81 senior profee coding auditor jobs found

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,...

Summary Of Position To aid and assist in providing direction, instruction, and guidance to a team of individuals with the purpose of training and developing staff. Works with the CBO A/R Manager to manage projects and develop process improvements, while providing the daily guidance and assistance needed to maintain optimal performance and productivity within the team. Provides supervisory guidance to the team as directed by the A/R Manager and perform all functions with a high level of discretion and professionalism. Nature and Scope An effective Senior Team Lead will provide guidance to their team based on management direction, will use their experience and knowledge of the tools the team uses (e.g., EPIC), policies, and guidelines to educate team members, will identify areas for improvement systematically and within their team, and will communicate directly with management the status of resolved and outstanding issues/roadblocks within the team. Principal Duties and...

Medical Records - Coder I - Full Time - Days Department: CODING Job Summary Under the general direction of the Director CDI/Coding or designee, the Medical Records Coder I will improve documentation, data quality and revenue cycle operations. The coder assigns International Classification of Disease system- 10 (ICD), CM, and PCS codes according to AHA – AMA Guidelines, CMS and NGS. Core Job Responsibilities Assign diagnosis and procedure codes, for accurate and timely billing of most appropriate payer Audit charges and establish proper coding in collaboration with providers Initiate and follow up on queries with providers Assist departments with diagnostic and procedural coding Respond to Insurance, compliance and RAC denials Review and assist in the maintenance of coding related policies and procedures Perform other duties as required. Education/Experience Requirements REQUIRED: AS in Health Information Management , a...

Job Description CSCA Auditor - Travel based Intertek, a leading provider of quality and safety solutions to many of the world's top-recognised brands and companies, is actively seeking a Supplier Management / Corporate Social Responsibility CSCA Auditor to join our Business Assurance team. This is a fantastic opportunity to grow a versatile career with a company that wants to build something great with an incredible group of people. Intertek's Business Assurance team goes beyond testing, inspection and certification to look at the underlying elements that make a company and its products successful. Our assurance solutions provide confidence and total peace of mind that a client's operating procedures, systems and people are functioning properly to provide a competitive advantage in the marketplace. What are we looking for? The CSCA Auditor will lead and/or participate as an assessor during all phases of a Supplier Management system audit in accordance with Intertek...

Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid...

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 a 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 payers. Researching...

Description Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization. Reporting to the Compliance Manager, MAPD Audit, you will contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide regulatory readiness and operational improvement. This position calls for a strong foundation in CMS guidelines, managed care compliance, and effective collaboration with both internal teams and external partners. In this role, you will: Conduct compliance audits related to operational functions, vendor performance, data validation, RADV, Triennial Review, pre-delegation reviews, and...

M&D Capital is a leading third-party Medical Billing and Revenue Cycle Management company serving clients across the United States. We operate offices across multiple states, along with a growing international team. We specialize in out-of-network surgical claims, and partner directly with our clients to ensure the maximum reimbursement for their services. Our rapidly growing organization provides employees with generous opportunities for professional growth and advancement. We're looking for talented, dedicated employees who are eager to grow and contribute to our success. If you meet the qualifications below, we encourage you to apply. Job Description We are seeking an experienced and detail-oriented Senior Medical Biller to join our dynamic billing department. The ideal candidate will possess deep knowledge of the full claims lifecycle, surgical billing, and current coding guidelines, including CMS CPT, ICD-10, NDC, and LCD regulations. Strong communication skills and...

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities The Inpatient Coder Auditor reviews and analyzes documentation present in the medical record for Inpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software.  The Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International...

Inpatient Senior Coder The Inpatient Senior Coder is responsible for accurate, compliant, and timely coding and abstracting of inpatient medical records, including the assignment of ICD-10-CM/PCS codes and validation of MS-DRG and APR-DRG groupings. This position ensures proper reimbursement, adherence to regulatory and coding guidelines, and supports overall clinical documentation accuracy for inpatient services. This is a remote position with onsite availability required as needed. Education: High school diploma or equivalent. CCS (Certified Coding Specialist) required. Experience: Three to five years of inpatient hospital coding experience. Proficient in ICD-10-CM and ICD-10-PCS coding. In-depth knowledge of MS-DRG and APR-DRG reimbursement systems. Familiarity with coding audits and clinical documentation review. Experience with Observation or complex outpatient cases is a plus. Prior mentoring or training experience preferred. Special Skills: Medical terminology required....

Overview At Houston Methodist, the Lead Inpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to inpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. Houston Methodist Standard...

Risk Adjustment Nurse/Coder AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! Full-time permanent position (40 hours) Standard working hours: 8am to 4:30pm EST, M-F This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories...

SSM Health Dermatology's mission is to strive as a team for excellence by providing the most comprehensive, patient-centered care every day. We are looking for a Patient Scheduling Representative to contribute in their own unique way to our Company’s exceptional services and performance for our patients Objective: Under the general guidance of leadership, the Medical Billing Supervisor is responsible for the daily oversight of billing and revenue cycle operations, ensuring timely and accurate submission of claims, resolution of denials, and compliance with all payer requirements. This role directly supervises billing team members, provides performance management, conducts routine employee development meetings, and monitors key performance metrics to support organizational efficiency and financial objectives. The Medical Billing Supervisor serves as an advanced resource to staff, providers, and internal departments, while maintaining a high level of accuracy, productivity,...

Summary of Position To aid and assist in providing direction, instruction, and guidance to a team of individuals with the purpose of training and developing staff. Works with the CBO A/R Manager to manage projects and develop process improvements, while providing the daily guidance and assistance needed to maintain optimal performance and productivity within the team. Provides supervisory guidance to the team as directed by the A/R Manager and perform all functions with a high level of discretion and professionalism. Nature and Scope An effective Senior Team Lead will provide guidance to their team based on management direction, will use their experience and knowledge of the tools the team uses (e.g., EPIC), policies, and guidelines to educate team members, will identify areas for improvement systematically and within their team, and will communicate directly with management the status of resolved and outstanding issues/roadblocks within the team. Principal Duties and...

CSCA Auditor - Travel based Intertek, a leading provider of quality and safety solutions to many of the world's top-recognised brands and companies, is actively seeking a Supplier Management / Corporate Social Responsibility CSCA Auditor to join our Business Assurance team. This is a fantastic opportunity to grow a versatile career with a company that wants to build something great with an incredible group of people. Intertek's Business Assurance team goes beyond testing, inspection and certification to look at the underlying elements that make a company and its products successful. Our assurance solutions provide confidence and total peace of mind that a client's operating procedures, systems and people are functioning properly to provide a competitive advantage in the marketplace. What are we looking for? The CSCA Auditor will lead and/or participate as an assessor during all phases of a Supplier Management system audit in accordance with Intertek and Client social,...

Mountain View Hospital is looking for a Medical Coding Auditor to join our team! JOB SUMMARY: Medical Record Auditor will be responsible for assisting/ conducting audits of medical records, coding and billing information. The auditor will look at both departments inside the hospital, outside departments and physician records and billing. Auditors will put together informational reports of finding and relay the information to the appropriate source. Reporting will be generated to help track which providers, locations or target areas need to be audited. The medical auditor will assist in putting together appeals/ rebuttals for external auditing sources. Auditor should have audits completed within a timely manner that is set up with the supervisor/ manager. Auditor will be provided as education as directed by the Auditing Integrity Department manager. Works collaboratively with the unit-specific educators, department manager, department supervisor, the DON and the compliance...

Position Overview The Inpatient Coder Level 3 is a senior-level position responsible for coding high-complexity inpatient records with accuracy and efficiency. This role requires expert-level knowledge of ICD-10-CM and ICD-10-PCS coding systems, MS-DRG and APR-DRG assignment, and comprehensive understanding of clinical documentation. The Level 3 coder ensures coding compliance, supports training and mentoring of junior staff, and contributes to audit and quality improvement efforts within the HIM department. Primary Department, Division, or Unit: Coding Support Services, UHS Revenue Cycle Operations Primary Work Shift: Day Compensation Range: $33.63 - $50.45 per hour, depending on experience You will be eligible for benefits if you are hired into a regular position with at least 24 scheduled weekly hours. Key Responsibilities Demonstrate proficient understanding of complex clinical scenarios, including comorbidities and complications. Analyze...

Who we are The real world is the next frontier, and at Metropolis, we are creating the artificial intelligence to make it responsive. We are pioneering the Recognition Economy - a future where mundane repetition disappears and being known unlocks access, comfort and belonging everywhere you go. From transforming parking into a seamless drive-in, drive-out experience for millions of Members to expanding our intelligence layer across retail and hospitality, we are building a world that feels instinctive and magical. The future isn't coming; it's here, and we need builders, innovators and problem solvers to help us create it. Who you are Metropolis is seeking an Operational Compliance Auditor to add value and improve our operations by bringing a systematic and disciplined approach to the effectiveness of risk management, control, and governance processes. The ideal candidate possesses thorough knowledge of accounting procedures and sound judgment, as you will review control...

***To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia*** The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility)...

Department/Unit: Health Information Services Work Shift: Day (United States of America) Salary Range: $60,367.47 - $90,551.20 The Senior Hospital Coder is responsible for performing detailed coding quality audits, scheduled and random, on staff and providing thorough education and feedback, projects assigned by management, and special requests to review coding for external departments such as quality management and CDI. Responsible for monitoring and tracking trends of staff, bringing forward concerns to leadership regarding coding quality and productivity, completes duties as assigned by the Quality Manager. Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities. Senior Hospital Coder may be asked to assist with denials work, including researching and writing appeal letters. These individuals are highly skilled and considered experts in medical coding. Essential Duties and...

Req Number 174853 Lead Compliance Auditor - Heavy Anesthesia & Healthcare Expertise Needed. This is a HYBRID position- MUST be in the office located in Chappaqua, NY 3 days a week. Are you a seasoned compliance professional with a passion for anesthesia and healthcare auditing? Do you thrive in fast-paced environments where your expertise can make a real impact? FlexStaff is seeking a dynamic, detail-oriented Lead Compliance Auditor to join our client's team and lead the charge in safeguarding healthcare integrity and regulatory excellence! Position Summary: As a Lead Compliance Auditor, you will leverage your extensive anesthesia auditing experience to oversee comprehensive compliance reviews, develop training programs, and collaborate with senior leadership to enhance our compliance framework. Your expertise will ensure the organization remains at the forefront of regulatory adherence, risk mitigation, and quality improvement. Ready to make a difference in...

Job Description Job Description Shift is the leading AI platform for insurance. Shift combines generative, agentic, and predictive AI to transform underwriting, claims, and fraud and risk - driving operational efficiency, exceptional customer experiences and measurable business impact. Trusted by the world's leading insurers, Shift delivers AI when and where it matters most, at scale and with proven results. Our culture is built on innovation, trust, and a drive to transform the insurance industry through our SaaS platform. We come from more than 50 different countries and cultures and together we are creating the future of insurance. As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and...