91 drg validation coding auditor jobs found

Ensemble Health Partners seeks an Inpatient/DRG Validation Coding Auditor to review medical records and ensure accurate DRG assignment and documentation. You will identify discrepancies, educate coders, and help improve reimbursement accuracy for hospital clients. The role requires 5+ years of coding and 3+ years of facility audit experience, proficiency with EMR systems and encoders, and maintaining HIPAA compliance. #J-18808-Ljbffr

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Job Description Job Description PYA is seeking an Inpatient/Outpatient Facility Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue and Compliance Advisory Program . RESPONSIBILITIES : Apply inpatient and outpatient facility/hospital coding and reimbursement methodologies to provide advisory services to PYA clients with a focus on the following: ICD-10-CM and PCS/CPT/HCPCS code assignment MS-DRG and other DRG validation APC validation and charge capture Clinical documentation improvement Regulatory compliance for third party payors Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional...

Job Description Job Description PYA is seeking an Inpatient/Outpatient Facility Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue and Compliance Advisory Program . RESPONSIBILITIES : Apply inpatient and outpatient facility/hospital coding and reimbursement methodologies to provide advisory services to PYA clients with a focus on the following: ICD-10-CM and PCS/CPT/HCPCS code assignment MS-DRG and other DRG validation APC validation and charge capture Clinical documentation improvement Regulatory compliance for third party payors Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional...

Summary This position, located in Health Information Management at Eastern Oklahoma VA Health Care System, involves coding and auditing patient records, ensuring coding accuracy and compliance. Candidates must be skilled in ICD, CPT, and HCPCS, and may provide coding education and conduct audits to improve data quality and documentation. Learn more about this agency Duties Help Complete all application requirements detailed in the "Required Documents" section of this announcement. Total Rewards of a VA Career: Total Rewards of a Allied Health Professional Code Assignment & Validation: Accurately reviews and assigns diagnostic and procedural codes using current versions of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS. Follows all official coding guidelines and industry standards (including AMA CPT Assistant and other established resources). Clinical Documentation Audit: Audits both inpatient and outpatient health records for completeness and accuracy of...

Job Description Job Description PYA is seeking an Inpatient/Outpatient Facility Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue and Compliance Advisory Program . RESPONSIBILITIES : Apply inpatient and outpatient facility/hospital coding and reimbursement methodologies to provide advisory services to PYA clients with a focus on the following: ICD-10-CM and PCS/CPT/HCPCS code assignment MS-DRG and other DRG validation APC validation and charge capture Clinical documentation improvement Regulatory compliance for third party payors Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional...

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Patient Safety DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of...

Job Description Job Description PYA is seeking an Inpatient/Outpatient Facility Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue and Compliance Advisory Program . RESPONSIBILITIES : Apply inpatient and outpatient facility/hospital coding and reimbursement methodologies to provide advisory services to PYA clients with a focus on the following: ICD-10-CM and PCS/CPT/HCPCS code assignment MS-DRG and other DRG validation APC validation and charge capture Clinical documentation improvement Regulatory compliance for third party payors Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional...

Job Description Job Description PYA is seeking an Inpatient/Outpatient Facility Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue and Compliance Advisory Program . RESPONSIBILITIES : Apply inpatient and outpatient facility/hospital coding and reimbursement methodologies to provide advisory services to PYA clients with a focus on the following: ICD-10-CM and PCS/CPT/HCPCS code assignment MS-DRG and other DRG validation APC validation and charge capture Clinical documentation improvement Regulatory compliance for third party payors Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional...

Job Description Job Description PYA is seeking an Inpatient/Outpatient Facility Coding Auditor to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue and Compliance Advisory Program . RESPONSIBILITIES : Apply inpatient and outpatient facility/hospital coding and reimbursement methodologies to provide advisory services to PYA clients with a focus on the following: ICD-10-CM and PCS/CPT/HCPCS code assignment MS-DRG and other DRG validation APC validation and charge capture Clinical documentation improvement Regulatory compliance for third party payors Work in collaboration with the PYA executive team and other service lines to offer complete business solutions to clients Manage the preparation of excellent client deliverables and exhibit exceptional project management skills while balancing firm risk and compliance with appropriate professional...

Coding Auditor (ICD-10) Position: Coding Auditor (ICD-10) Duration: Full-Time Location: Newark/Wall NJ Job Summary: This position is responsible for conducting on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionally provides guidance/instruction to various stakeholders on ICD9-CM, ICD-10, DRG assignment payment and auditing. Responsibilities: Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments through the appropriate channels. Identifies error trends as they relate to medical record and or billing documentation or misinterpretation of provider contract stipulations. Compiles statistics and other audit information to present to accounts, regulatory agencies, and internal requesters....

Outpatient Coder Auditor Trainee 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 3.0 million 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 Outpatient Coder Auditor Trainee reviews and analyzes documentation present in the medical record for outpatient 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 Outpatient Coder Auditor Trainee finalizes the coding and abstracting of the medical record upon ensuring...

Insight Global is seeking a Remote DRG Validation Auditor for one of our clients to sit 100% remote.  This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Below are the key responsibilities for this role: Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate...

Coding Auditor Department: SIU Employment Type: Full Time Location: Headquarters Description The Coding Auditor is a professional auditing role designed for a certified professional coder. Under direct supervision of Healthcare Fraud Shield SIU management, this position executes routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, Revenue codes. The ideal candidate has a strong foundation in primary medical coding and a keen eye for detail, eager to learn complex audit frameworks, regulatory policies, and documentation validation. Key Responsibilities Compare the procedures and codes billed on a claim to a medical record. Compare information submitted on the claims in order to determine amount and nature of billable services as needed. Determines appropriateness of billing and reimbursement as needed. Documents findings for each claim line in a spreadsheet as needed. Summarize findings in a written report as needed. Abstracts...

Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4PM Contract length: 4 months assignment with possible conversion Job Summary: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) 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 Day to Day: 75% 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...

Spectraforce Technologies in Columbia, SC seeks a Quality Medical Auditor to perform validation reviews of DRG, APC, and Never Events across lines of business. You will coordinate rate adjustments with claims and produce monthly and quarterly reports. The role requires strong knowledge of medical record coding, HIPAA compliance, and data analysis. This contract is 4 months with possible conversion, with a remote-friendly onsite-focused schedule. #J-18808-Ljbffr

Focusing on Coding & Clinical Chart Validation, the full-time Clinical Coding Auditor will analyze and audit inpatient claims, ensuring coding accuracy and appropriateness of treatment settings while utilizing proprietary auditing tools. Key responsibilities Analyzes and audits claims using advanced ICD-10 coding expertise and clinical guidelines Utilizes proprietary auditing systems to make determinations and generate audit letters Maintains production and accuracy standards set by the audit operations management team Required qualifications Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT) 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG Certification in coding/CDI (e.g., RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS) Proficiency in Word, Access, Excel, TEAMS, and other applications Expert knowledge of coding guidelines and compliance regulations

Focusing on Coding & Clinical Chart Validation, the full-time Clinical Coding Auditor will analyze and audit inpatient claims, ensuring coding accuracy and appropriateness of treatment settings while utilizing proprietary auditing tools. Key responsibilities Analyzes and audits claims using advanced ICD-10 coding expertise and clinical guidelines Utilizes proprietary auditing systems to make determinations and generate audit letters Maintains production and accuracy standards set by the audit operations management team Required qualifications Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT) 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG Certification in coding/CDI (e.g., RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS) Proficiency in Word, Access, Excel, TEAMS, and other applications Expert knowledge of coding guidelines and compliance regulations

JOB DESCRIPTION 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 (OMAP), and Kaiser Permanente organization/institutional coding...

McLaren Health Care in Michigan is seeking a Senior Coding Auditor Facility to lead ongoing coding and documentation education for physicians, coders, CDI and allied staff to improve documentation and accurately assign codes and charges. Core duties include quality assurance audits, POA indicator validation, audits of MS-DRG/APC assignments and pre-bill compliance, and supporting the Clinical Validation Initiative with guidance for identified conditions. #J-18808-Ljbffr

Clinical Coding Auditor & Trainer 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 education to clinical, coding, and...

About Us McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio. Coding Auditor Senior Facility Michigan, Shelby...

Inpatient Facility Medical Coder 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 (OMAP), and Kaiser Permanente organization/institutional coding...