27 rn crc coding auditor jobs found

Registered Nurse - Utilization Management/Coder RN Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Bienvivir is currently accepting applications for the following position: REGISTERED NURSE - UTILIZATION MANAGEMENT / CODER The...

Description Summary: The Compliance Auditor II will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws. Conducts audit activities, reporting and communicates audit findings. Works in conjunction with Compliance Director on compliance work plans, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with...

QA Nurse / Coder (RN) As a QA Nurse / Coder, you will ensure the accuracy, completeness, and regulatory compliance of Home Health documentationparticularly OASIS assessments, the Home Health Plan of Care (485), and face-to-face encounter noteswhile properly sequencing diagnoses according to federal/state standards and agency policy. Core responsibilities include: Review OASIS forms and Plans of Care for appropriateness, completeness, and compliance. Assign and sequence ICD?10 codes in line with current home health coding guidelines. Ensure consistency and compliance of face-to-face encounter documentation with OASIS and care plans. Conduct additional clinical record audits and OASIS reviews as assigned. Stay current on Medicare reimbursement policies, home health regulations, and compliance requirements. Maintain relevant certifications (HCS?D, HCS?O or COS?C). Participate in quality assurance and performance-improvement efforts. Coordinate with physicians, facilities,...

Remote Certified Coder Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: CMS HCC Risk Adjustment HEDIS Medical Record Reviews (Accreditation) And more Job Description These are remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient...

A company is looking for an Inpatient DRG Auditor / Coder (RN and Non RN). Key Responsibilities Perform inpatient DRG auditing and coding reviews Analyze disease processes and clinical indicators affecting DRG assignment Review audit outcomes and implement corrective actions Required Qualifications Experience with inpatient DRGs Previous auditing experience in an inpatient setting Strong knowledge of clinical documentation and DRG impact Ability to reference and apply coding guidelines accurately Professional communication skills

Job Description Summary The Compliance Auditor reports to the Internal Audit Coordinator and performs audits to evaluate adherence to laws, regulations and policies by reviewing records, analyzing data, and interviewing staff and stakeholders. These audits include but are not limited to services identified as high-risk via the annual risk assessment, OIG-CMS-PGBA workplan areas, ad hoc audit requests, and "for cause" coding and billing concerns. The audit scope includes a) the regulatory and industry research needed for audit planning, b) pre and post audit meetings with stakeholders, c) cohesive audit report that communicates results and includes a corrective action plan if warranted, and d) education and training to stakeholders as needed. Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type Regular Cost Center CC002278 SYS - Compliance Program Pay Rate Type Salary Pay Grade Health-27 Scheduled Weekly Hours...

Internal Reference Number: R1050337 Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have...

Benefits: 401(k) Competitive salary Employee discounts Paid time off Overview: We are seeking a Clinical Coding Auditor & Trainer to lead DRG and medical record auditing and deliver staff training programs. This role supports quality improvement, compliance, and education across clinical and coding teams. Responsibilities: Conduct audits of staff work; report findings and improvement recommendations. Develop and deliver coding and DRG training programs. Revise policies and procedures to improve audit accuracy. Maintain training and audit records and track staff progress. Ensure compliance with company policies and healthcare standards. Requirements: RN, PA, MD, APRN, DO, or MBBS license. Associate's degree in Nursing or equivalent experience. 4+ years of DRG and/or medical record audit experience. 1 year of clinical experience in a hospital setting. Strong written communication skills. Preferred: Inpatient coding experience....

Position Purpose: Develop and conduct training and quality auditing programs for Diagnosis Related Group (DRG) and Medical Record Audit programs. Location: Primarily remote with biannual travel to New York required, applicant outside of New York can also apply for this role, as long as they are open to NYC few times in year. Travel: Travel to New York twice a year Key Responsibilities: udit work performed by staff and present findings and recommendations for improvements to management. Manage auditing projects independently, requiring originality and critical thinking. ssist in revising policies, procedures, and work process development. nalyze training needs for clinical and coding staff. Develop or select appropriate training programs and create training aids. Maintain records of audit and training activities and track employee progress. Review patient letters for accuracy and clarity with strong English grammar skills....

6 days ago Be among the first 25 applicants This range is provided by TalentPlug LLC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $55,100.00/yr - $99,000.00/yr Direct message the job poster from TalentPlug LLC Job Title Clinical Coding Auditor & Trainer Job Location Remote (Candidates must be residents of New York) Summary The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Position Purpose Responsible for developing and conducting training and quality auditing programs for the Diagnosis Related Group (DRG) and Medical Record Audit Programs for Fidelis Care. Applicants must be willing to travel to New York twice a year. Responsibilities Conducts auditing of work performed by staff and present findings and recommendation for areas...

Clinical Coding Auditor & Trainer Location: Remote (U.S.) – Must be willing to travel to New York twice a year for onsite meetings or training sessions. Position Type: Full Time This role is responsible for conducting clinical documentation and coding audits to ensure compliance with federal regulations, payer requirements, and company policies. The focus is on DRG validation, inpatient medical record auditing, and education/training for clinical and coding teams. Key Responsibilities Conduct DRG validation and inpatient coding audits to ensure medical record accuracy and compliance. Provide training and education to clinical, coding, and quality staff on coding guidelines, audit findings, and process improvements. Review clinical documentation and coding practices for adherence to federal and payer standards (CMS, AHIMA, AAPC, etc.). Evaluate and recommend process improvements to enhance coding accuracy and quality of medical record documentation. Collaborate with...

About the job Clinical Coding Auditor & Trainer We are looking for a Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis. Candidates must be willing to travel to New York twice a year to be considered for the position. Position Purpose: Responsible for developing and conducting training and quality auditing programs for the Diagnosis Related Group (DRG) and Medical Record Audit Programs for Fidelis Care. Responsibilities: Conducts auditing of work performed by staff and present findings and recommendation for areas of improvement to management Under minimal supervision responsible for all aspects of auditing projects that are broad in nature and require originality and/or ingenuity Assists with revisions to Policy and Procedure and/or work process development Conducts training needed analysis to determine specific training needs for clinical and coding staff Identifies, selects, or...

Clinical Coding Auditor & Trainer Location: Remote (U.S.) - Must be willing to travel to New York twice annually Position Type: Full Time The Clinical Coding Auditor & Trainer is responsible for conducting clinical documentation and coding audits to ensure compliance with federal regulations, payer requirements, and company policies. This position focuses on DRG validation , inpatient medical record auditing , and education/training for clinical and coding teams. The role is primarily remote, with occasional travel to New York twice a year for onsite meetings or training sessions. The ideal candidate will possess strong analytical and clinical expertise, proficiency in medical coding standards, and exceptional written communication skills to ensure audit accuracy and compliance across departments. Key Responsibilities: Conduct DRG validation and inpatient coding audits to ensure medical record accuracy and compliance. Provide training and...

Role: Clinical Coding Auditor & Trainer Location: Remote, NY, US (The Clinical Coding Auditor & Trainer position is primarily remote with a small travel expectation on an annual basis Candidates must be willing to travel to New York twice a year to be considered for the position.) Permanent/Full Time Salary: USD $55,100 - $99,000 / yr Must-haves Willingness to travel to New York twice a year RN, PA, MD, APRN, DO, or MBBS license Valid/Current CPC or CIC Certification, through APPC desired or CCS through AHIMA Inpatient coding experience 1 year of experience in clinical environment - hospital Required Skills RN, PA, MD, APRN, DO, or MBBS license Associate's degree in Nursing or equivalent experience 4+ years of DRG and/or Medical Record Audit experience 1 year of clinical experience in a hospital setting Strong written communication skills Preferred or Nice-to-have Skills Inpatient coding experience Valid/Current CPC or CIC Certification, or...

Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of...

Position Purpose Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Location This is a remote position, Monday - Friday from 8:30am - 5pm. What You’ll Do Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates. Manages records retrieval, release, HIPAA compliance, and all aspects of document management. Serves as expert resource on methodology...

Job Overview Clinical Coding Auditor & Trainer – Remote, NY, US. The position is primarily remote with a small travel expectation (twice a year to New York). Full‑time, permanent, salary $55,100–$99,000 / yr. Required Qualifications RN, PA, MD, APRN, DO, or MBBS license Associate’s degree in Nursing or equivalent experience 4+ years of DRG and/or Medical Record Audit experience 1 year of clinical experience in a hospital setting Valid/Current CPC or CIC Certification, or CCS through AHIMA Inpatient coding experience preferred Preferred or Nice-to-­Have Skills RHIA/RHIT credentials Training or auditing experience in a managed care or healthcare setting Years of Experience 4+ years in DRG/Medical Record Audit; 1 year in hospital clinical setting. Industry Experience Healthcare, specifically in a hospital or managed care setting. This is a remote position. Compensation: $55,100 – $99,000 per year. I was referred to this position by a current employee. #J-18808-Ljbffr

Overview We are seeking a Clinical Coding Auditor & Trainer to lead DRG and medical record auditing and deliver staff training programs. This role supports quality improvement, compliance, and education across clinical and coding teams. Responsibilities Conduct audits of staff work; report findings and improvement recommendations. Develop and deliver coding and DRG training programs. Revise policies and procedures to improve audit accuracy. Maintain training and audit records and track staff progress. Ensure compliance with company policies and healthcare standards. Requirements RN, PA, MD, APRN, DO, or MBBS license. Associate’s degree in Nursing or equivalent experience. 4+ years of DRG and/or medical record audit experience. 1 year of clinical experience in a hospital setting. Preferred Valid/current CPC or CIC Certification (AAPC) or CCS (AHIMA). RHIA/RHIT credentials. Prior training or auditing experience in managed care. Notes Primarily remote position...

Overview Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. Benefits for Full and Part-time Employees We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay 100% of the DENTAL monthly premiums for Employee Only coverage. We provide an...

Job Description Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. BENEFITS for Full and Part-time employees who work 30 or more hours per week: We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay...

Job Description Job Description Description: POSITION SUMMARY: Reporting to the VP of Compliance, the Compliance Auditor is responsible for ongoing analysis and review of coding accuracy, medical necessity documentation, and regulatory compliance in patient records. ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES: Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity, supporting documentation and other operational functions. Conducts ad hoc reviews and audits based on high risk, problem prone, or otherwise specified areas. Maintains tools, reports, data, metrics, benchmarking, tracking, and trending patient and compliance data. Participates in various committees to address risks and opportunities for improvement, to report on compliance data, and collaborate in process improvement initiatives. Provide reports to management on compliance metrics and audit findings as requested. Requirements: EDUCATION AND QUALIFICATIONS: RN or...

Pride Health is hiring a Remote RN Certified Coder for a well-known client! (REMOTE) Schedule: Monday-Friday (9am-5pm EST) Contract: 12 months Pay Rate: 60-64/hour Job Responsibilities Determine which codes belong to the language in the benefit plans Review what peers have designated as correct coding Facilitate any discussions needed to get to a coding document Review audit results and make adjustments as necessary Participate in project meetings Requirements 3 + years' experience with coding and reimbursement methodologies (e.g. CPT, HCPCS, ICD-10, CMS,), 3+ years Certified Professional Coder (AAPC or AHIMA) Active unrestricted RN license AAPC or AHIMA certification Apply with Pride Health for this opportunity! Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement...

Job SummaryWe are seeking an experienced Certified RN Medical Coder to support a full-time COC / SPD project focused on building out coding for benefit plans.This role combines clinical knowledge with technical coding expertise to ensure accuracy, consistency, and compliance across plan documentation.You'll work closely with a team of certified coders and business analysts in a collaborative, fast-paced environment where precision and partnership drive success.Why this Opportunity?Top ranked company in Fortune's 2024 World's Most Admired Companies for over a decade consecutively.This healthcare client is ranked number one in key attributes of reputation :Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness.Job Responsibilities :Determine and assign appropriate codes to benefit plan language as part of the COC / SPD project.Review coding selections made by peers...