24 professional coding auditor jobs found

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. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Review medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines Utilize encoders and various coding resources Perform CPT Procedure reviews...

Auditor The auditor reviews professional fee billing, coding and documentation. Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses. Customers include employed providers, senior leadership, clinical and non-clinical staff of Cooper University Health Care. Under the supervision of the Chief Compliance Officer, auditors are responsible for supporting the corporate compliance program, responsibilities include: Performance of timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy, identify compliance related risks, internal control weaknesses, revenue capture opportunities and assist in determining the root cause of any identified non-compliance with government rules and regulations, state laws and Cooper policies and procedures Preparatory work for reviews/audits including developing a scope of work. Reviewing available documentation. Analyze/review audit data and...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with...

Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Physician Billing (PB) Coding Auditor and Educator is responsible for auditing and educating healthcare providers on related applicable clinical documentation. This work supports coding and billing regulations that ensure appropriate reimbursement, public reporting, and various initiatives as directed by the Hackensack Meridian Health (HMH) Network. Responsibilities A day in the life of a Physician Billing (PB) Coding Auditor and Educator...

About UsAt Cooper University Health Care , our commitment to providing extraordinary health care begins with our team.Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.We have a commitment to our employees to provide competitive rates and compensation programs.Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement.We also provide attractive working conditions and opportunities for career growth through professional development.Discover why Cooper University Health Care is the employer of choice in South Jersey.Short DescriptionThe auditor reviews professional fee billing, coding and documentation.Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses.Customers include employed providers, senior leadership,...

About Us At Cooper University Health Care , our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs.  Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development. Discover why Cooper University Health Care is the employer of choice in South Jersey. Short Description The auditor reviews professional fee billing, coding and documentation.  Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses.  Customers include employed providers,...

DRG Coding Auditor Principal _Virtual: _ _ ​_ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from...

Datavant is a leading data platform company revolutionizing health data exchange. Our mission is to ensure that every healthcare decision is made with the right data, delivered timely and in the appropriate format. Powered by the most extensive health data network in the U.S., our platform guarantees secure, accessible, and usable data to enhance health decisions. We are proud to be trusted by the foremost life sciences organizations, government bodies, and healthcare providers. By joining our team, you will be part of a high-performing and values-driven culture. Together, we are addressing some of healthcare's most challenging issues with innovative technology solutions. We embrace a diverse array of professional and personal experiences among our team members as we pursue our ambitious goals for healthcare. What We're Seeking We are on the lookout for seasoned and certified inpatient coders to join our team. The perfect candidate will have exceptional attention to...

Join Datavant, a leading data platform company revolutionizing health data exchange. Our mission ensures that every healthcare decision is guided by the right data at the right time and in the right format. As the world's foremost health data network, our platform enables secure, accessible, and actionable data, empowering healthcare stakeholders including life sciences firms, government agencies, and care providers. By becoming part of Datavant's high-performing, values-driven team, you'll contribute to innovative technology solutions that address some of healthcare's most challenging issues. Our diverse team brings various professional, educational, and life experiences together to achieve our ambitious goals for the healthcare sector. What You'll Be Doing: Conduct audits of coded medical charts according to the client's guidelines as assigned by the quality supervisor. Navigate multiple client guidelines with ease. Maintain a 95% quality average at the...

Job Description Job Description Medical Biller (ABA Services) Lakewood, NJ $60K–$75K (DOE) In Office | 6 Hrs Min. Job Description: We are seeking a detail-oriented and experienced Medical Biller to join our billing team for a multi-state ABA (Applied Behavior Analysis) company. The ideal candidate will be highly organized, familiar with behavioral health billing, and capable of managing end-to-end revenue cycle tasks. Key Responsibilities: Submit accurate and timely claims to insurance payers (commercial and Medicaid) Review session data, verify coding, and ensure compliance with payer requirements Follow up on unpaid or denied claims, resubmitting as necessary Post payments and reconcile Explanation of Benefits (EOBs) Communicate with insurance companies, internal teams, and occasionally families regarding billing issues Stay current on payer policies, authorization guidelines, and industry changes Assist in monthly reporting and audits as...

Medix - American Metro Center 300 [Medical Records Clerk] As a Coder at Medix, you'll: Analyze medical records to assign appropriate codes for billing and insurance purposes; Ensure accuracy and compliance with coding guidelines and regulations; Collaborate with healthcare professionals to clarify diagnoses and procedures; Maintain confidentiality of patient information; Update coding knowledge through continuous education and training; Assist in audits and reviews to improve coding processes and accuracy...Hiring Immediately >>

Job Description Job Description Behind every great practice is a great billing team. We’re hiring a detail-driven Medical Billing Specialist to support a busy orthopedic office. If you like solving problems, keeping things organized, and making sure providers get paid correctly — this is your lane. What You’ll Do✨ Post and reconcile insurance and patient payments Submit clean, accurate claims and patient statements Follow up on denials and resubmit appeals Help patients understand their bills (with clarity and professionalism) Stay up to date on coding rules and payer guidelines Keep billing records organized and audit-ready Assist with insurance verification and prior authorizations What You Bring ✨ Experience in medical billing or revenue cycle Knowledge of insurance claims and coding basics Strong attention to detail Comfort with billing software and EMR systems Clear communication skills Ability to manage multiple tasks without missing details...

Job Description: The HIM Hospital Inpatient & Same Day Surgery Coding Analyst deciphers and interprets provider documentation in the health record and assigns diagnostic information using ICD-10-CM/PCS and CPT codes for a complex range of acute care services for Intermountain Health. The caregiver provides specific coding expertise in the various fields of NCCI edits, Drugs and Biologicals, Revenue Codes, Current Procedural Terminology (CPT) codes, ICD-10 & CPT codes, DRGs, anatomy and physiology, pharmacology. The analyst also performs audits, provides feedback, and advanced training to clinical teams and physicians on ICD-10 and CPT coding best practices. Essential Functions Reviews and analyzes inpatient medical records for completeness, accuracy, and compliance for Same Day Surgery, Observation and Inpatient acute services at Intermountain Health. Performs coding at an advanced level of complexity for inpatient hospitals including governmental and/or...

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...

Job Description Day to Day Insight Global is hiring several CPC, Certified Professional Coders to join a large healthcare client in Southern NJ. This role focuses on multi-specialty professional fee coding in a high-volume, production-driven environment. Candidates will work remotely but must reside in approved states and be available for occasional onsite visits. Responsibilities  • Abstract billing for outpatient evaluation and management (E/M) codes, minor surgical procedures, and HCPCS codes (including supplies and pharmaceuticals) from provider documentation.  • Assign CPT-4 and ICD-10-CM codes with appropriate modifiers.  • Investigate coding and billing questions to determine the best approach.  • Analyze medical records to verify coding accuracy and detect potential misuse.  • Collaborate with Coding, Charge, and Audit Analysts to resolve discrepancies.  • Work across multiple Epic work queues for different specialties.  • Meet productivity expectations...

Position Summary Certified Professional Coder provides quality review and analysis of a wide range of patient medical records, ensures accuracy of coding, and maintains records in accordance with accepted medical and legal standards. Responsible for reviewing medical records to ensure proper billing of the medical record, comparison of the physician-chosen CPT and ICD-10 codes to the physician's documentation to substantiate the level of coding, and complete review of medical records to accurately optimize all professional services documented for billing. Responsibilities Verifies patient demographic data for accuracy and completeness Performs audit of services on a daily basis for accuracy Evaluates designated medical records to identify diagnoses, operations and procedures, and accurately assigns and sequences ICD-10 and/or CPT codes Reviews the accuracy and consistency of medical record documentation and brings any inconsistencies to the attention of the...

Position Summary The Certified Inpatient Coder is responsible for the accurate diagnostic and procedural coding of medical records. The Coder is also responsible for the accurate abstracting of medical, financial and demographic information, in addition to performing other events. Core Duties and Responsibilities • Per standard process reviews and evaluates designated medical records to identify diagnoses and procedures and accurately assigns and sequences ICD CM, ICD PCS and/or CPT codes • Reviews medical record for proper assignment of diagnosis and procedure codes according to AHA coding guidelines • Contacts Physicians and Other Healthcare Providers to clarify diagnoses and procedures • Sequence codes appropriately for accurate DRG • Abstracts required data from the medical record, including, but not limited to, Attending Physician, Discharge Disposition, ICD-9-CM , ICD-10-CM, CPT diagnosis and/or procedure codes, and Physician Consultation • Completes medical...

POSITION SUMMARY: Position Summary The Inpatient Senior Coder is responsible for accurate, compliant, and timely coding and abstracting of inpatient medical records, including the assignment of ICD-10-CM/PCS codes and validation of MS-DRG and APR-DRG groupings. This position ensures proper reimbursement, adherence to regulatory and coding guidelines, and supports overall clinical documentation accuracy for inpatient services. This is a remote position with onsite availability required as needed. EDUCATION: High school diploma or equivalent. CCS (Certified Coding Specialist) Required . EXPERIENCE: * Three to five years of inpatient hospital coding experience * Proficient in ICD-10-CM and ICD-10-PCS coding * In-depth knowledge of MS-DRG and APR-DRG reimbursement systems * Familiarity with coding audits and clinical documentation review * Experience with Observation or complex outpatient cases is a plus * Prior mentoring or training experience preferred...

Lakewood Surgery Center is hiring a full time Medical Biller Welcome to Lakewood Surgery Center At Lakewood Surgery Center, we provide first-class surgical services for local communities and recognize our employees as our number one assets. We focus on offering a high quality, ambulatory care alternative to a hospital for surgical procedures. Our facility is accredited by The Joint Commission. Medical Biller at Lakewood Surgery Center The Medical Biller is responsible for overseeing the entire billing process for patient accounts, from submitting all billings to insurance in a timely manner, to working with our coding specialist to ensure that all cases are coded correctly, leading monthly coding audits, and taking the lead role in driving insurance collections. Essential Job Duties and Responsibilities include the following: Electronically submit patient procedure bills to third party payers Perform timely and accurate postings of payments received from...

Job Description The Sterile Processing Department Supervisor continuously assesses activities of SPD Team associated in the processing of reusable medical devices, distribution of procedural supplies, and deployment of patient care equipment. Provides subject matter expertise and evidence-based practice to support the department's operational improvement. The SPD Supervisor assists the assistant manager to evaluate and implement educational programs for the department. Principal Accountabilities: Provides SPD team members (internal and external) with educational support, including needs assessments. Provides standardized education in area of expertise, as well as general education including but not limited to orientation, annual competency assessment, regulatory, accreditation and certification. Develops and communicates a full range of educational and quality monitoring programs to assist SPD Assist Manager/ SPD Manager, Lead Technicians, Sterile Processing...

Local candidates preferred - requires ability to be onsite as needed. Job Summary : Responsible for leading professional fee (pro-fee) coding quality audits, education, and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. This includes leading the workflow of the audit team performing internal audits and providing education and training to the pro-fee coders and clinicians. Responsible for leading all activities related to the large scale external audit, including creating and maintaining audit documentation, ensuring audit schedule and reporting meet required timelines, and coordinating post-audit activities (including provider education and re-audit). Works with Director to implement and execute on the compliance plan for VMG coding. Position Responsibilities: Leads and coordinates all phases of external clinical professional fee coding audit: Selects audit sample and applies national bell curve in...

Job Summary: Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. This includes performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders. Responsible for working with VMG practices to resolve all coding issues that prevent accounts from being processed appropriately. Responsible for developing, implementing and maintaining compliance plan for pro-fee coding and abstracting. Position Responsibilities: Training and Education: Providing training and education for newly hired coders that includes utilizing the medical record in conjunction with rules and regulations to properly code VMG encounters. Audits new coders once they approved to submit charges in the work queues and provides appropriate feedback. Developing coding and training resources for the entire coding team...

Please note all candidates must complete & pass onsite testing in Marlton, NJ prior to an interview. Position Responsibilities: Responsible for abstracting clinical information and assigning CPT-4 and ICD-10 codes from medical records and documents to support physicians professional fees, including but not limited to outpatient evaluation and management (E/M) services and procedures in accordance guidelines. Job Description Job Description Position Responsibilities: • Abstract billing for outpatient evaluation and management codes, minor surgical procedure(s) and HCPCS (supplies and pharmaceuticals) codes from provider documentation to include; assignment of CPT-4, ICD-10-CM codes and modifiers. • Research simple coding/billing issues for the physicians to identify and recommend the most appropriate method of coding/billing. Research may involve interaction with such organizations as American Medical Association, specialty societies, or other coding...