36 profee coding auditor jobs found

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...

Datavant is seeking a Profee Auditing Specialist to join their remote team in Austin, Texas. The role involves performing Professional Fee coding audits and ensuring compliance with regulatory requirements. Candidates should have over 5 years of coding experience and a CPC certification to succeed. The position offers a competitive hourly pay range of $35—$45, along with comprehensive benefits including medical and dental coverage, paid time off, and ongoing education opportunities. #J-18808-Ljbffr

Under general supervision of the Director, the Coder II provides consistency and efficiency in outpatient claims processing and data collection to optimize APC reimbursement and facilitate data quality in outpatient services. Reviews, audits, and reports on charge capture. Maintains patient confidentiality at all times. ESSENTIAL JOB FUNCTIONS Analyzes IP, OP, Recurring, & SDC records and appropriately codes per coding guidelines, ICD-10-CM and CPT rules and updates, creating APC or DRG group assignments. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Concurrently codes Recurring records for interim billing. Processes records for deficiencies and return for completion. Enters codes into the Abstracting Module as needed, including use of the 3M encoder. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and...

Analyze patient charts, physician notes and discharge summaries Ensure documentation is complete and accurate before coding Translate diagnoses and procedures into standardized codes using: ICD-10-CM (diagnoses) CPT (procedures) HCPCS (supplies/services) Make sure codes correctly represent services provided Follow healthcare laws and regulations (HIPAA, Medicare/Medicaid guidelines) Company Policies Prevent coding errors that could lead to claim denials or audits Stay updated on coding changes and updates Work with billing teams to submit coded claims to insurance companies Verify claim accuracy to ensure proper reimbursement Fix rejected or denied claims by reviewing and correcting codes Communicate with healthcare providers and insurance companies Protect sensitive patient information Follow strict privacy and data security standards Clarify documentation with physicians when needed Collaborate with billing and administrative teams Regularly update knowledge of coding systems...

Job Description Job Description Certified Professional Coder Medical Billing Department Exceed Healthcare Why join Exceed Healthcare? At Exceed Healthcare, our mission is simple: improving lives through innovation . We are redefining healthcare by delivering cutting-edge medical services, expanding access through seamless virtual care, and always putting patients at the center of everything we do. Our vision is to lead the future of healthcare by exceeding expectations through technology, strategic insight, and a deep commitment to excellence. We value integrity, respect, accountability, and collaboration. We foster a diverse and inclusive culture where courage and resiliency thrive—and where every team member plays a vital role in making an impact. Join us to be part of a forward-thinking team that prioritizes exceptional patient care, supports your growth, and believes in leading from every role. Job Summary: The Certified Professional Coder is...

Are you looking for a career that will make an impact? The Leidos Military and Veterans Health Solutions Operation has an opening for a Clinical Informaticist / Clinical Coder in the Operational Readiness Directorate at the Naval Health Research Center in San Diego, CA. This is a full‑time position. The employee must be located within commuting distance of San Diego to work on‑site at the Naval Health Research Center as needed. The number of days on‑site may vary, and the schedule is subject to change based on program and customer requirements. Work hours will coincide with the standard command business hours of 0700–1630. Primary Responsibilities Obtain and maintain required access to military electronic health records (EHR) systems, such as Joint Longitudinal Viewer (JLV) and Theater Medical Data Store (TMDS). Perform detailed reviews of health records and supporting documentation in multiple systems throughout the continuum of care to assign precise medical coding. Assign...

Integrative Emergency Services, LLC (“IES”) is seeking a Certified Medical Coding Specialist with emphasis on surgical services. The Coding Specialist is responsible for accurate professional fee coding and documentation review for assigned surgical service lines (URSA/NTCC/TSN). This role evaluates medical records to ensure proper CPT, HCPCS Level II, and ICD-10-CM code assignment in accordance with payer guidelines and regulatory standards. The Coding Specialist supports documentation integrity, identifies coding compliance risks (including undercoding, overcoding, and unbundling), and contributes to clean claim submission and optimal reimbursement through coding analysis, audits, and special projects. Work will be based in a Hybrid format at the corporate office in North Dallas, TX, 75244. IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and...

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...

Company Overview Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women Children's Health Insurance Program (CHIP) for the children of low‑income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions. Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare...

Overview Bonus Potential! Monthly and Quarterly Bonus Incentives! Through our evidenced based medicine approach, Concentra’s goal is to provide quality patient care while treating everyone with friendliness, skill, and respect. We strive daily to promote a diverse environment of acceptance and compassion for our colleagues and cultivate a welcoming atmosphere where our patients can heal. As we’ve grown, we’ve expanded into urgent care, wellness services, administration, onsite health and wellness centers, and telemedicine. All these services together make achieving health easier and more accessible for our patients, clients, colleagues, and all provide you with unmatched support, education, career advancement opportunities, and benefits. The Associate Director of Medical Operations position involves providing direct patient care and leading by example to ensure an exceptional patient experience. The role includes identifying and communicating opportunities for clinical quality...

About Us Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits,...

Certified Professional Coder Job Category: Finance and Accounting Full-Time On-site Odessa, TX 79761, USA Description Key Responsibilities: Analyze patient charts, physician notes and discharge summaries Ensure documentation is complete and accurate before coding Translate diagnoses and procedures into standardized codes using: ICD-10-CM (diagnoses) CPT (procedures) HCPCS (supplies/services) Make sure codes correctly represent services provided Follow healthcare laws and regulations (HIPAA, Medicare/Medicaid guidelines) Company Policies Prevent coding errors that could lead to claim denials or audits Stay updated on coding changes and updates Work with billing teams to submit coded claims to insurance companies Verify claim accuracy to ensure proper reimbursement Fix rejected or denied claims by reviewing and correcting codes Communicate with healthcare providers and insurance companies Protect sensitive patient information Follow strict privacy and data...

Citizens Medical Center is a not-for-profit hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 338-bed acute care hospital with over 1,000 dedicated employees. Citizens offers a generous benefit package that includes retirement plans upon hire, and an excellent medical plan with optional insurance plans to choose from. If you are interested in pursuing a career with an award-winning hospital, welcome home. The Physician Coder I performs evaluation/management coding for clinic, inpatient, and outpatient encounters as well as coding for in-office ancillary services and minor procedures. Assigns and sequences all codes for services rendered. Collaborates with coders, billers, clinical staff, managers, and healthcare professionals to ensure accurate coding assignment and to resolve any coding-related claim denials. JOB DUTIES AND RESPONSIBILITIES Job Specific Assigns...

INPATIENT MEDICAL CODER “ ACUTE CARE Location Sherman, TX Onsite COMPENSATION & SCHEDULE Starting at $40.00/hour(DOE) Monday- Friday:8am - 5pm W2 employment ROLE IMPACT:The Inpatient Medical Coder ensures accurate translation of complex acute care documentation into compliant diagnosis and procedure codes. This role directly impacts reimbursement, regulatory compliance, and overall revenue cycle performance. Success is measured by coding accuracy, proper MS-DRG assignment, audit readiness, and effective collaboration with clinical and Health Information Management (HIM) teams. Key Responsibilities Review inpatient medical records to assign accurate diagnosis and procedure codes Apply ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) and ICD-10-PCS (Procedure Coding System) standards in alignment with official coding guidelines Ensure accurate MS-DRG (Medicare Severity Diagnosis-Related Group) assignment to...

INPATIENT MEDICAL CODER “ ACUTE CARE Location Sherman, TX Onsite COMPENSATION & SCHEDULE $40.00per hour (based on experience) Full-time schedule Employment type:W2 ROLE IMPACT The Inpatient Medical Coder ensures accurate code assignment and reimbursement integrity for acute care hospital services. This role supports compliant revenue cycle operations by translating complex clinical documentation into precise ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) and ICD-10-PCS (Procedure Coding System) codes. Performance in this position directly supports MS-DRG (Medicare Severity Diagnosis Related Group) accuracy, audit readiness, and regulatory compliance. Key Responsibilities Review and analyze acute care inpatient medical records to assign accurate diagnosis and procedure codes Apply ICD-10-CM and ICD-10-PCS codes in accordance with official coding guidelines Ensure accurate MS-DRG assignment to support proper...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

CSI Companies is seeking an experienced Professional Fee (ProFee) Coder with a strong background in Mental Health and/or Primary Care coding. This role is responsible for accurately reviewing, assigning, and validating CPT, ICD-10-CM, and HCPCS codes for outpatient provider services to ensure compliance with federal regulations and payer-specific guidelines.The ideal candidate brings strong knowledge of behavioral health documentation standards, E/M coding guidelines, and regulatory compliance within physician practice or outpatient settings. This role requires high accuracy, productivity, and the ability to work independently in a remote environment.Hours:40 hours/week - Monday to Friday, standard business hours Location:Remote (CST) - Must reside in TexasPay:Competitive Market Rate Position Type:Consultant - No C2C Work Authorization:Visas are acceptable (any EAD). Candidates must be eligible to work on W2 and must not require sponsorship for at least 6-12 months. What you'll...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Description The Leidos Military and Veterans Health Solutions Operation has an opening for a Clinical Informaticist / Clinical Coder to join the Operational Readiness Directorate at the Naval Health Research Center in San Diego, CA. This position will provide support to the Epidemiology and Data Management Support Department and involves clinical coding and data abstraction to support research on the physical and mental health of military personnel to improve overall health and readiness. The person in this position will work closely with department professionals in records management, information technology, and research teams to ensure alignment of clinical coding with research needs. This is a full‑time position in San Diego. The candidate must be located within commuting distance of San Diego to work on‑site at the Naval Health Research Center as needed. Work hours will coincide with the standard command business hours of 0700‑1630. Primary Responsibilities Obtain and...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 months (possible extension) Schedule: Monday Through Friday 8am-5pm CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 17 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI) Description: Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing and coding perspective, ensure all state/federal guidelines are utilized, document findings, identify trends, this is a production environment, Top Skills Required: Coding certification with demonstrated experience in Fraud/Waste/Abuse audits, i.e. RAC audits, Special Investigation Units, etc. (able to distinguish approach to audits versus clinical/medical necessity review) . Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue...

Medical Coder Revenue Cycle Management is looking for a Medical Coder to join our team. Remote opportunity after in-person training. The Medical Coder is responsible for reviewing medical documentation and accurately assigning CPT, ICD-10-CM, HCPCS, and/or ICD-10-PCS codes depending on the encounter type. The position ensures accurate billing, compliance, and optimized reimbursement across outpatient and/or facility (inpatient) settings. Essential Functions: Assign accurate diagnosis and procedure codes based on medical record documentation using CPT, ICD-10-CM, HCPCS, and/or ICD-10-PCS. Review provider documentation to ensure coding is supported and complete for billing submission. Apply proper modifiers, sequencing, and coding conventions appropriate to the setting (inpatient or outpatient). Ensure compliance with coding regulations, organizational policies, and HIPAA standards. Meet coding productivity and quality benchmarks. Collaborate with clinical, billing, and...