23 community based contract compliance auditor jobs found

The Community Based Contract Compliance Auditor will be part of a regional team that provides on-site monitoring and reviews of DCS community based contracted provider businesses. on-site monitoring and reviews of DCS community based contracted provider businesses. The auditor will conduct reviews throughout DCS regions 9, 10, and 11 which covers the central part of the state. Community Based reviews will evaluate DCS services and billing to assure there are no errors and billing has been performed appropriately. The auditor will educate, recommend and create plans of corrections when any errors are found. The auditor will conduct audits throughout the same regions as listed above. Community based audits will be a more comprehensive look at a providers practices from point of service to billing. The auditor will educate, recommend, and create plans of corrections as well as pursue any financial damages to the state within this process. The auditor will travel in a team to DCS...

About the job Community Based Contract Compliance Auditor, Central Region Work Arrangement: Onsite Agency Interview Type: Webcam only Engagement Type: Contract NOTE : Applications with resumes in PDF Format will be automatically rejected. Only Word format resumes will be considered. Short Description: The Community Based Contract Compliance Auditor will be part of a regional team that provides on-site monitoring and reviews of DCS community based contracted provider businesses. Complete Description: on-site monitoring and reviews of DCS community based contracted provider businesses. The auditor will conduct reviews throughout DCS regions 9, 10, and 11 which covers the central part of the state. Community Based reviews will evaluate DCS services and billing to assure there are no errors and billing has been performed appropriately. The auditor will educate, recommend and create plans of corrections when any errors are found. The auditor will conduct...

The Community Based Contract Compliance Auditor will be part of a regional team that provides on-site monitoring and reviews of DCS community based contracted provider businesses The auditor will conduct reviews throughout DCS regions 8, 12, 13, 14,15,16,17, and 18 which covers the bottom half of the state. Community Based reviews will evaluate DCS services and billing to assure there are no errors and billing has been performed appropriately. The auditor will educate, recommend and create plans of corrections when any errors are found. The auditor will conduct audits throughout the same regions as listed above. Community based audits will be a more comprehensive look at a providers practices from point of service to billing. The auditor will educate, recommend, and create plans of corrections as well as pursue any financial damages to the state within this process. The auditor will travel in a team to DCS contracted provider locations to conduct reviews and audits. The auditor...

Role: Community Based Contract Compliance Auditor Location: Indianapolis IN on-site monitoring and reviews of Client community based contracted provider businesses. The auditor will conduct reviews throughout Client regions 9, 10, and 11 which covers the central part of the state. Community Based reviews will evaluate Client services and billing to assure there are no errors and billing has been performed appropriately. The auditor will educate, recommend and create plans of corrections when any errors are found. The auditor will conduct audits throughout the same regions as listed above. Community based audits will be a more comprehensive look at a providers practices from point of service to billing. The auditor will educate, recommend, and create plans of corrections as well as pursue any financial damages to the state within this process. The auditor will travel in a team to Client contracted provider locations to conduct reviews and audits. The auditor will also be...

Description: The Community Based Contract Compliance Auditor will be part of a regional team that provides on-site monitoring and reviews of DCS community based contracted provider businesses. The auditor will conduct reviews throughout DCS regions 8, 12, 13, 14,15,16,17, and 18 which covers the bottom half of the state. Community Based reviews will evaluate DCS services and billing to assure there are no errors and billing has been performed appropriately. The auditor will educate, recommend and create plans of corrections when any errors are found. The auditor will conduct audits throughout the same regions as listed above. Community based audits will be a more comprehensive look at a providers practices from point of service to billing. The auditor will educate, recommend, and create plans of corrections as well as pursue any financial damages to the state within this process. The auditor will travel in a team to DCS contracted provider locations to conduct reviews and...

Job Title: Compliance Auditor Job Description The Compliance Auditor will play a crucial role in supporting compliance leadership by assisting in the creation and maintenance of compliant procedures and reference materials. This position requires auditing transaction closings, verifying licensing requirements, conducting internal audits, and performing risk assessments. The auditor will also manage vendor risk processes, recommend policy updates, oversee content, and support compliance training. Responsibilities Assist the Chief Compliance Officer and Compliance Manager in maintaining compliant procedures and reference materials. Review transaction closings to ensure compliance with procedures and state licensing requirements. Regularly verify licensing requirements for referral partners in California, South Dakota, and other applicable states. Help implement and perform audits under the Internal Audit Program. Assist in identifying compliance risks and tracking...

Job Description Job Description Hybrid-Sunrise, Florida Position Summary: The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities: Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud...

Overview Certified Medical Coder required (AHIMA, AAPC, or PMI). Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud...

Coding Auditor We at Pine Rest believe in the power of healing and that everyone in our community has the right to expert care for mental health and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers who witness the impact of our life-changing work each day. Each day, we are closing the gaps in access to care. We are innovating through leading-edge research, testing, programs, and treatment modalities that others replicate across the country. Our services include a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day programs), assessment and testing, residential, addiction treatment and specialty services such as crisis response, employee assistance programs, forensic psychiatry and...

Coding Auditor Sr CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. The CareBridge Coding Auditor Sr is responsible for auditing coders that diagnosis data collected from physician and hospital medical records to ensure proper ICD-9 coding and compliance with risk adjustment requirements. Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from...

Job Details ChristianaCare is searching for a Compliance Auditor to support the Office of Compliance & Privacy through assigned compliance activities and audits to ensure effective clinical documentation that meets regulatory guidelines. The Compliance Auditor performs a variety of audits to investigate and monitor compliance with federal and state laws, as well as Centers for Medicare and Medicaid Services (CMS) regulations, billing, coding and medical necessity documentation guidelines, and HIPAA Privacy standards. They perform financial, operational and compliance audits for the Office of Compliance & Privacy. Work is diverse and assignments could include a wide array of business areas such as inpatient and outpatient services, physician practices, and contracts. An individual with clinical/medical necessity expertise is preferred. The successful candidate must have clinical chart review experience, in addition to broad knowledge of medical claims...

Coding Auditor Sr CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. The CareBridge Coding Auditor Sr is responsible for auditing coders that diagnosis data collected from physician and hospital medical records to ensure proper ICD-9 coding and compliance with risk adjustment requirements. Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from...

Job Description Job Description Salary: $30hr-$35hr DOE Position Purpose: The Jr. Coder is responsible for accurately assigning standardized codes to diagnoses, procedures, and treatments for patient records, insurance claims, and billing processes. This role ensures compliance with applicable coding standards, regulations, and payer policies to facilitate timely and accurate reimbursement. Core Duties and responsibilities, include but are not limited to: Reviewing patient charts to accurately assign the appropriate billing codes (ICD-10-CM, CPT, HCPCS) for diagnoses, procedures, and services rendered, in accordance with FQHC requirements across all lines of business Assist in the submission of accurate claims to payers after correction Ensuring coding compliance with federal and state regulations as well as insurance requirements Communicate with patients and insurance companies to resolve billing discrepancies Maintain knowledge of the latest coding updates, billing...

Job Title: HIM Hospital Outpatient Coder I (Contract) Location: Fully Remote - Candidates must be located in the state of Hawaii, California, Oregon, or Washington. Compensation: $38-$40/hour (W2 Contract via LHH) Schedule: Monday to Friday, 8:00 AM - 4:30 PM HST About the Role We are seeking a skilled and credentialed HIM Hospital Outpatient Coder I to join our team on a contract basis. This role is ideal for professionals with strong clinical content knowledge and coding expertise who are passionate about accuracy, compliance, and collaboration in healthcare documentation. Key Responsibilities Review medical records to identify diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II coding systems. Assign appropriate codes and select DRGs for inpatient cases. Abstract and verify medical data to ensure accuracy and compliance with regulatory standards (JCAHO, OSHPD, CMS). Interact with physicians to...

Coding Auditor Sr CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. The CareBridge Coding Auditor Sr is responsible for auditing coders that diagnosis data collected from physician and hospital medical records to ensure proper ICD-9 coding and compliance with risk adjustment requirements. Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from...

Job Summary and Responsibilities The remote Senior Coder acts as a lead coder for their designated team. This position will train staff on department policies, procedures, systems and correct coding requirements. The Sr. Coder additionally will audit Coders, fill in for out-of-office Coders, and make recommendations to Coding Leadership to help improve the efficiency of the team. 1.1 Employee will comply with all laws, rules, and regulations relating to the position. 1.2 The employee has a duty to report any suspected violations of the law to his/her immediate supervisor, compliance officer, or CEO. 1.3 Employee will follow the coding guidelines set by AHIMA (American Health Information Management Association,) NCCI (National Correct Coding Initiative) edits, CMS (Center for Medicare and Medicaid Services,) and the Standards of Coding Ethics. 1.4 Selects appropriate assignments for coding from assigned work queues. 1.5 Assigns codes by encounter: -Selecting the...

Job Description Job Description:\n\nDescription: Position Summary: CODER: Reviews medical documentation from physicians and other healthcare providers. Assigns diagnostic and procedure codes for inpatient, outpatient, symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards. Provides accurate and timely ICD-10 CM and CPT procedure coding, and may utilize HCPCS, in accordance with official coding standards, regulatory coding compliance guidelines and company procedures. Review and update medical record documentation to accurately reflect healthcare coding and substantiate appropriate service reimbursement. Working with other departments and organizations to assure availability and quality of information used in statistical reporting for local facility management and helping identify overall healthcare trends, issues and concerns. Follow up of coding denials and regular maintenance of coding work queues. INSURANCE APPLICATION...

Job Description Job Description INTRODUCTION Under the supervision of the Medical Billing Coding Manager, the coding specialist is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding specialist also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. DUTIES AND RESPONSIBILITIES Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered. Supports the Senior Medical Billing and Coding Specialist to respond to audit findings and make applicable coding additions or corrections. Registers and analyzes claims in the EMR...

Join to apply for the Professional Coding Compliance Auditor role at Emory Healthcare Join to apply for the Professional Coding Compliance Auditor role at Emory Healthcare Get AI-powered advice on this job and more exclusive features. Overview Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare w e fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career Overview Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare w e fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career And Be What You Want To Be. We Provide Comprehensive health benefits that start day 1 Student Loan Repayment Assistance &...

Compliance Auditor, Billing and Coding Compliance Join to apply for the Compliance Auditor, Billing and Coding Compliance role at UT Health San Antonio Compliance Auditor, Billing and Coding Compliance 2 weeks ago Be among the first 25 applicants Join to apply for the Compliance Auditor, Billing and Coding Compliance role at UT Health San Antonio Job Description The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Job Description The Compliance Auditor, Billing and Coding...

Job Description Job Description MISSION, VISION, AND VALUES Our mission is to provide quality, comprehensive healthcare and supportive services to those in our community. Our vision is "Improving the Health and Well Being of our Community." Our Core Values consist of Integrity, Compassion, and Excellence. Employees must possess a strong commitment to the mission, policies, goals and philosophy of Harbor Community Health Centers. JOB SUMMARY Reporting to the Revenue Cycle Manager (RCM), the Medical Biller II is responsible for the billing and collection of the overall clinic’s primary care, pediatric, behavioral health and dental services. This position works closely with providers, front office, and Quality Improvement Department. ESSENTIAL DUTIES & RESPONSIBILITIES To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability...

Senior Coder The remote Senior Coder acts as a lead coder for their designated team. This position will train staff on department policies, procedures, systems and correct coding requirements. The Sr. Coder additionally will audit Coders, fill in for out-of-office Coders, and make recommendations to Coding Leadership to help improve the efficiency of the team. Employee will comply with all laws, rules, and regulations relating to the position. The employee has a duty to report any suspected violations of the law to his/her immediate supervisor, compliance officer, or CEO. Employee will follow the coding guidelines set by AHIMA, NCCI, CMS, and the Standards of Coding Ethics. Selects appropriate assignments for coding from assigned work queues. Assigns codes by encounter: Selecting the accurate principal diagnosis and procedure code; Sequencing codes to optimize reimbursement in conformance with policies; Coding only diagnoses and procedures which can be substantiated by...

3 weeks ago Be among the first 25 applicants Calibre is an established and growing public accounting firm with a 80-year history in the Washington DC, NY, IL and CA markets. We are dedicated to providing the best possible working environment, including a commitment to the personal and professional growth of our employees. It is our goal to cultivate our employees and give them a variety of resources to develop and grow into a career at Calibre. Calibre CPA Group is seeking a Payroll Compliance Auditor to work in the firm's Payroll Compliance Audit department. This position involves analyzing and reviewing payroll, tax, and personnel records to determine employer compliance with collective bargaining agreements. Our Compliance Auditors are responsible for creating and submitting reports of audit findings to fund administrators on a variety of employee benefit plans. This exciting entry-level opportunity involves local travel to client sites in the Chicago Metropolitan and...