49 professional coding auditor educator jobs found

Medical Records Coder II/III San Mateo County Health is seeking an experienced Medical Records Coder II/III to join Correctional Health and support the coding of CalAIM billable services, including clinic visits and ancillary services. This position plays an important role in ensuring accurate reimbursement while supporting continuity of care for justice-involved individuals. The successful candidate will perform billing functions related to the Department of Health Care Services (DHCS) Justice-Involved CalAIM Initiative. This initiative allows eligible incarcerated individuals to enroll in Medi-Cal prior to their release and enables reimbursement for covered healthcare services provided during the 90 days before reentry, helping support successful transitions back into the community. This position requires independent proficiency in ICD-10 and CPT coding, coding audits, physician education on coding practices, Evaluation and Management (E/M) coding, and identifying and...

Medical Records Coder II/III San Mateo County Health is seeking an experienced Medical Records Coder II/III to join Correctional Health and support the coding of CalAIM billable services, including clinic visits and ancillary services. This position plays an important role in ensuring accurate reimbursement while supporting continuity of care for justice-involved individuals. The successful candidate will perform billing functions related to the Department of Health Care Services (DHCS) Justice-Involved CalAIM Initiative. This initiative allows eligible incarcerated individuals to enroll in Medi-Cal prior to their release and enables reimbursement for covered healthcare services provided during the 90 days before reentry, helping support successful transitions back into the community. This position requires independent proficiency in ICD-10 and CPT coding, coding audits, physician education on coding practices, Evaluation and Management (E/M) coding, and identifying and...

Job Posting Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Reviews inpatient records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Records types including inpatient encounter types. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work. Job Requirements: Education and Work Experience: High School Education/GED or equivalent: Required...

DRG Coder The Senior DRG Coder is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-Related Group (DRG) assignment. This role ensures coding accuracy, reimbursement integrity, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent Practice Association (IPA) and Management Services Organization (MSO) environment, the Senior DRG Coder partners with utilization management, care management, finance, and provider network teams to support accurate payment, risk adjustment, quality reporting, and medical expense analysis. What You'll Do Review inpatient hospital records and assign accurate diagnosis and procedure codes Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation Conduct coding validation and auditing to ensure compliance with payer and regulatory...

Medical Records Coder II/III San Mateo County Health is seeking an experienced Medical Records Coder II/III to join Correctional Health and support the coding of CalAIM billable services, including clinic visits and ancillary services. This position plays an important role in ensuring accurate reimbursement while supporting continuity of care for justice-involved individuals. The successful candidate will perform billing functions related to the Department of Health Care Services (DHCS) Justice-Involved CalAIM Initiative. This initiative allows eligible incarcerated individuals to enroll in Medi-Cal prior to their release and enables reimbursement for covered healthcare services provided during the 90 days before reentry, helping support successful transitions back into the community. This position requires independent proficiency in ICD-10 and CPT coding, coding audits, physician education on coding practices, Evaluation and Management (E/M) coding, and identifying and...

Job Description Job Description The Revenue Cycle Management CPC Auditor is responsible for conducting comprehensive audits across all phases of the revenue cycle to ensure accuracy, compliance, and optimal reimbursement. This role is critical in identifying revenue leakage, reducing denials and strengthening internal controls and staff productivity requirements. The Auditor will evaluate charge capture, coding accuracy, documentation integrity, billing workflows, payment posting, denial follow-up, Appeals, and AR follow-up for RCM, clinical, and provider teams to drive continuous process improvement. *This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA. What you will do: Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including:  Charge entry and charge capture accuracy  CPT, HCPCS, and ICD-10 coding compliance  Modifier usage  Workers’...

Description Under direction of the Coding Supervisor and Coding Manager, performs coding audits of patient care billing documentation to ensure adherence with CPT and ICD coding guidelines and federal, state, and commercial payor billing and payment policy for all services provided by Providence Medical Foundation. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them. Required qualifications: Upon hire: National Certification from American Academy of Professional Coders. Or Upon hire: National Certified Coding Associate - American Health Information Management Association. Or Upon hire: National Certified Coding Specialist - American Health Information Management...

Sherman Oaks Hospital Coder Auditor At Sherman Oaks Hospital, our dedicated team of professionals are committed to our core values of quality, compassion, and community. Sherman Oaks Hospital is a 153-bed, not-for-profit, acute-care community hospital located in Sherman Oaks, California. Staffed with over 500 employees and an extraordinary team of physicians, the hospital is recognized for advanced technology and compassionate care and provides 24/7 emergency care in addition to a full range of specialized medical, surgical, and diagnostic services to improve and save lives. Responsibilities The Coder Auditor reviews and analyzes documentation present in the medical record for both inpatient and outpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software. Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of...

Certified Coder Professional Reporting to the Manager Physician Coding Services, the Certified Coder Professional will be responsible for reviewing and evaluating clinical documentation within medical records to ensure high quality and compliant coding. The Certified Coder Professional will provide training, consultation, and feedback to clinicians on their documentation and coding to ensure Emanate Health Medical Group receives appropriate reimbursement and conforms to applicable guidelines and regulations. Collaborates with Emanate Health's Compliance team and with all third party billing and reimbursement requirements including, but not limited to, the requirements of Medicare and Medicaid programs. Serves as the coding subject matter expert for the physicians. Minimum Education Requirement: Associate degree preferred; college degree preferred, knowledge of Medical Terminology, Anatomy & Physiology and Computer experience. Minimum Experience Requirement: Minimum of 2+...

Coding Compliance Auditor In accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant. The Coding Compliance Auditor will also, provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics Re: coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems...

Health Coder - Hcc & Risk Adjustment Burlingame, CA 94010 Overview Salary Range $42.79 - $48.75 Hourly Description The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance. Essential Job Functions: Hcc Coding and Risk Adjustment (Ra) Program Support Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with Hcc and risk adjustment guidelines. Ensure all...

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. What you will do: Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with other departments to address coding updates and support risk adjustment...

Job Description Job Description The Certified Cardiology Coder plays a critical role in accurately translating cardiology medical records into standardized codes used for billing and documentation. This position requires expertise in cardiology procedures and coding standards to ensure compliance and data integrity. The coder works closely with clinicians and utilizes specific coding software alongside manual coding processes to support effective claims processing and reporting.   Responsibilities Assign accurate codes based on cardiology medical records Review and audit medical records for coding compliance Ensure data accuracy and adherence to coding guidelines Generate reports related to coding and billing activities Analyze patient data for completeness and coding accuracy Conduct coding audits to identify discrepancies and improve processes Collaborate with clinicians to clarify documentation and coding queries Process claims efficiently to support timely...

The Revenue Cycle Management CPC Auditor is responsible for conducting comprehensive audits across all phases of the revenue cycle to ensure accuracy, compliance, and optimal reimbursement. This role is critical in identifying revenue leakage, reducing denials and strengthening internal controls and staff productivity requirements. The Auditor will evaluate charge capture, coding accuracy, documentation integrity, billing workflows, payment posting, denial follow-up, Appeals, and AR follow-up for RCM, clinical, and provider teams to drive continuous process improvement. *This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA. What you will do: Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: Charge entry and charge capture accuracy CPT, HCPCS, and ICD-10 coding compliance Modifier usage Workers' compensation billing rules and state-specific...

The Medical Coder is primarily responsible for performing chart reviews and coding audits; reviewing appropriate ICD-10 diagnoses codes, and CPT and HCPCS procedure codes assigned for evaluation and management of the patient. Additional responsibilities include supporting pre-or post-payment coding audit for benchmark and/or reimbursement recovery, and other coding-related activities such as pre-appointment chart audits for HCC or risk adjustment, appeals of denied claims, providing information or education to providers for specificity of documentation to align with the coding guidelines to comply with federal, state, and regulatory requirements. ESSENTIAL JOB FUNCTIONS: Performs pre-appointment HCC or risk adjustment chart reviews, coding audits, or other coding-related projects Acts as internal resource for all coding inquiries from providers, Billing, Laboratory, Radiology, and other departments. Provides real time coding consultation and review and evaluation of...

You Matter Make a difference every day in the lives of the underserved Join a mission driven organization with a people first culture Excellent career growth opportunities Join us and find a career that supports Caring for overlooked, underserved, and vulnerable patients Diversity, equity, inclusion, and belonging Autonomy in a warm team environment Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: DailyPay, receive your money as you earn it! Tuition Assistance and dependent Scholarships Employee Assistance Program (EAP) including free counseling and health coaching Company paid life insurance Tax free Health Spending Accounts (HSA) Wellness program featuring fitness memberships and product discounts Preferred banking partnership and discounted rates for...

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County. Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values. Why Join Us? We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The Risk Adjustment Coding Auditor is responsible for...

JOB SUMMARY The Health Information Coder III PD is a senior-level inpatient coder with advanced knowledge and skill set to utilize the ICD-10-CM, ICD-10-PCS, CPT, HCPCS classification systems. The skill set extends to advanced knowledge and comprehension of code sequences into Diagnoses-Related Groups. Cases are coded to comply with the official guidelines for coding and reporting, practice standards and code of ethics for HIMS coder. Cases are abstracted according to UCSF Health policies and procedures. The focus of coding and abstracting is on a range of all primary hospital services. This is a per diem position with no set schedule. OTHER FUNCTIONS AND RESPONSIBILITIES Demonstrate understanding of DRG coding mission within UCSF Health. Demonstrate understanding of DRG coding, AR, and data submission information flow. Ability to solve problems and troubleshoot computer issues. Perform data searches. Maintain patient confidentiality and IT...

Position Overview Under the general direction of the Revenue Manager/Associate Director, this senior coder role oversees a large range of coding combinations (approximately 1,500–5,000), applies specialized coding knowledge to manage ICD‑10 and CPT procedural codes, and guides a centralized coding team as a subject matter expert to improve accuracy and efficiency of professional fee coding. Responsibilities Lead as a subject matter expert, presenting information to the team. Audit and oversee team members’ accuracy and production. Ensure compliance with all federal, state, and local carrier guidelines. Provide education and training to coding staff and physicians. Perform high‑production coding to meet UCSF goals for accuracy and charge lag. Conduct in‑depth reviews of physician documentation and prepare documentation audits. Create coding analysis reports and online presentations with findings and recommendations. Determine methods and procedures for new assignments and...

Default Work Shift: Day (United States of America) Hours: 40 Salary range: $23.97 - $36.42 Schedule: Full Time Shift Hours: 8 Employee Department: Patient Financial Services Job Objective Responsible for performing revenue cycle integrity audits within the Charge Descriptive Master and other revenue cycle charge capture and reconciliation processes. Job Description Education: Required: High school diploma, GED or higher level degree if hired after March 1, 2025. Preferred: Medical coding coursework or bachelor’s degree in related field. Licensure/Certification: Required: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) within one (1) year if hired into position after January 1, 2021. Experience: Required: Two (2) years of medical billing, charge capture, coding or patient account auditing experience. Preferred: Revenue cycle experience, hospital/clinical experience. Reports To: Manager or Director. Supervises: N/A. Ages of Patients: N/A. Blood Borne...

Job Details Level: Experienced Job Location: Sheraton Redding Hotel at the Sundial Bridge - Redding, CA 96003 Position Type: Full-Time/Part-Time Salary Range: $19.00 - $21.00 Hourly Job Shift: Graveyard Job Category: Hospitality - Hotel POSITION PURPOSE Record, process, and analyze the days closing figures. Complete all required reports and ensure that the days credit transactions are all in balance. Attend to guests needs, including but not limited to, registration, checkout, cashiering, and making guest wake up calls. ESSENTIAL RESPONSIBILITIES Acts as the MOD during the night-time hours. Greets and welcomes guests upon arrival. Performs guest registration and check out procedures. Accept payment for guests accounts both at the time of registration and at checkout. Maintain a house bank and make a deposit and accurate reports of receipts daily. Cash checks and exchange currency for guests. Accurately handle cash transactions and balance a cash drawer to the given amount....

Join to apply for the Compliance Coding Auditor , ATM role at Advanced Medical Management, Inc. Your actual pay will be based on your skills and experience. Talk with your recruiter to learn more. Base pay range: $75,000 to $80,000 per year. Role Overview As a member of AMM’s Compliance and Ethics team, the Compliance Coding Auditor is an important driver of our mission. They are responsible for supporting the Company’s Compliance & Ethics Program (the Program) auditing, tracking, and monitoring initiatives. Robust auditing, testing, and monitoring capabilities are essential to fulfilling the expectations of AMM’s key stakeholders, including patients, families, and government agencies. The Program is led by AMM’s Chief Compliance & Ethics Officer, who reports to the CEO and the Board, and oversees the AMM Compliance Committee. This role requires sound, risk‑aware judgment, productive collaboration across the Company, and demonstrated success in performing audits to...

Job Description Job Description Overview The Sr Compliance Coding Auditor performs complex coding audits across a range of services, including those delivered in correctional settings and through third-party billing vendors. This role serves as a subject matter expert on coding and documentation guidelines, identifying risks and preparing detailed audit findings. The position works closely with leadership to develop corrective actions and deliver education to providers and coders. This role also supports regulatory audits and provides guidance and mentorship to compliance staff. Responsibilities Plan and conduct complex coding audits using risk-based sampling and established methodologies. Review provider documentation, coding, and modifier usage to ensure compliance with coding standards and payer rules. Analyze findings, prepare detailed audit reports, and present results to providers, coders, and leadership. Support corrective action planning, education efforts,...