85 provider coding auditor educator jobs found

Risk Adjustment Coding Specialist II Department: Quality - Risk Adjustment Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Yuvone Washington-Oshon Compensation: $70,000 - $85,000 / year Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects. What You'll Do Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company Review medical record information on both a retroactive and prospective...

Job Description Job Description Description The 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 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...

Title: HCC & ProFee Coder Location: Remote Job Type: Contract to Hire Compensation: $30.00 per hour (W2) Industry: Hospital & Healthcare About the Role Our firm is recruiting on behalf of a healthcare services client that supports health plans, provider organizations, and value-based care initiatives through advanced coding, risk adjustment, and documentation review services. We are seeking an experienced HCC & ProFee Coder to perform high-level coding validation, risk adjustment auditing, and clinical documentation review activities. This role is ideal for a coding professional with deep expertise in CMS HCC, Rx HCC, ICD-10-CM, and Medicare coding guidelines who thrives in a detail-oriented, quality-focused environment. Job Description The HCC & ProFee Coder is responsible for reviewing medical records to validate coding accuracy, ensure compliance with regulatory guidelines, and support risk adjustment and quality improvement initiatives. The position requires...

Job Details: Job Location: Main Office - Santa Barbara, CA, Position Type: Full Time, Salary Range: $31.17 - $45.20Hourly, Job Category: Financial Analytics, Central Coast Salary Range: $31.17 - $45.20 Job Summary The Risk Adjustment Coder Specialist ensures accurate medical diagnosis data submission to CMS for CenCal Health Medicare Advantage D-SNP line of business. This role optimizes diagnosis documentation, identifies barriers to appropriate risk adjustment, oversees outsourced vendor coding for CMS compliance, and partners with provider outreach teams to educate providers on accurate and comprehensive medical coding. Duties & Responsibilities Perform reviews of records to identify, validate, and ensure accurate capture of diagnosis codes aligned with CMS-HCC, HHS-HCC, ICD-10-CM and applicable risk adjustment requirements. Oversee vendor coding activities, including monitoring work quality, reviewing vendor coded records, validating findings, resolving...

Job Description At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre‑billing coding edits, and reviewing post‑billing coding‑related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer‑specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. Primary Job Duties Audit Responsibilities Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer policies....

SUMMARY: Reads and interprets medical record documentation to assign diagnosis codes, assigns CPT codes, and applies knowledge of payer reimbursement guidelines to ensure proper reimbursement. Performs related duties as required. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. 1. Adheres to the ICD-9-CM (International Classification of Diseases, 10th revision, Clinical Modification) coding conventions, official coding guidelines approved by the cooperating parties, the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets. 2. Selection and sequencing of diagnoses and procedures must meet the...

The Health Care Agency is a comprehensive healthcare system serving our diverse community of Ventura County through Ventura County Medical Center (VCMC), Santa Paula Hospital, primary and specialty care clinics, Ambulatory Care, Public Health, and Behavioral Health. Join our team and use your coding expertise to support accurate documentation, appropriate reimbursement, regulatory compliance, and quality patient care. Are you a detail‑oriented coding professional who takes pride in accuracy and continuous learning? The Health Care Agency is seeking a Coder‑Certified to perform outpatient facility and physician professional fee (Pro‑Fee) coding across hospital and ambulatory care settings. THE POSITION: Under general direction, the Coder‑Certified reviews and analyzes medical documentation, assigns appropriate diagnosis and procedure codes, applies coding and billing guidelines, and collaborates with physicians and other healthcare professionals to support accurate and compliant...

Medical Billing Specialist I/II The Department: As a vital department of Ventura County Health Care Agency (HCA), Ventura County Behavioral Health (VCBH) provides comprehensive mental health and substance use treatment services tailored to meet the needs of our community. From mobile crisis response to outpatient treatment, our array of programs ensures individuals receive the support they need at every stage of their journey. The Position: Under general supervision at the (I) level, or direction at the (II) level, the incumbent is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements. What We Offer: The County of Ventura offers an attractive compensation and benefits package. Aside from our base salary range, an employee within this position will also be eligible for the following: Educational Incentive - An educational incentive of 2.5%...

Coder-Certified The Health Care Agency is a comprehensive healthcare system serving our diverse community of Ventura County through Ventura County Medical Center (VCMC), Santa Paula Hospital, primary and specialty care clinics, Ambulatory Care, Public Health, and Behavioral Health. Join our team and use your coding expertise to support accurate documentation, appropriate reimbursement, regulatory compliance, and quality patient care. Are you a detail-oriented coding professional who takes pride in accuracy and continuous learning? The Health Care Agency is seeking a Coder-Certified to perform outpatient facility and physician professional fee (Pro-Fee) coding across hospital and ambulatory care settings. Under general direction, the Coder-Certified reviews and analyzes medical documentation, assigns appropriate diagnosis and procedure codes, applies coding and billing guidelines, and collaborates with physicians and other healthcare professionals to support accurate and compliant...

Salary : $83,674.74 - $127,725.91 Annually Location : Ventura, CA Job Type: Full-Time Regular Job Number: 0103HCA-26AA (VM) Department: Health Care Agency Division: Ventura County Medical Center and/or Santa Paula Hospital Opening Date: 10/07/2026 Closing Date: Continuous Description How to Submit a Successful Application video: THE DEPARTMENT: The Health Care Agency is a comprehensive healthcare system serving our diverse community of Ventura County through Ventura County Medical Center (VCMC), Santa Paula Hospital, primary and specialty care clinics, Ambulatory Care, Public Health, and Behavioral Health. Join our team and use your coding expertise to support accurate documentation, appropriate reimbursement, regulatory compliance, and quality patient care. Are you a detail-oriented coding professional who takes pride in accuracy and continuous learning? The Health Care Agency is seeking a Coder-Certified to perform outpatient facility and...

Coding Compliance Auditor Opportunities for you! Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek Free Continuing Education and certification Tuition reimbursement, education programs and scholarships Vacation time starts building on Day 1, and builds with your seniority Free money toward retirement with a 403(b) and matching contributions Great food options with on-demand ordering Free parking and electric charging Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community. We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page. Responsibilities The Coding Compliance Auditor is a member of the Compliance Office and contributes to the Community Health System's mission to better the lives of all those we serve. As a Coding Compliance Auditor, you will be responsible...

Coding Compliance AuditorOpportunities for you!Consecutively recognized as a top employer by Forbes, and in 2025 by NewsweekFree Continuing Education and certificationTuition reimbursement, education programs and scholarshipsVacation time starts building on Day 1, and builds with your seniorityFree money toward retirement with a 403(b) and matching contributionsGreat food options with on-demand orderingFree parking and electric chargingCommitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page.ResponsibilitiesThe Coding Compliance Auditor is a member of the Compliance Office and contributes to the Community Health System's mission to better the lives of all those we serve. As a Coding Compliance Auditor, you will be responsible for conducting coding and documentation...

Overview Opportunities for you! Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek Free Continuing Education and certification  Tuition reimbursement, education programs and scholarships Vacation time starts building on Day 1, and builds with your seniority Free money toward retirement with a 403(b) and matching contributions Great food options with on-demand ordering Free parking and electric charging Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community. We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page. Responsibilities The Coding Compliance Auditor is a member of the Compliance Office and contributes to the Community Health System’s mission to better the lives of all those we serve. As a Coding Compliance Auditor, you will be responsible for conducting coding and documentation...

Hours Hours: Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Flex hours are 6:00-9:00 am to 14:30-17:30 pm Weekend Requirements: As Needed On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $34.170 - $44.090 - $49.370 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. What You Will Do To identify and report coding and documentation practices and make recommendations which assure the accurate reporting and documentation of services provided by entity clinical providers. To support and facilitate the implementation of correct coding...

Coding Compliance Auditor Riverside University Health System (RUHS) is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences including physicians and other staff. The ideal candidate will have at least five years of progressive experience...

Certified Risk CoderThe Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.Our Values:Put Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One TeamWhat You'll DoReview medical records and provider documentation to ensure accurate capture of risk-adjusting diagnoses and compliance with CMS guidelinesPerform retrospective and...

Physician Compliance AuditorAlign with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. We provide an outstanding benefit package that includes paid vacation, wellness initiatives and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals.What you will be doing in this role:The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks associated...

Certified Coder, Acute Hospital Ed, Cancer & Edits 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: Adventist Health is seeking a Certified Coder, Acute Hospital ED, Cancer & Edits for a full-time role with 8-hour day shifts. We are looking for a qualified and dedicated individual who can work full-remote. Reviews acute hospital outpatient emergency department (ED), medical oncology, adult outpatient rehab including cardiac rehab patient records including charge capture/entry to identify the diagnosis and procedure codes performed during...

Certified Coder, Acute Hospital Ed, Cancer & EditsLocated 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: Adventist Health is seeking a Certified Coder, Acute Hospital ED, Cancer & Edits for a full-time role with 8-hour day shifts. We are looking for a qualified and dedicated individual who can work full-remote.Reviews acute hospital outpatient emergency department (ED), medical oncology, adult outpatient rehab including cardiac rehab patient records including charge capture/entry to identify the diagnosis and procedure codes performed during the...

For questions regarding this position, please contact the Recruiter listed in the Supplemental Information section. About The Position Riverside University Health System (RUHS)is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences...

Certified Risk Coder Department: Quality - Risk Adjustment Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation: $56,000 - $85,000 / year Description The Certified Risk Coder plays a critical role in supporting Astrana Health's value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. This position partners closely with providers and clinical teams to improve documentation quality, coding accuracy, and compliance with CMS risk adjustment guidelines. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement. What You'll Do Review medical records and provider documentation to ensure accurate capture of risk-adjusting...

Job Title HCC & ProFee Coder Location: Remote Job Type: Contract to Hire Compensation: $30.00 per hour (W2) Industry: Hospital & Health Care About the Role Our firm is recruiting on behalf of a healthcare services client that supports health plans, provider organizations, and value-based care initiatives through advanced coding, risk adjustment, and documentation review services. We are seeking an experienced HCC & ProFee Coder to perform high-level coding validation, risk adjustment auditing, and clinical documentation review activities. This role is ideal for a coding professional with deep expertise in CMS HCC, Rx HCC, ICD-10-CM, and Medicare coding guidelines who thrives in a detail-oriented, quality-focused environment. Job Description The HCC & ProFee Coder is responsible for reviewing medical records to validate coding accuracy, ensure compliance with regulatory guidelines, and support risk adjustment and quality improvement initiatives. The position requires...

Job DescriptionJob Description SUMMARY The Certified Risk Adjustment Coder is responsible for accurately abstracting provider services into ICD-10 codes from medical documentation.This role adheres to the coding ethics of organizations such as the American Academy of Procedural Coders (AAPC), American Health Information Management Association (AHIMA), and the National Alliance of Medical Auditing Specialists (NAMAS), as well as payer guidelines.The coder conducts concurrent, prospective, and retrospective reviews of medical record documentation to ensure the accurate and complete capture of the clinical picture, severity of illness, and complexity of patients.Additional duties include provider communication and education to support the closure of both risk adjustment and quality care gaps, as well as providing ongoing feedback to physicians regarding coding guidelines and requirements. ESSENTIAL JOB FUNCTIONS Perform coding quality audits of medical records to ensure ICD-10 codes...