Regulatory compliance auditor jobs

Full Time

Billing Compliance Curriculum Development Specialist

Dana-Farber Cancer Institute Remote (Boston, MA)

Billing Compliance Curriculum Development Specialist Dana-Farber Cancer Institute Boston, MA Full Time, Remote (Occasional Onsite) Overview Reporting to the Manager of Billing Compliance, the Billing Compliance Curriculum Development Specialist is responsible for designing, implementing, and maintaining a comprehensive billing compliance education and awareness program that supports adherence to federal and state regulations and aligns with industry standards. This role develops and delivers training for billing providers, including physicians and advanced practice providers, and provides post-review education and feedback in collaboration with Billing Compliance Reviewers and Senior Billing Compliance Reviewers, as needed. The Specialist creates, updates, and manages instructional materials such as presentations, tip sheets, slide decks, and other training resources, and tracks training completion and effectiveness. The position also supports the...

EP

Full Time

Ophthalmology Coding Auditor

Eye Physicians & Surgeons Milford, CT

This is a non-remote position. We are seeking a detail-oriented, on-site Ophthalmology Coding Auditor to join our premier private practice. Under direct supervision of the Billing Manager, the Coding Auditor audits ophthalmology and optometry medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines. In this role, you will work directly alongside our clinic team to review clinical documentation, surgical charts, and diagnostic reports, ensuring accurate coding, regulatory compliance, and optimal reimbursement. You will serve as our internal expert, identifying billing risk areas and providing face-to-face feedback and education to our providers and staff to support the financial health of our practice. Key Responsibilities Perform On-Site Audits: Conduct regular retrospective and prospective reviews of clinical...

Full Time

Coding Auditor

AllCare Health Hybrid (Grants Pass, OR)

Coding Auditor AllCare Health | Quality Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members. This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes. Essential Duties Ensures the accuracy and...

Full Time

Coding Educator

SSM Health Remote

Bring your coding expertise to SSM Health in a role where education, quality, and compliance come together. As a Coding Educator, you’ll partner with providers and coders, lead training initiatives, and influence documentation and coding practices that support accuracy, consistency, and revenue integrity across the organization. PRIMARY RESPONSIBILITIES Drives optimal clinical and financial outcomes through thorough assessment of provider documentation and coding competency, identification of improvement opportunities. Develops and delivers training and education of all coding processes. Stays abreast of regulatory changes and works with leadership to ensure compliance and revenue integrity. Act as subject matter expert for providers and coders while providing guidance and clarification on issues which present in their daily account processing. Establishes and coordinates internal quality review processes and corresponding training for providers and coders....

Contract

Medical Coders (ER, SDS and IP) and Data Quality Auditors

Pena4 Inc. Remote

Multiple ED, SDS and IP Coding Assignments Available & Data Quality Auditors Needed Description: Coders and Auditors with 3-5+ years of facility coding experience are needed to provide coverage to Pena4’s clients. Responsibilities : Pena4 M edical Coders are responsible for accurately assigning ICD-10-CM/PCS diagnosis and CPT procedure codes for inpatient and outpatient hospital services. This role ensures coded data is complete, compliant, and supports appropriate reimbursement, quality reporting, and regulatory requirements. Coders must meet or exceed determined productivity and quality standards for respectively assigned client engagements in order to ensure the highest level of coding. Summary: Position Type: 1099 Independent Consultant 100% Remote Assignments Schedule/Shift varies per assignment. See current assignment details below. Credentials: CPC, CCS, RHIA, RHIT (preferred) 3-5+ years of Facility Coding Will be required to complete ED,...

Full Time

Coding Specialist

Bridge Remote

About Bridge Bridge is the fastest, most compliant way to scale insurance billing nationwide. We enable virtual care companies to go in-network nationally in as little as 30 days, without the operational lift. Our platform handles payer contracting, credentialing, real-time benefit verification, medical coding, claim submission, denial management, and compliance in a single integrated solution. Backed by leading investors including General Catalyst, Andreessen Horowitz, Thrive Capital, Khosla Ventures, Greenoaks, and Mischief, we're scaling rapidly. The Role We are seeking a detail-oriented and experienced RCM Coding Specialist with CPC (Certified Professional Coder) certification to join our Revenue Cycle Management team. This role is responsible for accurate and timely medical coding in accordance with current coding guidelines, payer requirements, and company standards. The ideal candidate has strong analytical skills, in-depth knowledge of CPT, ICD-10, and...

VP

Full Time

Director of Documentation Integrity and Coding

Vistec Partners NY

The goal is this position is to educate providers on proper use of CPT codes, ICD10 codes, modifiers and audit activities related to health plan operations, risk adjustment, payer audits and regulatory requirements. This role ensures accurate medical coding, documentation integrity, and adherence to federal, state, and payer-specific guidelines. The ideal candidate will possess advanced CPC coding expertise, strong analytical skills, and extensive experience supporting compliance initiatives within a managed care or health plan environment. This is a full-time position, on site, 5 days a week. Responsibilities: • Serve as subject matter expert on CPT, HCPCS, ICD10 and modifier coding for physicians and coders. • Ensure provider documentation and coding practices comply with CMS, Medicare, Medicaid, commercial payer, and applicable federal and state regulatory requirements. • Conduct coding compliance audits to identify...

MG

Full Time

Certified Coding Auditor - Outpatient

Marwood Group Hybrid (New York, NY)

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm’s private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker’s compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions. The Advisory Group is currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely. Principal duties and responsibilities: Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payors....

Full Time

Coding and Compliance Analyst

Family Health Center Hybrid (WI)

* This is a hybrid position to be located in WI with travel required. * JOB SUMMARY The Coding and Billing Compliance Analyst plays a critical role in safeguarding the accuracy, integrity, and regulatory compliance of coding and billing operations across all service lines. This position supports the organization’s revenue cycle and compliance initiatives by conducting detailed coding and billing reviews, identifying areas of risk, and contributing to the development of corrective action plans and educational programs. The analyst ensures adherence to federal and state billing regulations, including Medicaid/Medicare guidelines, HRSA program requirements, and Office of Inspector General (OIG) guidance specific to Federally Qualified Health Centers (FQHCs). The Analyst collaborates with providers, billing teams, compliance officers, and revenue cycle leadership, to improve clinical documentation, optimize reimbursement, and maintain full compliance with all applicable...

9 regulatory compliance auditor jobs found