26 provider coding compliance auditor jobs found

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...

Risk Adjustment AuditorThe Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.Key Responsibilities:Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.Provide detailed audit findings and recommendations to coding teams, providers, and leadership.Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.Track and...

Medical Records Coder V (Supervisor)Koniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Coder V-Supervisor to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust.This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more.Join our team where precision, integrity, and leadership matter. Koniag Advisory Business Solutions (KABS) is seeking an experienced, highly skilled, and mission-focused Medical Records Coder V (Supervisor) to lead a coding team supporting a large-scale healthcare mission serving hospitals and clinics. This is a critical leadership role supporting coding and billing for more than 300,000 patient visits, where technical expertise,...

Koniag Advisory Business Solutions, LLC, a Koniag Government Services company is seeking a Medical Records Technician Coder V-Supervisor to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid Vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Leadership Matter. Koniag Advisory Business Solutions (KABS) is seeking an experienced, highly skilled, and mission-focused Medical Records Coder V (Supervisor) to lead a coding team supporting a large-scale healthcare mission serving hospitals and clinics. This is a critical leadership role supporting coding and billing for more than 300,000 patient visits, where technical expertise, accountability, oversight,...

Certified Professional Coder, PAMDRH Business Center (CBO and CWS) - Duncan, OK 73533OverviewPosition Type Full Time Job Shift Day Shift Education Level Certification Travel Percentage None Category AdministrativeDescriptionThis position is responsible for reviewing a patient's medical records after a Clinic visit and translating the information into codes that insurers use to process claims for patients. Duties include confirming treatments with medical staff, identifying missing information, and submitting information to insurers for reimbursement.Responsibilities (Essential Functions):Accurately assigns and sequences codes (ICD-10-CM, CPT, HCPCS/modifiers as necessary) for each patient encounter, following proper coding guidelines and legal requirements to ensure compliance with federal and state regulations.Ensures professional/physician billing CPT codes/ICD-10 codes are assigned correctly and sequenced appropriately as per government and insurance regulations.Queries...

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...

Koniag Advisory Business Solutions, LLC, a Koniag Government Services company , is seeking a Medical Records Biller V-Supervisor to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid Vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Leadership Matter. Koniag Advisory Business Solutions (KABS) is seeking an experienced, highly skilled Medical Biller V (Supervisor) to lead a billing team supporting a large-scale healthcare mission serving hospitals and clinics. This is a key leadership role responsible for billing quality, workflow oversight, denials management, and day-to-day supervision of Medical Biller IV (Lead) and Medical Biller III staff....

Position Title: Professional Coder - Radiology Department: Revenue Integrity Job Description: New to OU Health? Ask your recruiter about our competitive wages and total rewards package. Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. SPECIALTY AREA: Neuro Interventional Radiology Looking for a coding team to love at OU Health? This is it! While this role is specifically searching for an experienced Neuro Interventional Radiology coder, we also cover multiple specialties so there's opportunities to learn and grow . 100% remote. Flexible shifts once training is complete. Opportunity to work four 9 hour days, and one 4 hour day. So if you're work-from-home ready, work well independently, and have strong coding skills we just may be the right fit for you! ***The ideal candidate would have teaching hospital or trauma center coding experience and familiarity with CT, MRI...

Job Purpose The Lead Coder will code all patient types as needed; inpatient, swing bed, same‑day surgery, ancillary, ambulatory and provider‑based clinics, and will mentor, train, and assist coding staff, including newly hired staff. They must review documentation to assign appropriate CPT/HCPCS and ICD‑10‑CM‑PCS diagnosis codes and procedures for hospital and physician (professional) services for inpatient and outpatient records based on knowledge of coding systems. Essential Functions Ensures that coding compliance initiatives are met with all record types. Conducts regular internal coding audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures and education as needed. Assists with productivity reporting and reducing DNFC. Coding complex outpatient or inpatient accounts utilizing encoder software and references in the assignment of ICD‑10‑CM/PCS, CPT/HCPCS codes, DRG, POA assignments, APC assignment and...

Professional Coder - RadiologyIndependently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, wRVU integrity, and audit defensibility in an academic and research enterprise.Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position.Code complex professional encounters and procedures; ensure correct sequencing, modifiers, E/M level selection, and documentation alignment. Advanced expertise in ICD?10?CM, CPT®, HCPCS, and modifiers; strong E/M coding proficiency and payer policy interpretation.Resolve coding-related edits and denials by identifying root cause, coordinating documentation...

JOB SUMMARY: The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. KEY RESPONSIBILITIES: • Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. • Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines. • Identify unsupported diagnoses, over coding, under-coding, and documentation gaps. • Provide detailed audit findings and recommendations to coding teams, providers, and leadership. • Monitor compliance with CMS Risk Adjustment Data Validation (RADV)...

Current Saint Francis Employees - Please click HERE (https://wd115.myworkday.com/saintfrancis/d/task/2998$46522.htmld) to login and apply. Full Time Job Summary: The Coding Auditor performs coding audits to assure compliance with Corporate Compliance Plan standards. This role develops, coordinates, and implements clinic wide education for coding and billing issues while serving as a resource to physicians, office staff, management and patients for coding and billing issues. Additionally, this role coordinates successful response to regulatory bodies and insurance companies for medical record reviews and audits. Minimum Education: High School Diploma or GED. Bachelor's degree in Healthcare Administration or Business Administration, preferred. Licensure, Registration and/or Certification: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA). Work...

Become a part of our caring community The Inpatient Medical Coding Auditor - PPI Coding Disputes reporting to the Manager reviews the appropriate DRG and ICD-10-CM/ PCS coding assignments for accuracy within the coding disputes team from a variety of medical records. The Disputes Auditor - MSDRG Inpatient Coding on the Disputes Team consults and collaborates with coding professionals within and across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality. Will be an experienced medical coding auditor with in-depth experience in inpatient coding audits (MSDRG/APDRG) Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate coding guidelines and communicates disputes outcomes to providers in a professional and concise manner. Leverages advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices Manages multiple...

Labela is seeking certified U.S. medical coders for high-level coding and documentation consulting. You will serve as a subject matter expert to validate, refine, and audit the coding logic and documentation reasoning of frontier AI models. This is a flexible, remote role designed for practicing coders and auditors to influence the accuracy and compliance of medical AI at scale. In this role you will audit AI outputs for ICD-10-CM/PCS, CPT, and HCPCS, provide expert-level validation for full #J-18808-Ljbffr

Professional Coder - RadiologyIndependently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, wRVU integrity, and audit defensibility in an academic and research enterprise.Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position.Code complex professional encounters and procedures; ensure correct sequencing, modifiers, E/M level selection, and documentation alignment. Advanced expertise in ICD?10?CM, CPT®, HCPCS, and modifiers; strong E/M coding proficiency and payer policy interpretation.Resolve coding-related edits and denials by identifying root cause, coordinating documentation...

Surg/Op CoderFully Remote • Home Office - Oklahoma City, OK 73134OverviewPosition Type Full Time Job Shift Day Education Level Certification Travel Percentage Occasional Category Health Information Management (HIM)DescriptionJOB PURPOSE: This position is for an Outpatient Coder with Emergency Dept and Ambulatory Surgery coding experience. The coder will code Surgery, Emergency department, and Ancillary records. Emergency Dept coding includes injection & infusion coding as well as the assignment of the E&M Professional fee. Coder will demonstrate competency by meeting productivity standards and achieving an accuracy rate of 95% on all chart types coded.Will abstract and code every account compliantly, accurately, and completely, to ensure accurate and timely reimbursement and reporting. Verifies, reviews, analyzes, and abstracts medical information; researches missing clinical information; assigns accurate codes; appropriately queries physicians when required; elevates...

Medical Records Technician Coder IV-LeadKoniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Technician Coder IV-Lead to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more.Join Our Team Where Precision, Integrity, and Expertise Matter. Koniag Advisory Business Solutions (KABS) is seeking highly skilled, self-directed Medical Records Coder IV (Lead) professionals to support a large-scale healthcare mission serving hospitals and clinics. This is an opportunity to bring your expertise to a team responsible for coding and billing more than 300,000 patient visits, where accuracy, compliance, sound...

Overview Koniag Advisory Business Solutions (KABS), a Koniag Government Services company, is seeking a Medical Records Biller V‑Supervisor to support KABS and its government customer in Oklahoma City, OKC. The position requires obtaining a Public Trust. This role is covered under the Service Contract Act and offers competitive compensation plus a comprehensive benefits package: health, dental and vision insurance; 401(k) with company matching; paid holidays; paid vacation; paid sick leave and more. Work Schedule and Hybrid Conditions This hybrid position is based at 701 Market Dr, Oklahoma City, OK 73114. The project kick‑off is July 1. During the first few weeks of onboarding, employees are required to work on site full‑time, Monday‑Friday, 8:00 a.m. to 5:00 p.m. CT. Core hours are generally 9:00 a.m. CT to 3:00 p.m. CT, with start and end times determined by the Program Manager. Hours may flex based on client needs. Based on demonstrated proficiency and performance, employees...

Certified Medical Coder Edmond, OK | Full‑Time $20-$26/hour DOE | Pay: Competitive Schedule: Monday – Thursday: 8:00 AM – 5:00 PM Friday: 8:00 AM – 1:00 PM Are you a detail-oriented Certified Medical Coder looking to join a fast‑paced specialty clinic where your work truly matters? We are seeking a motivated CPC‑certified professional to become part of a supportive team focused on accuracy, collaboration, and exceptional patient care. Certified Medical Coder – Must‑Have Requirements Certified Professional Coder (CPC) certification required High School Diploma or GED required Minimum of 2 years of medical coding experience preferred Strong knowledge of CPT, ICD‑10, and HCPCS coding Experience with medical billing, insurance verification, authorizations, and collections preferred Knowledge of Medicare and third‑party payer guidelines Experience using EMR/EHR systems and coding software Strong attention to detail and organizational skills Excellent communication and problem‑solving...

Medical Records Biller V-SupervisorKoniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Biller V-Supervisor to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more.Join Our Team Where Precision, Integrity, and Leadership Matter. Koniag Advisory Business Solutions (KABS) is seeking an experienced, highly skilled Medical Biller V (Supervisor) to lead a billing team supporting a large-scale healthcare mission serving hospitals and clinics. This is a key leadership role responsible for billing quality, workflow oversight, denials management, and day-to-day supervision of Medical Biller IV (Lead) and...

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:...

Job Posting Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status. Job Summary Reviews billing data from medical office or hospital records to ensure amounts and account numbers are accurate, responsible for account posting, collections, and verifying patient benefits. Responsible for accurate diagnose and procedure coding. Responsible for insurance pre-certifications, pre-authorizations, pre-determinations and other required insurance notifications for procedures performed in the clinic. Essential Functions Review and analyze patient records and physician documentation for completeness and accuracy, focusing on areas such as radiology reports, neurological procedures, office visit notes, and laboratory results. Assign precise CPT, ICD-10, HCPCS (and when applicable, APC/DRG) codes to...

Koniag Advisory Business Solutions LLC, a Koniag Government Services company , is seeking a Medical Records Technician Coder III to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid Vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Expertise Matter. Koniag Advisory Business Solutions (KABS) is seeking detail-oriented, highly capable, and motivated Medical Records Coder III professionals to support a large-scale healthcare mission serving hospitals and clinics. This is an opportunity to contribute to a team responsible for coding and billing more than 300,000 patient visits, where accuracy, compliance, accountability, and sound judgment are...

Medical Records Technician Coder III Koniag Advisory Business Solutions LLC, a Koniag Government Services company, is seeking a Medical Records Technician Coder III to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more. Join Our Team Where Precision, Integrity, and Expertise Matter. Koniag Advisory Business Solutions (KABS) is seeking detail-oriented, highly capable, and motivated Medical Records Coder III professionals to support a large-scale healthcare mission serving hospitals and clinics. This is an opportunity to contribute to a team responsible for coding and billing more than 300,000 patient visits, where accuracy, compliance,...