68 professional coding auditor and educator jobs found

Coder II 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. Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position. 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...

Join Our Caring Community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities Deliver coding and documentation education to providers and clinic staff within IPA clinics. Be a consultative resource and ongoing support for providers in assigned clinics. Conduct documentation audits to identify gaps, trends, and opportunities for improvement. Perform quarterly chart reviews to support coding accuracy...

Coder II, Coding US:TX:McAllen | Health Information Management | Full Time This is a mid-level, work from work position. Coder is responsible for: Analyzing provider documentation Assign and sequence ICD-10-CM, CPT/HCPCS appropriately Append billing modifiers when appropriate Reconcile CPT(s) Resolves billing edits according to 3M Code editor Participates in educational activities and attends staff meetings. Position Education/Qualifications: Coding credential from an accredited coding organization required Credentials from AHIMA, AAPC preferred Extensive knowledge of medical terminology Knowledge of Coding Guidelines Knowledge of CPT rules and regulations Knowledge of NCCI policies Highly reliable Must be a team player with good people skills and possess strong initiative to get daily work finished and processed Maintain productivity levels Job Knowledge/Experience: Extensive experience in medical coding, medical terminology, and anatomy and physiology...

Coder Lll - FT Days - Coding DHR Health - US:TX:McAllen - Days Summary: POSITION SUMMARY: The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the...

Description Summary: Responsible for maintaining current and high-quality ICD-10-CM/PCS coding for all Inpatient diagnoses and procedural occurrences, through the review of clinical documentation and diagnostic results, with a consistent coding accuracy rate of 95% or better. Coder will accurately abstract data into any and all appropriate CHRISTUS Health electronic medical record systems, verifying accurate patient dispositions and physician data, following the Official ICD-10-CM and ICD-10-PCS Guidelines for Coding and Reporting. Inpatient coding is applicable towards all regional Inpatient encounters. Coder will work collaboratively with various CHRISTUS Health HIM and Clinical Documentation Specialists to ensure accurate and complete physician documentation to support accurate billing and reduce denials. Coder will also assist in other areas of the department, as requested by leadership. Coder will report directly to their Regional Coding Manager, with additional...

Become a part of our caring community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will...

Summary About the Position: This is an open continuous announcement. Multiple vacancies exist and may be filled from this announcement at any of the locations listed. We accept applications on an ongoing basis; qualified applicants will be considered as vacancies become available. Salary negotiation may be available for those candidates who are new to Federal service. This is a Direct Hire Solicitation Responsibilities Perform retrospective audits of diagnoses, E/M levels, procedures, and documentation to identify inaccurately coded services and ensure regulatory compliance. Review medical records, analyze coding accuracy trends, prepare finding reports, and coordinate results with leadership to drive performance improvement. Use encounter audits to identify operational and regulatory issues, ensures complete data capture, and support development of compliance plans. Develop and deliver one-on-one and group training on documentation and coding requirements; updates clinical...

Become a part of our caring community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will...

Basic Function HF Sinclair Midstream is seeking a Compliance Auditor Lead. The position is open to Dallas, TX; Tulsa, OK; Artesia, NM or Salt Lake City, UT. The Compliance Auditor Lead ensures compliance with regulations and conducts moderate to complex regulatory compliance and auditing assignments for assigned areas under general supervision. Job Duties Reviews, interprets, and ensures compliance with applicable federal, state, and local regulatory requirements for all assigned locations. Plans, conducts, and leads regulatory compliance and operational risk‑based audits, including evaluations and review of internal policies and procedures of the company operations. Serves as the primary liaison to regulatory agencies and as the Company's point of contact for general inquiries, audits, and on‑site evaluations. Leads and coordinates follow‑up activities associated with regulatory inspections, audits, and enforcement actions by tracking corrective actions, conducting gap...

Medical Coder IIILocation: Remote Duration: 12 Months Payrate: $27/hr. on W2Will this role be fully remote?: Yes Are there any specific locations the candidates should be in (i.e., do they need to live in IL): Any approved states What is the expected schedule (include dates/time/time zone): 7-4pm or 8-5pm local time M-F.What are the day-to-day job duties?: Abstract and review inpatient and outpatient medical records for (Hierarchical Condition Categories) HCCs to determine if the HCC is supported by the medical record documentation. Knowledge of ICD-9 ICD10 Official Coding Guidelines, AHA Coding Clinic, including Codling clinic clarifications for DOS year under review. CMS RADV Medical Reviewer Guidance (1/10/2020).Top Skills Required: Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM audits. Must have prior vendor coding review experience. Must have the ability to complete chart review production...

Risk Adjustment Coder II The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a subject matter expert for risk adjustment and will assist in the development of team trainings, quality assurance audits, and collaborating with multiple departments across the organization. Job Specifications and Core Competencies: Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions, utilizing ICD-10 coding guidelines for Commercial and Medicare risk...

Medical Coder Revenue Cycle Management is looking for a full-time 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,...

Remote Position (MondayFriday, 8:00 AM4:30 PM) Hims-Op Coding Support Remote position (MondayFriday, 8:00 AM4:30 PM) Hims-Op coding support is needed to maintain timely Cvir coding and billing. Hospital Cvir coding experience is required. Proficient in coding and EHR software. Expert knowledge of ICD-10 CM and CPT modifiers. Expert knowledge in NCCI/OCE billing edits. Preferred: 2 years education/audit review or specialty/complex acute care OP surgical coding experience. Minimum 3 years acute care hospital outpatient surgical coding experience. Candidate must hold one of the following certifications CIRCC, COC, CPC or CCS. EEO: Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of minority/gender/disability/religion/LGBTQI/age/veterans.

Physician Associate Director of Medical Operations Onsites / Clinics Location: US-TX-Denton Overview Bonus Potential! Monthly and Quarterly Bonus Incentives! Through our evidence 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...

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. Job Description: At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there’s no place like home, and that’s why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Senior Compliance Auditor . Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of...

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 Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position. 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,...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. The Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Conduct a...

Join Our Caring CommunityHumana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands.As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices.This is a hybrid position that requires occasional travel within the assigned market.ResponsibilitiesDeliver coding and documentation education to providers and clinic staff within IPA clinics.Be a consultative resource and ongoing support for providers in assigned clinics.Conduct documentation audits to identify gaps, trends, and opportunities for improvement.Perform quarterly chart reviews to support coding accuracy and...

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. Job Description: Senior Compliance Auditor - RN (Remote) At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Senior Compliance Auditor . Being a part of something this great starts by carrying out our mission every day through your...

Summary About the Position: This is an open continuous announcement. Multiple vacancies exist and may be filled from this announcement at any of the locations listed. We accept applications on an ongoing basis; qualified applicants will be considered as vacancies become available. Salary negotiation may be available for those candidates who are new to Federal service. This is a Direct Hire Solicitation Learn more about this agency Duties Help Perform retrospective audits of diagnoses, E/M levels, procedures, and documentation to identify inaccurately coded services and ensure regulatory compliance. Review medical records, analyze coding accuracy trends, prepare finding reports, and coordinate results with leadership to drive performance improvement. Use encounter audits to identify operational and regulatory issues, ensures complete data capture, and support development of compliance plans. Develop and deliver one-on-one and group training on...

Summary The medical coder is responsible for evaluating medical records documentation, coding all diagnosis and procedures for claim data entry.Essential Duties and Responsibilities include the following. Other duties may be assigned as needed to meet our department productivity standards.Comply with all legal requirements regarding coding procedures and practiceFamiliarity with ICD-10 codes, CPT/HCPCS codingEnsure correct coding compliance for procedures performed for various specialtiesWork in high volume medical coding environment while maintaining exceptional standards of excellenceRelays any necessary information to appropriate clinic staff and providersParticipates in educational activities and reports needed information to Manager and ProvidersMaintains expert knowledge of coding workflow and optimizes use of available technologyResponsible for helping review insurance denials related to any coding issuesWorking knowledge of medical terminology and anatomyConduct audits and...

EDUCATION & EXPERIENCE: Minimum Qualifications: Two years of medical billing or related experience, or related training from a non-accredited program or accredited agency. Preferred Qualifications: Outpatient women's and pediatric coding experience preferred. Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology and medical abbreviations. REQUIRED LICENSES, REGISTRATIONS, OR CERTIFICATIONS: One of the following: CCA – Certified Coding Associate (AHIMA) or CCS – Certified Coding Specialist (AHIMA) or CCS-P – Certified Coding Specialist – Physician Based (AHIMA) or RHIA – Registered Health Information Administrator (AHIMA) or RHIT – Registered Health Information Technician (AHIMA) CIC – Certified Inpatient Coder (AAPC) or COC – Certified Outpatient Coder (AAPC) or CPC – Certified Professional Coder (AAPC) or CPC-A – Certified Professional Coder – Apprentice (AAPC) or CRC –...

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,...

Coder Lll - FT Days - CodingDHR Health - US:TX:McAllen - DaysSummary:POSITION SUMMARY:The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the Standards of...