12 clinical compliance auditor jobs found in Atlanta, GA

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed....

Entry-Level Medical Billing & Coding Assistant.This is a great opportunity for someone looking to begin a career in healthcare administration with training, growth potential, and long-term adva... Show more $80.00 hourly Remote Full-time Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems.We are seeking experienced Billing and Claims Managers to support the evaluation of AI too... Show more $70,000.00 yearly Full-time Quick Apply Legal Billing Specialist - Atlanta, GA To Apply Now - email your resume to job-knemkq7d-1e4ngrk82rw3kdm@sagedata.A respected and growing law firm in the Atlanta area is looking to add a skilled Leg... Show more Full-time Greenberg Traurig (GT), a global law firm with locations across the world in 15 countries, has an exciting opportunity for a Legal Billing Specialist to join our Revenue Management Department.We of... Show more Full-time Note : This is an educational program, not a...

Join the WellStreet Urgent Care Revenue Cycle Team! WellStreet Urgent Care is seeking an experienced Certified Medical Coder to support our growing Revenue Cycle team. In this role, you will accurately assign ICD-10-CM, CPT, HCPCS, and Evaluation & Management (E&M) codes for urgent care encounters while ensuring compliance with coding guidelines, quality standards, and productivity expectations. This is an excellent opportunity for a detail-oriented coding professional with Epic experience who enjoys working in a collaborative, fast-paced healthcare environment. What You'll Do Code patient encounters for WellStreet Urgent Care Centers using internal coding software. Accurately assign ICD-10-CM, CPT, HCPCS, and E&M codes based on provider documentation. Apply current coding guidelines and regulatory requirements to ensure coding accuracy and compliance. Utilize coding encoders and other coding resources to support accurate code selection....

Professional Coding Auditor & Educator The Professional Coding Auditor & Educator works collaboratively with physicians, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to all patients, as well as ensuring compliant reimbursement of patient care services. Responsibilities: Responsible for reviewing and analyzing all aspects of the department clinical documentation and care to ensure timely, accurate, and compliant charge capture and submission Works as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges Collaborates with Coding Supervisor to ensure clinical documentation in high-risk areas is consistent and complete Identifies...

Responsibilities Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration. Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted. Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations. Coordinates research and responds to system inquiries and appeals. Conducts research of claims systems and system edits to identify...

Professional Coding Auditor & Educator The Professional Coding Auditor & Educator works collaboratively with physicians, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to all patients, as well as ensuring compliant reimbursement of patient care services. Responsibilities: Responsible for reviewing and analyzing all aspects of the department clinical documentation and care to ensure timely, accurate, and compliant charge capture and submission Works as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges Collaborates with Coding Supervisor to ensure clinical documentation in high-risk areas is consistent and complete Identifies...

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:...

Whatever the role, everyone at Grady is part of something bigger. Choosing a career at Grady is choosing to be part of a legacy of service and commitment to our communities. If you want to make a difference, we want to hear from you. Job Summary Responsible for coding and abstracting procedural (CPT) and diagnosis codes (ICD-10) for physician services, reviewing physician documentation in the electronic medical record for completeness and accuracy to ensure proper code assignment, providing physician feedback of discrepancies/trends, resolving edits and denials, and releasing encounters for billing. Utilizes intermediate problem‑solving skills to address coding related tasks of detailed, medium complexity. Duties include procedural (CPT) and diagnosis (ICD-10) coding for all places of service, including, but not limited to ER, observation, inpatient, outpatient, ambulatory surgery, and other ancillary services. Responsible for reviewing, analyzing, and interpreting physician...

Are you seeking a career with a growing company, a place where you can make an impact in the community? Then Positive Impact Health Centers is the company for you. What makes us different? We offer our employees the following: • 1 Health Wellness day per quarter • Parental Leave • Free parking at our locations/bus line accessibility • Competitive Salary & Benefits • Automatic 3% Safe Harbor & 2% Profit Sharing (Retirement Program) • 100% allotted for benefit elections for employees, 50% allotted for benefit elections for employees' spouse/dependents • Credit Union Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services. The PIHC model of care assures that persons with HIV have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes. Job Summary : The Medical Billing &...

Pharmacy Supervisor How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift: Day (United States of America) Job Summary: The Pharmacy Supervisor shall plan, organize, and supervise all pharmaceutical activities occurring in his/her respective pharmacy as directed by the Pharmacy Manager/Director. Such proceedings shall comply with the policies and procedures established by the WellStar Health System, federal, state and local laws governing the practice of pharmacy, and the rules and standards established by the regulatory agencies (e.g. TJC, Medicare,...

A Medical Coder for WellStreet Urgent Care is responsible for supporting all aspects of the Revenue Cycle for our Urgent Care Centers. Responsibilities • Coding for our Urgent Care Centers using our internal software • Knowledge of ICD-10 Coding and compliance • Experience using an encoder • Setting up insurance plans within our software • Working with the Revenue Cycle Management to identify & resolve issues related to coding and the process flow • Interfacing with clinic staff on billing & coding issues. • Comply with all legal requirements regarding coding procedures and practices • Conduct audits and coding reviews to ensure all documentation is accurate and precise • Assign and sequence all codes for services rendered • Collaborate with billing department to ensure all bills are satisfied in a timely manner • Communicate with insurance companies about coding errors and disputes • Contact physicians and other health care professionals with questions...

Medical Coder A Medical Coder for WellStreet Urgent Care is responsible for supporting all aspects of the Revenue Cycle for our Urgent Care Centers. Responsibilities Coding for our Urgent Care Centers using our internal software Knowledge of ICD-10 Coding and compliance Experience using an encoder Setting up insurance plans within our software Working with the Revenue Cycle Management to identify & resolve issues related to coding and the process flow Interfacing with clinic staff on billing & coding issues. Comply with all legal requirements regarding coding procedures and practices Conduct audits and coding reviews to ensure all documentation is accurate and precise Assign and sequence all codes for services rendered Collaborate with billing department to ensure all bills are satisfied in a timely manner Communicate with insurance companies about coding errors and disputes Contact physicians and other health care professionals with questions about...