28 professional coding auditor jobs found

Job Description Job Description PYA is seeking a Professional Coding Auditor/Consultant to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue Integrity team in a professional coding auditor role . RESPONSIBILITIES: Responsible for the accurate review of PYA clients’professional fee coding per industry coding audit standards, support of the management team with project management tasks, support of the verbal and written reporting to the client, and conducting provider coding and documentation education ( generally, conducted remotely ). Coding auditing of complex services rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare, medical necessity, and NCD/LCD requirements. Professional coding auditing expertise in multiple specialties is required, including...

Physician Compliance Auditor Grady Health System offers many career paths for experienced professionals. Whether you have many years of experience or are in the early stages of your career, you can find a rewarding career at Grady! Location: Atlanta, GA Job Type: FTE Shift/Schedule: Days This is a remote role, but the ideal candidate will be required to come into the office occasionally to meet with the providers. The Physician Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, the appropriateness of treatment setting, HIPAA matters, and other compliance issues as directed by the Physician Coding Director, Compliance Director. This position requires effective communication with internal...

Whatever the role, everyone at Grady is part of something bigger. Choosing a career at Grady is choosing to be part of a legacy of service and commitment to our communities. If you want to make a difference, we want to hear from you. Job Summary Core Competencies These competencies reflect the values and behaviors expected of all Grady team members, regardless of role. They ensure that every employee contributes to safe, high-quality care, positive patient experience, and a collaborative work environment. 1. Patient-Centered Care - Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well-being and satisfaction of patients and their families. 2. Integrity & Accountability - Acts ethically, maintains confidentiality, and accepts responsibility for actions, decisions, and outcomes. 3. Collaboration & Teamwork - Builds positive relationships, works effectively across departments, and supports colleagues to...

Overview Be inspired . Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoingmentorshipand leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, and leadership programs And more Description Overview: Reporting to the Director, the Sr. Compliance Auditor, develops and executes audit, monitoring, and education for both facility and professional billing, coding and documentation programs that ensure compliance with regulatory standards across Physician Services. Continuously evaluates facility/professional billing compliance activities to...

Overview Be inspired. Be valued. Belong. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs...and more! Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. Reviews discrepancies between the Clinical...

Medical Coding Auditor Become a part of our caring community and help us put health first. The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal...

Job Description Job Description Description: Seeking a detail-oriented and knowledgeable Provider/Coding Auditor Educator to support accurate and compliant coding practices across our provider network. This role will be responsible for performing audits of medical documentation and coding, educating providers on best practices, and ensuring adherence to industry guidelines and payer regulations. The ideal candidate is a certified coding professional with strong communication skills and a passion for education and compliance. This role requires flexibility to travel 50% of the time to various provider locations in the State of Georgia for onsite education and auditing support, as needed Requirements: Key Responsibilities Conduct prospective, concurrent, and retrospective coding audits for professional and/or facility services. Review medical documentation to ensure codes assigned (ICD-10-CM, CPT, HCPCS) are supported and meet regulatory and payer guidelines. Deliver coding...

A healthcare organization based in Atlanta is seeking a Physician Compliance Auditor to conduct audits, report findings, and lead training sessions on coding and billing. The ideal candidate will possess at least five years of coding experience, with a strong organizational skill set and effective communication abilities. Preferred qualifications include a Certified Professional Coder certification and experience in auditing. Join a team committed to ensuring compliance and excellence in healthcare billing processes. #J-18808-Ljbffr

Become a part of our caring community and help us put health first The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy and operating objectives, and follows established guidelines and procedures while making decisions in ambiguous situations. Where you come in The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g.,...

Medical Coder A Medical Coder for WellStreet Urgent Care is responsible for supporting all aspects of the Revenue Cycle for our Urgent Care Centers. Responsibilities Coding for our Urgent Care Centers using our internal software Knowledge of ICD-10 Coding and compliance Experience using an encoder Setting up insurance plans within our software Working with the Revenue Cycle Management to identify & resolve issues related to coding and the process flow Interfacing with clinic staff on billing & coding issues. Comply with all legal requirements regarding coding procedures and practices Conduct audits and coding reviews to ensure all documentation is accurate and precise Assign and sequence all codes for services rendered Collaborate with billing department to ensure all bills are satisfied in a timely manner Communicate with insurance companies about coding errors and disputes Contact physicians and other health care professionals with questions about...

Risk Adjustment Coder Specialist Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for...

Inpatient Facility Coder My client is hiring for an experienced Inpatient Facility Coder to support hospital-based coding operations within a Trauma Level I teaching facility. This is a fully remote opportunity offering flexible daytime hours, with the expectation that candidates are available to work full-time (40 hours per week). Key Responsibilities: Assign accurate ICD-10-CM and ICD-10-PCS codes for inpatient facility encounters Review clinical documentation to ensure compliant and complete coding Apply inpatient coding guidelines in accordance with CMS, UHDDS, and facility standards Support DRG assignment and coding quality initiatives Collaborate with CDI, physicians, and revenue cycle teams as needed Meet established productivity and accuracy benchmarks Required Qualifications: CCS, RHIT, or RHIA certification (required) 23 years of inpatient facility coding experience Experience coding in a Trauma Level I teaching hospital Strong knowledge of inpatient...

Job Description Job Description The Staff Pad has partnered with Blue Ridge Medical Center in Blue Ridge, Georgia. Blue Ridge Medical Center is seeking an experienced Health Information Management (HIM) Coder to join our team in a fully remote capacity. This individual will be responsible for reviewing, analyzing, and assigning diagnostic and procedural codes for inpatient, outpatient, and/or emergency department medical records using ICD-10-CM, CPT, and HCPCS coding systems in accordance with official coding guidelines and facility standards. Key Responsibilities: Review and abstract clinical documentation from patient records to assign accurate codes for diagnoses and procedures Ensure compliance with federal regulations and hospital policies related to coding and billing Maintain productivity and quality standards established by the HIM department Query physicians when appropriate to ensure accurate and complete documentation Assist in resolving...

Datavant is a leading data platform company dedicated to health data exchange, with a vision that every healthcare decision is powered by accurate data at the right time. Our network is one of the largest and most diverse in the U.S., ensuring that data remains secure and accessible to enhance health decisions. Our clients include prominent life sciences firms, government agencies, and healthcare providers. Joining Datavant means becoming part of a high-performing, values-driven team that is committed to solving the intricate challenges of healthcare through technological innovations. Our diverse team members bring a rich array of professional, educational, and personal experiences to support our ambitious vision for the future of healthcare. Your Role: We are seeking credentialed inpatient coders who possess meticulous attention to detail and a solid understanding of medical terminology to join our dynamic team. This position offers the flexibility of fully remote work,...

Inpatient Coder 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...

Job Description Job Description Description: Southeast Primary Care Partners is seeking a dedicated and detail-oriented Certified Coder to join our dynamic team. The successful candidate will play a crucial role in accurately coding healthcare claims for reimbursements, ensuring compliance with federal regulations, and contributing to the efficiency and effectiveness of our healthcare services. Certified Coder reviews medical records to assure proper billing. Participates in audits to evaluate if all selected codes are accurate and develops methodologies to improve coding issues identified. Codes must meet QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Position Summary: Requirements: Key Responsibilities: Review patients' medical records to extract relevant information needed for billing and coding. Apply appropriate ICD-10, CPT, and HCPCS Level II code assignments to ensure accurate and timely billing. Work closely with healthcare...

Job Description Job Description Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas....

A leading health insurance company is seeking a Senior Specialist in Risk Adjustment to manage operations for Medicare Advantage and ACA lines of business. This remote position requires a bachelor's degree and certifications in coding, alongside at least two years of relevant experience. Key responsibilities include daily operations, compliance with standards, and participation in audits. The position comes with a competitive salary range and extensive employee benefits including medical and dental coverage, paid leave, and a 401(k) plan. #J-18808-Ljbffr

About the role The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities Responsible for daily operations pertaining to Risk...

Location: Fully Remote Schedule: Flexible Daytime Hours (Must Work Full-Time) Pay Rate: $35-40/hour Benefits: LaSalle Network contractors have the opportunity to enroll in benefits including medical, dental, and vision insurance. Job Description: My client is hiring for an experienced Inpatient Facility Coder to support hospital-based coding operations within a Trauma Level I teaching facility. This is a fully remote opportunity offering flexible daytime hours, with the expectation that candidates are available to work full-time (40 hours per week). Key Responsibilities: Assign accurate ICD-10-CM and ICD-10-PCS codes for inpatient facility encounters Review clinical documentation to ensure compliant and complete coding Apply inpatient coding guidelines in accordance with CMS, UHDDS, and facility standards Support DRG assignment and coding quality initiatives Collaborate with CDI, physicians, and revenue cycle teams as needed Meet...

Job Description Job Description The Medical Coder / Coder PAR at Apex Spine and Neurosurgery is responsible for reviewing clinical documentation and assigning accurate CPT, ICD-10, and HCPCS codes for spine, neurosurgical, and interventional pain management services. This role ensures compliant, complete, and timely coding to support revenue integrity, authorization accuracy, and efficient claims processing in accordance with CMS and payer guidelines. Key Responsibilities Review operative reports, clinic notes, imaging, and diagnostic studies to accurately assign CPT, ICD-10, and HCPCS codes for spine and neurosurgical procedures. Code surgical and procedural services including (but not limited to): spine surgeries, decompressions, fusions, discectomies, laminectomies, injections, nerve blocks, ablations, and other interventional pain procedures. Ensure compliance with CMS guidelines, NCCI edits, payer-specific policies, and internal coding standards. Communicate directly...

Job Description Job Description Job Summary We are a growing Arthritis and Rheumatology Center, seeking a highly experienced Lead Certified Medical Coder to support a compliance-driven rheumatology and infusion practice in Cumming, GA. This role is in-person and requires expert-level knowledge of rheumatology and biologic infusion coding, strict adherence to CMS and payer regulations, and active oversight of coding compliance through audits, monitoring, and corrective action. The Lead Coder serves as the primary coding authority and risk mitigation resource for the organization. Key Responsibilities Coding Compliance & Audit Oversight Ensure accurate and compliant coding of rheumatology services, biologic therapies, and infusion encounters Apply CPT, ICD-10-CM, HCPCS (including J-codes), modifiers, units, and wastage in strict accordance with CMS and payer guidelines Validate documentation supports medical necessity, infusion start/stop times, dosing, and...

You will be able to work from your home location within the United States PURPOSE AND SCOPE: Conducts data quality audits of outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology. Provides feedback and education to coders. Escalates compliance, risk-related issues to expedite mitigation. PRINCIPAL DUTIES AND RESPONSIBILITIES: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding. Chart Analysis, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA/AAPC). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to...