27 coding auditor jobs found in Raleigh, NC

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 identify opportunities for...

Baylor Scott & White Health is seeking a Coding Auditor I to perform coding quality audits and provide feedback to coders using ICD-10-CM/PCS, HCPCS, CPT and related references to ensure accurate classification and billing. The role collaborates with Clinical Documentation Specialists, abstracts data, and completes production coding when required. A certified coder with 5 years of experience (RHIA/RHIT/CCS/CCS-P/CPC/COC/CIC/CIRCC) is preferred, with at least 1 year as an auditor. #J-18808-Ljbffr

A leading health insurance company is seeking an Inpatient Medical Coding Auditor to work remotely. This role involves reviewing inpatient hospital claims and ensuring accurate coding and reimbursement. Candidates should hold an RHIA, RHIT, or CCS certification with substantial experience in coding audits. Strong attention to detail, excellent communication skills, and the ability to manage multiple priorities are essential. The job offers competitive compensation and various benefits to support overall well-being. #J-18808-Ljbffr

Humana Inc. seeks a Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and resolve provider disputes. You will extract clinical information, assign ICD-10-CM, ICD-10-PCS, and DRG codes to patient records. The role targets cost reduction through accurate payments and higher coding accuracy, with work hours Monday–Friday and occasional travel to Humana offices. #J-18808-Ljbffr

Become a part of our caring community and help us put health first The 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

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: Benefits may vary based upon position type and/or level. Job...

RCS Medical Coding Auditor page is loaded## RCS Medical Coding Auditorremote type: Hybridlocations: Raleigh, NCtime type: Full timeposted on: Posted 7 Days Agojob requisition id: JR10360**Position Summary**The **RCS Medical Coding Auditor** is responsible for auditing professional (ProFee) medical coding to ensure accuracy, compliance, and alignment with AMA CPT, CMS, NCCI and payer guidelines. This role supports coding integrity, mitigates compliance risk, and drives continuous quality improvement through targeted education and audit-based feedback.The ideal candidate brings strong hands-on experience with **professional fee coding**, deep knowledge of **E/M, surgical, and modifier use**, and the ability to translate audit findings into actionable insights.**Key Responsibilities*** Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback* Validate ICD‐10‐CM, CPT(R), HCPCS, and modifier assignment against clinical documentation to...

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $57,400 to $99,000 annually based on experience The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Provides guidance and leadership to coding and billing management in the implementation and administration of effective systems, processes, and procedures. Performs annual performance reviews and quality assurance reviews to assess comprehension of training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting...

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $57,400 to $99,000 annually based on experience The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Provides guidance and leadership to coding and billing management in the implementation and administration of effective systems, processes, and procedures. Performs annual performance reviews and quality assurance reviews to assess comprehension of training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting...

A healthcare data solutions provider is seeking an Inpatient Auditing Specialist who will perform audits on medical records and ensure compliance with DRGs. This fully remote role requires 3+ years of coding and auditing experience and offers a flexible schedule. Responsibilities include conducting audits, providing education, and maintaining communication with healthcare staff concerning clinical issues. Competitive salary and generous benefits are included in the role's compensation package. #J-18808-Ljbffr

CAREER OPPORTUNITY OFFERING:   Bonus Incentives  Paid Certifications  Tuition Reimbursement  Comprehensive Benefits  Career Advancement  This position will pay between $29.75 and $32.70/hr based on experience  Specialized Coders Wanted —$3,000 Sign‑On Bonus Awaits -- We are seeking candidates with experience in Cardiology, Vascular or Thoracic Surgery specialties.  The  Specialized Coder  is a certified coder with expert knowledge in physician coding for  Cardiology,   Cardiovascular Thoracic Surgery or Vascular Surgery . This position is responsible for reviewing physician charges to accurately code encounters, correct coding edits, and assist with research for denied claims. The Specialized Coder's role also includes tracking, trending coding issues, mentoring/training other coders, and supporting provider education.  Job Responsibilities:    Code claims directly from the medical record/operative report according to coding guidelines....

BlueCross BlueShield of South Carolina is seeking a qualified reviewer to validate DRG, APC, and Never Events, coordinating rate adjustments with claims teams across lines of business. In this remote role, you will produce monthly and quarterly reports, ensure HIPAA compliance, and serve as a subject matter expert on medical records and coding methodologies for the Healthcare Services and the Legal Department. #J-18808-Ljbffr

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $57,400 to $99,000 annually based on experience The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes . Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines .  Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties.   Job Responsibilities: Quality Review - Monitors and audits inpatient...

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $57,400 to $99,000 annually based on experience The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes . Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines .  Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties.   Job Responsibilities: Quality Review - Monitors and audits inpatient...

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...

Job Responsibilities Strong customer service skills; answering client calls; prompt return and follow up to all interactions; prompt response to requests for information, both internally and externally. Prepares charges for offshore operations and answers and resolves questions. Complete chargers and/or resolve charge and payment inquiries for off-shore vendors. Prepares assigns and reconciles batches; provides ongoing communication and reviews discrepancy process. Reviews source codes; tallies Hash totals. Maps ICD nine, CPT, and modifiers as needed. Creates claim edit report for charge entries. Reconciles imputed payment postings and balances batch reports. Prep charges for IHS, indicate any modifiers needed on CPT codes, notate the codes for any handwritten DX, procedure, etc., return any charges to the Doctors office that require clarification. Complete batch once IHS enters by validating, verifying, clarifying/correcting any questions they may have had, and closing...

Overview At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. About Duke Health's Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions. OCC Summary The Medical Records Coder II is a certified Coder. Coordinate/review the work of subordinate employees and assist with the training and continuing education programs. Code medical records utilizing ICD-10-CM and CPT-4 coding conventions. Review the medical record to assure specificity of diagnoses, procedures and appropriate/optimal...

Medical Records Coder II At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions. This position is 100% remote. All Duke University remote workers must reside in one of the following states: North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington. *Now offering a $10,000...

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. This position is 100% remote. All Duke University remote workers must reside in one of the following states:    North Carolina,  Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia,...

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. This position is 100% remote. All Duke University remote workers must reside in one of the following states: North Carolina,Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington....

Select how often (in days) to receive an alert: Select how often (in days) to receive an alert: At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. About Duke Health's Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions. This position is 100% remote. All Duke University remote workers must reside in one of the following states: North Carolina, Virginia, South Carolina, Tennessee, Florida, and Texas. Occ Summary The Medical Records Coder II is a certified Coder. Coordinate/review...

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Willing to pursue your passion for caring with the Patient Revenue Management Organization, the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. This position is 100% remote. All Duke University remote workers must reside in one of the following states: North Carolina, Virginia, South Carolina, Tennessee, Florida, and Texas. Occ Summary The Medical Coder Specialist will have frequent and daily interactions with internal and external clients, including but not limited to physician and non‑physician surgical providers. Responsibilities include primary...

PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke’s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance. This position is 100% remote. All Duke University remote workers must reside in one of the following states: North Carolina, Alabama, Arizona, Connecticut,...

Medical Billing SpecialistNestled in the heart of North Carolina, Harnett County offers a unique blend of small-town charm and convenient access to big-city amenities. Located less than an hour from both Raleigh and Fayetteville, residents enjoy the tranquility of rural living with the benefit of nearby urban excitement. At First Choice, we're proud to offer employment opportunities in this beautiful area, giving you the chance to work in a close-knit community while staying connected to the vibrant Triangle region. With a perfect balance of peaceful affordable living and easy access to cultural and career opportunities, Harnett County is an ideal place to call home.The Medical Billing Specialist will be responsible for billing and collections for Medicare, Medicaid, Insurance, and Self Pay patients for all Medical and Dental clinics. Responsibilities of individual Billing Specialist will vary depending on assignment of responsibilities given by Billing Supervisor. This role is...