33 provider coding compliance auditor jobs found

Compliance Auditor/Educator The Compliance Auditor/Educator serves as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services. Provides professional expertise and education in CPT, ICD and HCC coding. The Compliance Auditor/Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations. This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution. Performs medical record integrity audits and conducts one-on-one meetings with Providers for corrective educational guidance. Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies problems and...

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified Inpatient 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...

Job Title Employment Type: Full time Description Purpose: Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization's strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge. Note: "patients" refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program...

Employment Type: Full time Shift: Description: Purpose Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge. Note: “patients” refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency &...

Job Description Job Description Description: A Certified Professional Medical Auditor is responsible for reviewing and auditing medical documentation, including patient records, charts, and clinical notes, to ensure accuracy, compliance with regulations, and adherence to industry standards. This role is crucial in maintaining the integrity of medical records, billing processes, and healthcare facilities' compliance with applicable laws and regulations. Key Responsibilities: Medical Documentation Review: Conduct thorough audits of patient medical records, including physician notes, progress notes, discharge summaries, and other relevant documentation. Examine medical records to verify their completeness and conformity with established standards, ensuring they accurately reflect the patient's condition, diagnosis, treatment, and other pertinent information. Verify that documentation adheres to established coding guidelines, such as ICD-10 and CPT, and compliance with...

POSITION DESCRIPTION :The Compliance Auditor / Educator serves as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services.Provides professional expertise and education in CPT, ICD and HCC coding.The Compliance Auditor / Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations.This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution.Performs medical record integrity audits and conducts one-on-one meetings with Providers for corrective educational guidance.ESSENTIAL JOB FUNCTIONS :Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies...

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...

Medical Billing SpecialistAdministration - Flint, MI 48502OverviewPosition Type Full Time Education Level High School Category Health CareDescriptionThis position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third-party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilities.General responsibilitiesAble to perform accounts receivable collection activities timely and accurately including prioritizing subtasks.Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days.Accurately post all insurance payments by line item.Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely*Collects on outstanding claims from...

Yeo & Yeo Medical Billing & Consulting Come grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding. Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies. Our people are our future – we...

Employment Type: Full time Shift: Day Shift Description: Trinity Health IHA Medical Group is looking for a customer-focused Compliance Coding Auditor-Educator to join our team. In this role, you will serve as the subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services. Provides professional expertise and education in CPT, ICD and HCC coding. What You'll Do: Develops and leads audit projects for medical record integrity. Repots audit results utilizing a standard reporting process. Identifies new errors while performing audits, investigates and assesses root cause. Performs one-on-one Audit meetings and providers for corrective educational guidance. Maintains complete knowledge and complies with all relevant insurance, CPT coding and diagnosis guidelines Provides training for IHA staff and providers on CPT, ICD10 and HCC coding standards and procedures. General...

Trinity Health IHA Medical Group is seeking a Compliance Coding Auditor-Educator to serve as a subject matter expert for CPT, ICD and HCC coding procedures. The role involves leading audits, reporting results, and educating providers and staff on compliant coding standards. The position requires a Bachelor's degree or equivalent, CPC or RHIT, and at least 2 years in coding, reimbursement analysis, or medical record auditing. #J-18808-Ljbffr

CoordinatorThe Coordinator will support Hierarchical Condition Category (HCC) coding risk adjustment initiatives across value-based care contracts by preparing medical records, performing documentation review, ensuring accurate capture of diagnosis codes, and educating providers. This role partners closely with providers, clinical staff, coding teams and operational leadership to optimize HCC capture and improve documentation integrity.Qualifications: Professional coding certification; Certified Risk Adjustment Coder (CRC) strongly preferred or required within 12 months of hireExperience with risk adjustment programs preferred.Prior provider education or clinical collaboration experience preferred.Excellent communication skills for provider education and stakeholder collaborationEmployment Type: Full TimeShift: Mon-Thrs- 8am-4:30pm Fri- 8a-12pWeekly Scheduled Hours: 36Wage Range: $23.30 - $34.95 per hourWeekend Requirements: NARequirements:- High school diploma/GED or higher...

Certified Medical Biller/Coder & Revenue Cycle Manager Submissions from recruiters, staffing agencies, or third-party contractors will not be considered. Overview: Focus Clinic is seeking a full-time Certified Medical Biller/Coder and Credentialing Specialist to take ownership of our revenue cycle operations as our clinic continues to grow. This role is ideal for a highly organized, proactive, and mission-driven professional with expertise in medical coding, insurance billing, and accounts receivable. The successful candidate will combine exceptional attention to detail and accountability with the compassion and clear communication our patients and families deserve. Key Responsibilities: Medical Coding and Documentation Review Accurately assign CPT, ICD-10-CM, HCPCS, and applicable modifier codes across Focus Clinic's multidisciplinary services, including medical visits, diagnostic evaluations and testing, therapy services, and other covered services. Review...

Job OpportunityPositions Location: Lansing, MIJob DescriptionGeneral Purpose of Job: Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes Optum CAC in accordance with established workflow. Follows University of Michigan Medicine – Sparrow policies and procedures and maintains required quality and productivity standards.Essential...

Senior Medical Records CoderAre you an experienced inpatient coder who thrives in fast-paced, academic environments and wants to make a lasting impact beyond the chart? This Senior Medical Records Coder role sits at the heart of two dynamic Family Medicine Residency programs—Corewell Health Troy Beaumont and CHMG East–Grosse Pointe—supporting highly productive faculty physicians, community preceptors, and more than 24 residents and medical students. In this highly visible and influential position, you'll serve as both coding expert and educator, guiding providers through complex documentation, billing, and compliance requirements while helping shape the next generation of primary care physicians through audits, one-on-one education, resident orientation, and ongoing regulatory review.Under general supervision and according to established procedures, provides technical support to the Inpatient Coding Staff and coordinates daily workflow based on the needs of the department. On a...

On-site Sterling Heights, MI Full time R199913 Are you an experienced inpatient coder who thrives in fast‑paced, academic environments and wants to make a lasting impact beyond the chart? This Senior Medical Records Coder role sits at the heart of two dynamic Family Medicine Residency programs—Corewell Health Troy Beaumont and CHMG East–Grosse Pointe—supporting highly productive faculty physicians, community preceptors, and more than 24 residents and medical students. In this highly visible and influential position, you’ll serve as both coding expert and educator, guiding providers through complex documentation, billing, and compliance requirements while helping shape the next generation of primary care physicians through audits, one‑on‑one education, resident orientation, and ongoing regulatory review. Job Description Under general supervision and according to established procedures, provides technical support to the Inpatient Coding Staff and coordinates daily...

Yeo & Yeo Medical Billing & Consulting Come grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding. Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies. Our people are our future we provide...

Job Opportunity Positions Location: Lansing, MI Job Description General Purpose of Job: Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes Optum CAC in accordance with established workflow. Follows University of Michigan Medicine Sparrow policies and procedures and maintains required quality and productivity standards....

Are you an experienced inpatient coder who thrives in fast‑paced, academic environments and wants to make a lasting impact beyond the chart? This Senior Medical Records Coder role sits at the heart of two dynamic Family Medicine Residency programs—Corewell Health Troy Beaumont and CHMG East–Grosse Pointe—supporting highly productive faculty physicians, community preceptors, and more than 24 residents and medical students. In this highly visible and influential position, you’ll serve as both coding expert and educator, guiding providers through complex documentation, billing, and compliance requirements while helping shape the next generation of primary care physicians through audits, one‑on‑one education, resident orientation, and ongoing regulatory review. Responsibilities Provides technical coding support to the Inpatient Coding Staff and coordinates daily workflow based on the needs of the department and as directed by the Manager of Coding. Submits departmental statistics...

Back-End Medical Biller Full-Time, Temp to Hire Opportunity - Onsite Hours: 8 am to 4:30 pm M-F (30-minute lunch) $19-$20 per hour DOE Professional Summary This position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilities General Responsibilities Able to perform accounts receivable collection activities timely and accurately including prioritizing subtasks Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days Accurately post all insurance payments by line item Communicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely*...

Back-End Medical BillerFull-Time, Temp to Hire Opportunity - OnsiteHours: 8 am to 4:30 pm M-F (30-minute lunch)$19-$20 per hour DOEProfessional SummaryThis position is responsible for billing patient services covered by Medicaid, Medicare, and other third-party payers. This position functions as a liaison between patients, third party payers, physicians, clinics, and HCHN staff regarding billing. Works under the direction of the Director of Revenue Cycle Management or designee who assigns diverse billing duties and responsibilitiesGeneral ResponsibilitiesAble to perform accounts receivable collection activities timely and accurately including prioritizing subtasksUtilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 daysAccurately post all insurance payments by line itemCommunicates practice management system issues with the Billing Supervisor to ensure claims are processed accurately and timely*Collects outstanding claims from third party...

Yeo & Yeo Medical Billing & ConsultingCome grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding.Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies.Our people are our future – we provide the...

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:...

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...