-level, production-driven consulting role requiring strong critical thinking, independent decision-making, and the ability to clearly explain audit findings and rationale to clients. The ideal candidate has extensive experience across multi-specialty profee coding and auditing and can confidently operate in a fast-paced, autonomous environment. The annual salary for this role ranges from 85k-93k depending on the candidates years of experience. KEY RESPONSIBILITIES: Perform profee coding audits (CPT, ICD-10, HCPCS) in EMR systems to ensure accuracy and...

Registered Nurse - Utilization Management/Coder RN Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Bienvivir is currently accepting applications for the following position: REGISTERED NURSE - UTILIZATION MANAGEMENT / CODER The...

Job Description - Compliance Auditor (260015F) Job Description Compliance Auditor - 260015F Description Valero is the best-in-class producer of essential fuels and products that are foundational to modern life. We invite you to join our ~10,000 employees to drive exceptional results for our company, the energy industry and our community. As a Compliance Auditor you will assist Internal Audit Management in safeguarding corporate assets, supporting profitable operations, and ensuring the reliability and accuracy of financial information through the examination and evaluation of financial and operational controls and procedures. Provides observations and recommendations to improve internal controls and business processes. Additionally, ensures organizational compliance with federal, state, and international regulations, with an emphasis on low‑carbon and clean fuels programs and other applicable regulatory requirements. At Valero, we are committed to advancing the future of...

Job Description Job Description Specialty Senior Medical Coder – General Surgery Location: Irving, TX COMPENSATION & SCHEDULE • $35.75/hr (Non-CGSC Certified) | $42.00/hr (CGSC Certified – General Surgery) • Monday–Friday | 8:00 AM–5:00 PM • W2 | Temp to Perm • Start Date: 03/16/2026 ROLE IMPACT: The Specialty Coder Senior – General Surgery ensures accurate, compliant coding for high-dollar inpatient and outpatient professional services. This role drives revenue integrity by reducing denials, supporting clean claims, and maintaining a minimum 95% coding accuracy rate. Success is defined by precise code assignment, strong documentation review, and consistent productivity in a remote environment. Key Responsibilities • Assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes in accordance with Official Coding Guidelines and AMA CPT standards • Code inpatient and outpatient Evaluation & Management (E/M) and surgical/operative procedures, generating accurate...

Job Description Job Description Senior Medical Coder – Urology/Nephrology Location Irving, TX | Onsite Compensation & Schedule • $35.75/hour – Non-Urology Certified Coder | $42.00/hour – Certified Urology Coder (CUC) • Full Time |8:00 AM - 5:00 PM • Temp to Perm (W2) • Start Date: March 16, 2026 Role Impact: The Senior Medical Coder ensures accurate, compliant coding for high-dollar and specialty professional fee accounts within Urology and Nephrology. This role directly supports clean claims, optimized reimbursement, and reduced denials by maintaining a minimum 95% coding accuracy rate. Success is defined by precision in ICD-10-CM, ICD-10-PCS, and CPT code assignment, strong collaboration with HIM (Health Information Management) and CDI (Clinical Documentation Improvement) teams, and consistent productivity performance. Key Responsibilities • Assign diagnosis and procedure codes in accordance with ICD-10-CM/PCS Official Guidelines and AMA CPT guidelines...

Overview Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Benefits for Full and Part-time Employees We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay 100% of the DENTAL monthly premiums for Employee Only coverage. We provide an...

Job Description Insight Global is seeking a highly skilled Inpatient DRG Coding Specialist to provide the advanced skills necessary for proper coding of all pertinent diagnoses and procedures and to provide optimal DRG assignment after thorough review of medical record and analysis of DRG options. ESSENTIAL JOB FUNCTIONS · Selects records from EPIC WQ according to priority. · Reviews all federally insured and other patient discharge encounters for accurate coding and sequencing of diagnoses and procedures. · Correctly assigns ICD-10 -CM diagnoses and ICD-10-PCSprocedure codes and enters appropriate codes into EPIC Encoder. · Identifies responsible staff and resident physicians for each procedure coded. · Always protects confidentiality of patient information. · Participates in section meeting and office in-services. · Attends and participates in coding education sessions. · Keeps coding knowledge and skills current through attending continuing education...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

Job Description Insight Global is seeking a highly skilled Inpatient DRG Coding Specialist to provide the advanced skills necessary for proper coding of all pertinent diagnoses and procedures and to provide optimal DRG assignment after thorough review of medical record and analysis of DRG options. ESSENTIAL JOB FUNCTIONS Selects records from EPIC WQ according to priority. Reviews all federally insured and other patient discharge encounters for accurate coding and sequencing of diagnoses and procedures. Correctly assigns ICD-10-CM diagnoses and ICD-10-PCS procedure codes and enters appropriate codes into EPIC Encoder. Identifies responsible staff and resident physicians for each procedure coded. Always protects confidentiality of patient information. Participates in section meeting and office in-services. Attends and participates in coding education sessions. Keeps coding knowledge and skills current through attending continuing education activities and reviewing pertinent...

Requisition number: 2360324 Job category: Medical & Clinical Operations Optum 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Medical Coder performs concurrent review of FFS coding rules, ensuring all CPT and E/M codes are accurately coded and billed for maximum reimbursement and minimal denials. This position will support coding functions within charge review, claim edits, and denials and play a critical role in maintaining...

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

Preferred Qualifications: Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology and medical abbreviations. Radiation Oncology Coding experience. REQUIRED LICENSES, REGISTRATIONS, OR CERTIFICATIONS: CCA – Certified Coding Associate (AHIMA) CCS – Certified Coding Specialist (AHIMA) CCS-P – Certified Coding Specialist – Physician Based (AHIMA) RHIA – Registered Health Information Administrator (AHIMA) CPC – Certified Professional Coder (AAPC) CPC-A – Certified Professional Coder – Apprentice (AAPC) JOB SUMMARY: Properly codes and/or audits professional services for inpatient and/or professional and hospital outpatient technical services for multiple specialty areas to ensure accuracy and optimal reimbursement from all third-party payers. ESSENTIAL JOB FUNCTIONS: Reviews documentation in EPIC and/or on paper as provided to appropriately assign ICD-10-CM, PCS and CPT codes. Communicates with and provides feedback to the...

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts. It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be done accurately and in a timely manner. Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers. Must always adhere to customer service expectations including in-person and virtual (via...

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient's request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare. What We're Looking For We're looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing...

The Senior Medical Coder performs concurrent review of FFS coding rules, ensuring all CPT and E/M codes are accurately coded and billed for maximum reimbursement and minimal denials. This position supports coding functions within charge review, claim edits, and denials and plays a critical role in maintaining coding accuracy and supporting revenue cycle integrity. Schedule: Monday to Friday, 8 AM - 5 PM Location: Remote - Nationwide You will enjoy the flexibility to telecommute from anywhere within the U.S. while taking on challenging assignments. Primary Responsibilities Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes Identify unclear or incomplete documentation and generate queries to obtain additional information Follow...

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. What We’re Looking For We’re looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this...

JOB SUMMARYSupport and provide coding and compliance training to clinical personnel, billing, and / or other client staff.Establish effective communication with clinical staff, and / or hospital staff to address documentation, coding, and reimbursement issues.Use knowledge of coding and compliance guidelines to identify potential billing / reimbursement issues.Participate in special audits and system administration as necessary.ESSENTIAL DUTIES AND RESPONSIBILITIESInclude the following.Others may be assigned.Performs diagnosis data submissions to Client, Vendors and internal StakeholdersDevelop monthly productivity and revenue projectionsResponsible for chart assignment oversight and monitoring accounts on holdPrepares data collection reports for leadershipMonitors diagnosis submission progress; Audit diagnosis submission files to ensure accuracyReviews, analyzes and oversight of prebill / post bill reviews and pending accountsWorks to resolve workflow, systems and complex matters...