601 healthcare data quality coding auditor jobs found

CVS Health is seeking a skilled medical records auditor to perform chart reviews and abstract ICD codes for CMS risk adjustment. You will ensure accuracy and compliance with state and federal regulations while supporting coding decisions with evidence from records. Responsibilities include applying guidelines, identifying active vs historical conditions, meeting tight deadlines, and conducting self-audits to maintain quality within our healthcare operations. Strong CPC/CCS-P credentials required. #J-18808-Ljbffr

CVS Health is hiring for a medical records auditor responsible for reviewing and abstracting records, and assigning ICD codes for CMS risk adjustment. You will ensure documentation supports coding decisions and complies with all regulations. Qualified candidates have 1+ year in medical record documentation review or coding, with CPC or CCS-P certification. The role offers a full-time schedule and comprehensive benefits. #J-18808-Ljbffr

CVS Health is seeking a Medical Records Auditor to perform audit and abstraction of medical records for CMS risk adjustment, ensuring accuracy and compliance with state and federal regulations and internal policies. Requirements include a minimum of 1 year of related experience and CPC or CCS-P certification, with a high school diploma. The role is full-time, 40 hours per week, in Arizona, with comprehensive medical, dental and vision benefits and paid time off. #J-18808-Ljbffr

CVS Health is seeking a full-time Medical Records Auditor/Abstractor in Oklahoma to review and abstract medical records for CMS risk adjustment. You will ensure accurate ICD coding, validate documentation support, and maintain compliance with state and federal regulations. The role requires 1 year of related experience and CPC/CCS-P certification. We offer a comprehensive benefits package and a 40-hour work week, with compensation based on experience and geography. #J-18808-Ljbffr

CVS Health is seeking a skilled medical records auditor to perform auditing and abstraction of records for ICD coding and CMS risk adjustment. You will ensure codes are accurate and supported by clinical documentation, aligning with state and federal regulations. The role requires CPC/CCS‑P certification, with at least one year of related experience. This full-time position offers comprehensive benefits and the opportunity to contribute to the integrity of health data across care settings. #J-18808-Ljbffr

Where You'll Work Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system. Job Summary and Responsibilities As our Lead Inpatient Coder, you will be a cornerstone of our...

Job Description - Sr Compliance Auditor (301657) Job Description Sr Compliance Auditor - 301657 Description Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider‑coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties Conduct audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise...

Overview Compliance Auditor Sr. Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. Position Summary: Performs complex-level professional internal auditing. Work involves leading or conducting compliance audit projects for Covenant Health entities as they relate to charging, coding, documentation and billing compliance....

Description Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Performs technical and administrative work reviewing, abstracting and assigning accepted medical CPT, HCPCS, and ICD-10 codes for professional services. Duties are performed in compliance with third party, state and federal regulations according to standardized procedures. Employees report to an administrative superior but independently handle assigned tasks. Responsibilities: Assigns International Classification of Diseases 10-CM diagnostic and ICD-10-PCS procedural codes accurately and productively, and other applicable codes such as MS-DRG on inpatient cases for all Health Care system cases excluding the academic medical center Groups codes and completed product into payment group. Assigns codes that affect Severity of Illness and Risk of Mortality and...

\*\*\*To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia\*\*\* The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility)...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities: Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities: Communicates with insurance companies about coding errors and disputes (physician billing). Abstracts pertinent data points for billing and quality reviews. Communicates with various departments as needed to ensure accuracy of patient data. Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing). May assign and sequence basic CPT (Current...

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Performs technical and administrative work reviewing, abstracting and assigning accepted medical CPT, HCPCS, and ICD-10 codes for professional services. Duties are performed in compliance with third party, state and federal regulations according to standardized procedures. Employees report to an administrative superior but independently handle assigned tasks. Responsibilities: 1. Assigns International Classification of Diseases 10-CM diagnostic and ICD-10-PCS procedural codes accurately and productively, and other applicable codes such as MS-DRG on inpatient cases for all Health Care system cases excluding the academic medical center 2. Groups codes and completed product into payment group. 3. Assigns codes that affect Severity of Illness and Risk of Mortality and Hierarchal Condition...

Job Summary and Responsibilities As our Lead Inpatient Coder, you will be a cornerstone of our medical coding department, providing essential leadership and strategic direction for our inpatient coding team. You will be instrumental in driving coding accuracy, ensuring regulatory compliance, and optimizing revenue cycle performance for complex medical cases, making a direct impact on our healthcare data integrity and financial health. Every day you will provide expert technical guidance, conduct comprehensive quality oversight, and perform complex coding audits. You will actively collaborate with clinical and revenue cycle teams to enhance documentation and streamline processes. A significant part of your role involves mentoring, training, and fostering the professional growth of coding staff, ensuring adherence to the highest coding standards and best practices. To be successful in this role, you will possess advanced inpatient coding credentials (e.g., CCS, RHIA, RHIT),...

Medical Coding Auditor Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* as you take on some tough challenges. The Medical Coding Auditor is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. This position supports the identification of suspected Waste & Error of health...

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...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* as you take on some tough challenges. The Medical Coding Auditor is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. This position supports the identification of suspected Waste & Error of health insurance claims and...

Clinical Coder To undertake the role of a Clinical Coder to clinical groups or specialties as appropriate, abstracting from patient notes and other information sources and assigning suitable codes onto the Trust's patient administration system in line with National standards. Attend training sessions as necessary and work to maintain allocated reference manuals and standards manuals so that they are always up to date with national guidance. We are recruiting Band 4 Clinical Coders (with a 5% Recruitment & Retention Premium) who have completed the NHS Clinical Coding Foundation Course. Previous applicant need not apply. Please be advised that sponsorship is not eligible for this post. Please note that only the Band 4 role is subject to the R&R Premium (subject to renewal in December 2026). This will be applied upon commencement of the role. This will be included in the salary package from the start of employment. Closing Date: Please be advised that this job advert will...

Job Description Job Description Job Summary: Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment complies with the official coding guidelines as supported by clinical documentation in health records. Validates abstracted data elements that are integral to appropriate payment methodology. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.   Job Responsibilities/Duties: · Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or...

Description The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Summary Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD-10-CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. Monitors professional fee vendor‑coding services to...

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that...

Job Summary: HIM Coding auditor/trainer will coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Audits will focus on correct assignment of CPT, ICD-10, ICD-9- CM, HCPSC codes and clinician documentation to ensure that Kaiser Permanente is compliant with all regulatory guidelines and internal controls. Audits will encompass internal practitioners, contracted practitioners, coders, internal facilities and contracted facilities. The auditor will analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. When necessary, this position will initiate corrective action plan to ensure resolution of problem areas identified during auditing and monitoring activity. This position will serve as a liaison with HIM staff, Revenue Cycle, External and Internal practitioners, and other regional departments as appropriate including...

Description The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Summary Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD-10-CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. Monitors professional fee vendor‑coding services to...

Compliance Auditor/Educator - Compliance Quality (CPC Required) Clark St House (CMC) - Champaign, IL 61820 Overview Salary Range $28.03 - $38.54 Hourly Position Type Full Time Job Shift 1st Shift Education Level High School Category Coding/Compliance General Summary of Duties Christie Clinic's department of Compliance Quality is seeking a full-time Compliance Auditor/Educator at our Clark Street location in Champaign from Monday-Friday 8:00am-5:00pm, with no night or weekend requirements. Duties include performing ongoing functions related to quality of care and compliance including government and clinic regulations and policies in support of the Christie Clinic Compliance System. Job Qualifications and Expectations JOB DUTIES: (This list may not include all of the duties assigned.) Screen, review, identify and document potential quality and compliance issues. Perform billing and coding audits with both random samples as well as provider and department...