24 provider coding compliance auditor jobs found

*Risk Adjustment Coding Auditor* Overview We are seeking a detail-oriented *Risk Adjustment Coding Auditor* to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement. The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models. Key Responsibilities * Perform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy. * Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses. * Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting. * Evaluate coding practices...

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following: Review inpatient medical records and claims to ensure accurate coding and reimbursement Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes Audit coding quality and identify opportunities for...

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral health, transportation and other provider records, ensuring correct coding and documentation and adherence to regulatory standards. You will audit across Medicaid lines, identify FWA patterns, educate providers, and support regulator submissions while maintaining compliance with policies. Strong analytical skills and collaboration are essential. #J-18808-Ljbffr

RCM / Medical Billing SpecialistAlbany, New York, United States; Albuquerque, New Mexico, United States; Scottsdale, Arizona, United StatesWorkit Health is an industry-leading provider of on-demand, evidence-based telemedicine care. Our programs are based in harm reduction, and bring together licensed clinicians who really listen, FDA-approved medication, online recovery groups and community, interactive therapeutic courses, and care for co-existing conditions. Workit Health's patient-centered telemedicine model is improving clinical outcomes and eliminating barriers to treatment, making long-term recovery accessible to individuals who need it, without disrupting their daily lives.We're excited to expand our team as our impact and coverage areas continue to grow. Our team members are dedicated and passionate about our mission of making exceptional, judgment-free care for addiction more accessible.We believe everyone deserves respectful, effective treatment for substance use...

About Optima Medical :Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130medical providers, who care for more than 200,000 patients statewide.Our mission is to improve the quality of life throughout Arizona by helping communities Live Better, Live Longer through personalized healthcare, with a focus on preventing the nation's top leading causes of death.We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services.We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard.This position requires an initial 60-day training period at our corporate office in Scottsdale, Arizona.Upon successful completion of training, the position will transition to a fully remote role.Job Responsibilities :Audit Medical Records...

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...

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. Job...

Baylor Scott & White Health in Phoenix is seeking a Coding Auditor 1 to perform coding quality audits using ICD-10-CM/PCS, HCPCS, CPT and related references to support accurate classification and reimbursement. You will collaborate with Clinical Documentation Specialists, provide constructive feedback, and help ensure compliant documentation across internal teams and third-party vendors. A strong knowledge of coding rules and HIPAA is essential. #J-18808-Ljbffr

Job Description Job Description Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors with strong expertise in outpatient professional fee coding and coding audits , preferably within academic medical centers. You will review coding records, identify compliance risks, and provide expert feedback to support AI-focused projects. No prior AI experience is required. Key Responsibilities Conduct detailed audits of outpatient professional fee coding records. Review coding accuracy, documentation, and compliance. Identify coding trends, gaps, risks, and improvement opportunities. Apply academic medical center standards and coding guidelines. Document audit findings and provide clear recommendations. Evaluate complex coding and documentation scenarios. Contribute to AI training through expert coding and audit feedback. Support audit program management and quality improvement initiatives. Required Qualifications...

Audits charts and revies clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medica specialty upon translating audit findings Follows up and clarifies any information that i s not clear with the rendering provider Collaborates with IT and EHR teams to improve charge automation and optimize workflows Conducts ad-hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies Nonessential Functions Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program Ensures...

RCM / Medical Billing SpecialistAlbany, New York, United States; Albuquerque, New Mexico, United States; Scottsdale, Arizona, United StatesWorkit Health is an industry-leading provider of on-demand, evidence-based telemedicine care. Our programs are based in harm reduction, and bring together licensed clinicians who really listen, FDA-approved medication, online recovery groups and community, interactive therapeutic courses, and care for co-existing conditions. Workit Health's patient-centered telemedicine model is improving clinical outcomes and eliminating barriers to treatment, making long-term recovery accessible to individuals who need it, without disrupting their daily lives.We're excited to expand our team as our impact and coverage areas continue to grow. Our team members are dedicated and passionate about our mission of making exceptional, judgment-free care for addiction more accessible.We believe everyone deserves respectful, effective treatment for substance use...

Join to apply for the Professional Billing Coder II role at Onvida Health 2 days ago Be among the first 25 applicants Join to apply for the Professional Billing Coder II role at Onvida Health Get AI-powered advice on this job and more exclusive features. Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks Shift: Days Pay Rate Type: Hourly Location: Remote Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates. Min = $22.62 Mid = $28.28 Max = $33.93 Summary The Professional Billing Coder II is an intermediate-level coding professional responsible for independently reviewing medical documentation and assigning accurate diagnostic and...

Under general supervision of the HIM Director, the Certified Inpatient Coder is responsible for reviewing inpatient medical records and accurately assigning ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, and MS-DRGs in accordance with official coding guidelines, federal regulations, and Tribal 638 facility policies. Upholds the principles of WIHCC's Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times. This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive. Essential Duties & Responsibilities: Maintains regular attendance and punctuality. Review inpatient medical records to identify all diagnoses and procedures relevant to each patient encounter. Assign ICD-10-CM and ICD-10-PCS codes according to official coding guidelines. Determine and assign the appropriate MS-DRG. Ensure coding reflects the highest level of specificity...

PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center. Position Summary The Lead Medical Coder serves as a certified professional coder and assists the Medical Coding Office Manager with oversight of daily coding operations. Performs the full range of coding, assigns ICD, CPT, HCPCS, and medical inpatient codes; abstracts data from the record; performs chart analysis, research coding issues; peer reviews; and serves as a medical documentation and coding technical expert to TONHC providers. Scope of Work This position is located within Tohono O'odham Nation Health Care (TONHC). The work involves performing specialized medical record tasks and resolving problems using established processes, coding conventions, and guidelines. Performance of duties reflects directly on patient care by recording services performed on the patient. The incumbent works...

Job Title Essential Functions: Audits charts and reviews clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medical specialty upon translating audit findings Follows up and clarifies any information that is not clear with the rendering provider Collaborates with IT and EHR teams to improve charge automation and optimize workflows Conducts ad-hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies Nonessential Functions: Follows policies and procedures and adheres to the...

About Optima Medical: Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical providers, who care for more than 200,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and dedicated professionals aboard. We are currently seeking a Medical Coding Specialist to join our team! This role will transition to a fully remote position after up to 30 days of training. To be eligible, you’ll need to complete your initial training onsite at our...

Audits charts and revies clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medica specialty upon translating audit findings Follows up and clarifies any information that i s not clear with the rendering provider Collaborates with IT and EHR teams to improve charge automation and optimize workflows Conducts ad-hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies Nonessential Functions Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program Ensures...

Southwest Network is seeking a skilled medical coder auditor to audit charts and ensure coding accuracy. You will analyze clinical records for proper codes and modifiers, identify denials risk patterns, and stay current with evolving guidelines. The role includes coaching staff and communicating audit findings to providers. Collaborating with IT and EHR teams, you will help improve workflows and support the corporate compliance program through ad-hoc audits and documentation reviews. #J-18808-Ljbffr

Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical providers, who care for more than 200,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities “Live Better, Live Longer” through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and dedicated professionals aboard. We are currently seeking a Medical Coding Specialist to join our team! This role will transition to a fully remote position after up to 30 days of training. To be eligible, you’ll need to complete your initial training onsite at our Scottsdale office and remain...

Rockstar is an industry-leading staffing company based in Arizona that helps healthcare businesses across the United States streamline operations by connecting them with skilled remote professionals. We partner with talented individuals from around the world, providing meaningful remote career opportunities that empower personal and professional growth. At Rockstar, we are committed to placing team members who not only meet our clients' operational needs but who also reflect our core values of integrity, excellence, and long-term service. Every placement is an opportunity to make a meaningful difference, for the practice, for patients, and for you. Job Description This is a remote position. Rockstar is seeking an experienced Medical Billing Specialist to support U.S.-based healthcare practices on a full-time remote basis. This is a billing-first role built for professionals who know the full revenue cycle, not just one piece of it, and who take ownership of the financial health...

LOCATION: WICKENBURG, AZ Wickenburg Community Hospital is a beautiful and sophisticated rural-access hospital located in Wickenburg, Arizona. WCH is a 8-bed Emergency Department, 19-bed Acute department and many ancillary services. We also have 3 Primary Care Clinics. Here at WCH, we strive to maintain the highest standards of professionalism and care. Join us today and let us be part of your success story. We offer: Full Benefits PTO/Sick Leave Wellness Benefits Wickenburg Community Hospital is a non-profit organization and qualifies for the Public Service Loan Forgiveness (PSLF) program. GENERAL DESCRIPTION The Medical Coding Supervisor oversees daily operations of the coding staff in the HIM Dept which includes coding, auditing, peer review, chart review, charge capture, documentation improvement and compliance. Ensures efficient and effective department operations by managing employee relations as well as guiding and coaching staff to achieve...

Job Description Job Description Job Title: Medical Auditor Job Type: Contractor Location: Remote Job Overview We are seeking experienced Medical Auditors to contribute their specialized expertise to an innovative healthcare AI project. In this role, you will help improve next-generation AI systems by reviewing, evaluating, and refining medical coding and audit-related content. This opportunity is ideal for professionals with strong experience in outpatient professional fee coding, auditing, and academic medical center environments. No prior AI experience is required—your healthcare expertise is what matters most. Key Responsibilities Conduct detailed reviews and audits of outpatient professional fee coding records for accuracy, compliance, and quality. Identify coding trends, gaps, risks, and opportunities for improvement. Evaluate audit findings using knowledge of academic medical center protocols and industry best practices. Document audit results and...

Location: Tucson Employment Type: Full-Time Schedule: Monday – Friday Position Overview The Medical Biller / Coder & Credentialing Specialist will manage key functions of the revenue cycle including coding accuracy, claims processing, payer credentialing, denial management, and provider enrollment. This role works closely with providers, leadership, and clinical teams to ensure accurate billing, compliance with payer requirements, and efficient reimbursement processes. Key Responsibilities Medical Coding Review provider documentation and assign accurate ICD-10, CPT, and HCPCS codes. Ensure coding complies with payer regulations and industry guidelines. Identify documentation gaps and communicate with providers when clarification is required. Support coding compliance and documentation improvement. Claims & Billing Prepare and submit electronic claims through the practice management system. Monitor claim status and follow up on unpaid or denied claims....

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for a dynamic person to join us, working with our highly skilled Medical Coding Team to fill the role of Medical Coding Auditor & Educator.We are a 100% remote team supporting our clients across the United States! See us at.The ideal applicant will be a subject matter expert in both Facility and Profee medical coding auditing.Job Focus :The Senior Coding Auditor may be responsible for a variety of duties and obligations, depending on the client and assignment.These responsibilities may include inpatient / outpatient / professional fee facility auditing, denial management, coding, implementation specialist, job aid creation, training, and specialty coding.The position may also be responsible for management of the audit team and project management.All coding and auditing are performed within the scope of regulatory and compliance law expectations.Auditing Responsibilities :May include conducting inpatient,...