294 facility coding auditor claim review specialist jobs found

Job Title: Clinical Nurse Auditor / RN Nurse Coder (Payment Integrity) Job Type: Full-Time (40 hours/week, Monday - Friday) Schedule: Standard business hours Department: Payment Integrity & Claims Audit Location: Remote About the Role We are seeking experienced, detail-oriented Registered Nurses (RNs) with strong clinical acumen and medical coding knowledge to join our growing Payment Integrity team. In this role, you will analyze flagged claims data, review complex clinical documentation, and identify potential overpayments and billing discrepancies. You will leverage your clinical expertise to validate diagnoses, assess code assignments, and make authoritative determinations on claim validity-protecting healthcare resources while ensuring accurate reimbursement. Key Responsibilities Clinical Review & Determination: Review flagged claims (both inpatient and outpatient) to evaluate the clinical validity of billed services. Make independent clinical determinations,...

Job Description Primary Duties And Responsibilities The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Verify that all ICD-10-CM codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings. Performs other duties as assigned. Medical Coding - Hoag Hospital In addition to the above, the coder resolves billing related errors and assists with workflow changes and process improvement projects....

The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines. Verify that all ICD-10-CM codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings. Performs other duties as assigned. Job Description The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external...

This is fully remote in any state except NY, CA, HI or AK Pre-Payment Clinical Auditor (RN/Coder) Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical reviews of...

Job DescriptionPrimary Duties And ResponsibilitiesThe Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines.Verify that all ICD-10-CM codes are correctly captured. Verify that physician is correctly abstracted. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings.Performs other duties as assigned.Medical Coding - Hoag HospitalIn addition to the above, the coder resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing...

Job Title: Pre-Payment Clinical Auditor (RN/Coder) Contract Duration: 6 months, possible extension Work Arrangement: Remote Summary Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key Responsibilities Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive...

Description: Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical reviews of high-dollar or highly complex medical records before a claim is finalized for payment....

Description: Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities : Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical reviews of high-dollar or highly complex medical records before a claim is finalized...

This is fully remote in any state except NY, CA, HI or AK Pre-Payment Clinical Auditor (RN/Coder) Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical...

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,...

Medical Coding Specialist Key Responsibilities: Analyze patient charts, physician notes and discharge summaries Ensure documentation is complete and accurate before coding Translate diagnoses and procedures into standardized codes using: ICD-10-CM (diagnoses) CPT (procedures) HCPCS (supplies/services) Make sure codes correctly represent services provided Follow healthcare laws and regulations (HIPAA, Medicare/Medicaid guidelines) Company Policies Prevent coding errors that could lead to claim denials or audits Stay updated on coding changes and updates Work with billing teams to submit coded claims to insurance companies Verify claim accuracy to ensure proper reimbursement Fix rejected or denied claims by reviewing and correcting codes Communicate with healthcare providers and insurance companies Protect sensitive patient information Follow strict privacy and data security standards Clarify documentation with physicians when needed Collaborate with billing...

Medical Coding Specialist Work Style: Onsite Location: Jacksonville, FL FTE: Full-Time (1.0 FTE) Schedule: Variable Shift Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes in compliance with established coding guidelines and organizational policies. Collaborates with healthcare providers to clarify documentation and resolves coding discrepancies, ensures the integrity of coded data for billing and reporting purposes. Maintains current knowledge of coding standards such as ICD, CPT, and HCPCS, and supports the billing department by providing precise coded information for claims submission. Includes auditing coded data, training staff on coding procedures, and monitoring coding productivity and quality metrics to enhance departmental performance. Responsibilities Reviews and analyzes medical records to assign appropriate diagnostic and procedural codes. Ensures compliance with coding guidelines and organizational policies....

Experience preferred. Certified Coder with 5+ years experience coding professional and facility fees for surgical cases and office visits. Specialties include Obstetrics/Women's Health, Orthopedics, Podiatry, Cardiology, Urology & General Surgery. JOB SUMMARY The Coder is responsible for reviewing discharge abstracts and patient charts in order to assign the appropriate ICD-CM/CPT codes to diagnoses and procedures. Reviews charts for potential liability risk and documents specific information as necessary. Performs studies as requested by physicians or administration. Maintains State reporting documentation for certain procedures in compliance with regulations. The Coder encounters the mission of providing quality healthcare to the patients of WhidbeyHealth to ensure medical records are charged and coded accurately and efficiently. This position may be responsible for applying the appropriate codes for ICD-10, CPT / HCPCS, evaluation and management, and/ or modifiers...

Coder Reimbursement Specialist - Hospital The Coding and Reimbursement Specialist, CCS is responsible for coding and abstracting thoroughly, clinical data from the medical record. This includes both inpatient, outpatient, commercial, Medicare, Medicaid, and Illinois Public Aid, plus any other payor types. This accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis, grouped to the DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General. Manages workload and assigns work to three inpatient and two outpatient coders and oversees the day to day workings of the coding/reimbursement area. Monitors various regulatory sources to keep HIM coding and other staff informed and trained on various coding rules, regulations and related issues. Works closely with patient financial services to resolve any...

JOB SUMMARY: This position is responsible for reviewing a patient's medical records after a Clinic visit and translating the information into codes that insurers use to process claims for patients. Duties include confirming treatments with medical staff, identifying missing information, and submitting information to insurers for reimbursement. RESPONSIBILITIES (ESSENTIAL FUNCTIONS): Accurately assigns and sequences codes (ICD-10-CM, CPT, HCPCS/modifiers as necessary) for each patient encounter, following proper coding guidelines and legal requirements to ensure compliance with federal and state regulations. Ensures professional/physician billing CPT codes/ICD-10 codes are assigned correctly and sequenced appropriately as per government and insurance regulations. Queries providers or other Clinic team members when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Assigns and enters...

Overview A Certified Professional Coder (CPC) job description generally involves reviewing patient medical records, abstracting relevant clinical information, and assigning appropriate medical codes using ICD-10, CPT, and HCPCS code sets. CPC responsibilities also include ensuring accurate documentation and coding, facilitating claims processing, and complying with regulatory requirements. Responsibilities Coding and Abstracting: Accurately translate patient encounters into standardized medical codes (ICD-10, CPT, and HCPCS). Documentation Review: Analyze patient records for completeness, accuracy, and compliance with coding guidelines. Reimbursement Analysis: Research and analyze data needs for accurate and timely reimbursement. Auditing and Compliance: Conduct chart audits, identify coding discrepancies, and implement corrective actions. Communication and Collaboration: Communicate effectively with healthcare providers to clarify coding issues and...

Certified Professional Coder Consultant Come grow with us. Yeo & Yeo Medical Billing & Consulting was established in 1998 as an affiliate of Yeo & Yeo to provide clients with medical billing and additional practice management solutions. We have devoted ourselves to helping clients maximize their reimbursement and assist in educating them with the ever-changing rules and guidelines of Medicare and other insurance carriers as well as CPT, HCPCS and ICD-10 coding. Yeo & Yeo Medical Billing & Consulting maintains a highly trained staff with experience in all areas of physician billing. Several Certified Professional Coders on staff assist in choosing proper diagnostic codes and procedure codes. Our billing specialists receive ongoing training specific to medical specialty. We continually train our staff by updating and maintaining their knowledge of insurance carrier trends and changes in billing rules and policies. Our people are our future – we provide the...

Professional Fee Coding Auditor / Claims Edit Specialist This position may be performed onsite or remotely; however, onsite work is preferred based on business needs. Preference will be given to qualified candidates who are able to work onsite and are located within a reasonable commuting distance. This position is open to candidates located within the continental United States. Due to state-specific employment requirements and workers' compensation regulations, we are unable to support remote work arrangements in the following locations: Washington, Ohio, Wyoming, North Dakota, Puerto Rico, and the U.S. Virgin Islands. At Northbay Health, the Professional Fee Coding Auditor / Claims Edit Specialist is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials. This role ensures coding accuracy, documentation integrity,...

Job Description Staff Position Description Position Title: Professional Services Coder and Coding Reviewer Position Code: Coder-8125 Oracle code: Coder-8215 Department: Health Information Management Safety Sensitive: ☒ Yes ☐ No Reports to: HIM Director/Manager Exempt Status: ☐ Yes ☒ No Position Purpose: All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI's vision to be among the kindest, highest quality health systems in the country. Key Responsibilities Evaluates medical record documentation and charge reports to ensure completeness, accuracy and compliance with the Correct Coding Initiative Edits; evaluates and report audit findings or reviews and reports on results to physicians and/or operations directors; evaluate insurance requests and claim denials to assist the Business Office with the revenue cycle. Ensures data quality in compliance with State, Federal and regulatory...

HIM Specialty Coder II You'll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006. And you'll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here. Billings Clinic is a community-owned, not-for-profit, physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a...