288 medical coding auditor coding validation reviewer jobs found

Job Summary Job Summary: Location: 100% remote (US only), supporting VA medical centers in VISN 7 Term: 12-month base period plus four 12-month option periods. Pay: 25.00/hr-30.00/hr About the role Aptive Resources is looking for experienced coding auditors to run external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina. You'll audit inpatient DRG, outpatient, and professional fee coding, report what you find, and teach VA coding staff and clinicians how to improve. The VA expects about 5,000 audited records a year across the Atlanta, Birmingham, Columbia, and Augusta facilities. Primary Responsibilities What you'll do Audit coded data for accuracy and compliance, separately from the regular coding work. Each audit focuses on one area: inpatient facility (DRG), outpatient facility, inpatient professional services including surgery, or outpatient services (urgent care, clinic visits, and ambulatory surgery). Review up to the first 25...

Audit inpatient DRG, outpatient, and professional fee coding for VA facilities. Build statistical samples, classify errors, and draft facility reports. Lead training sessions and exit conferences with HIM leadership. Required qualifications: Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential. 3+ years consulting, coding, and training experience. Expertise in ICD-10-CM/PCS, CPT, HCPCS, DRG, APC, and NCCI edits. About Aptive: Service-Disabled, Veteran-Owned Small Business JV. Supports VHA facilities with integrated critical staffing. Aptive Resources Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach. #J-18808-Ljbffr

Job Summary Job Summary: Location: 100% remote (US only), supporting VA medical centers in VISN 7 Term: 12-month base period plus four 12-month option periods. Pay: 25.00/hr-30.00/hr About the role Aptive Resources is looking for experienced coding auditors to run external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina. You'll audit inpatient DRG, outpatient, and professional fee coding, report what you find, and teach VA coding staff and clinicians how to improve. The VA expects about 5,000 audited records a year across the Atlanta, Birmingham, Columbia, and Augusta facilities. Primary Responsibilities What you'll do Audit coded data for accuracy and compliance, separately from the regular coding work. Each audit focuses on one area: inpatient facility (DRG), outpatient facility, inpatient professional services including surgery, or outpatient services (urgent care, clinic visits, and ambulatory surgery)....

Select how often (in days) to receive an alert: Date: Sep 9, 2026 Location: Any city, TN, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for aSenior Coding Auditor, Itemized Bill Reviewer who is responsible for performing itemized bill review, chart review, and coding validation to ensure that billed services were ordered, allowable, and accurately documented in the patient record....

We are sharing a specialised consulting opportunity for experienced Medical Auditors with strong expertise in outpatient professional fee coding, coding audits, academic medical center workflows, audit-program management, and coding quality assurance to contribute to an advanced AI training and medical-coding evaluation project. Selected professionals will audit outpatient professional fee coding, review other coders' work, resolve complex coding cases, identify recurring quality issues, and provide structured feedback grounded in professional coding standards. No prior experience in AI is required. Key Responsibilities Coding Audit & Complex Case Review Audit outpatient professional fee coding for accuracy, compliance, and documentation support Review other coders' work and identify incorrect, incomplete, or inconsistent coding Evaluate complex or ambiguous cases and document well-supported determinations Apply coding guidance consistently across varied clinical...

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for a Senior Coding Auditor, Itemized Bill Reviewer who is responsible for performing itemized bill review, chart review, and coding validation to ensure that billed services were ordered, allowable, and accurately documented in the patient record. The candidate must have an extensive background in inpatient hospital bill auditing, outpatient facility coding with charge master...

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts. It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation.Supervisory Responsibilities: This position has no supervisory responsibilities.General Requirements: All duties performed will be done accurately and in a timely manner.Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.Must always adhere to customer service expectations including in-person and virtual (via telephone, or...

Certified Professional CoderJob Location: Hopewell, NJ Job Duration: 6 Months (possibility of extension) Payrate: $35 - $38/ hr. on w2 Job Summary: This position is responsible for leading on-site and desk audits of hospital billing and coding practices, including forms development, audit profiling, and tracking institutional audit trends. The role involves designing audit protocols, handling special projects, and performing/finalizing per diem audits, bill verification, DRG validation (utilization review audits), and credit balance reviews. The position also provides education and guidance on ICD-10-CM coding, DRG assignment, payment methodologies, and auditing practices.Key Responsibilities:Lead hospital billing and coding audits, both on-site and remoteIdentify and present billing discrepancies and coordinate improper claim payment referralsAnalyze trends related to documentation, billing errors, and provider contract interpretation issuesCompile audit reports, statistics, and...

Northwell Health is seeking an Acute Inpatient Coding Validation professional in New York to validate DRG assignments based on the documentation in the Medical Record. You will perform full reviews of CDI suggested code changes and apply coding rules. Audits cover Medicare and non-Medicare charts to ensure compliance with federal and state regulations. Candidates should hold a NY RN license with a BSN or equivalent and ICD coding experience; inpatient rehab experience preferred. #J-18808-Ljbffr

Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Job Responsibility 1. Leverages clinical expertise to identify and validate DRG code assignment. 2. Full review of CDI suggested code changes 3. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5. Applies coding rules and regulations to the validation review process. 6. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7. Communicates DRG changes and rationale to the coding and CDI staff. 8. Identifies appropriate coding changes necessary to provide the most valid documentation in compliance with Federal and State regulations. 9. Operates under...

Professional Coder IThis position is accountable for accurately reviewing, interpreting, auditing, coding and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction. Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business.Responsibilities:Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.Identify, compile and code member/patient data, using ICD-9/ICD 10-CM and other standard classification coding systems.Support the...

## Inpatient and Facility Coding Auditor - Claims Review Specialist (FT/REMOTE)Apply: US - Remote: Full time: Posted Yesterday: JR106127**About Us:**Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.**JOB SUMMARY:**The Claim Review Specialist serves as a revenue cycle and coding consultant, partnering with the Director of HIM to perform complex concurrent and retrospective audits of hospital inpatient, facility and outpatient claims. This role evaluates coding accuracy and documentation compliance by validating ICD-10, CPT, and HCPCS code...

Experienced Professional Coding Specialist Revenue Integrity New to OU Health? Ask your recruiter about our competitive wages and total rewards package. Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Looking for a coding team to love at OU Health? This is it! We cover multiple specialties, so there's opportunities to learn and grow . 100% remote. Flexible shifts once training is complete. Opportunity to work four 9 hour days, and one 4 hour day. So if you're work-from-home ready, work well independently, and have strong coding skills we just may be the right fit for you! ***The ideal candidate would have teaching hospital or trauma center coding experience. While coding knowledge in multiple specialties is a big plus, the CIRCC certification moves you to the top of the list of candidates. Epic, Encoder Pro and Solventum/3M experience preferred.*** General Description Independently performs complex...

The Sarnova Family of companies includes Digitech Computer, Bound Tree Medical, Tri-anim Health Services and Cardio Partners. Digitech is a leading provider of advanced billing and technology services to the EMS transport industry. Since its founding in 1984, Digitech has refined its software platform to create a cloud-based billing and business intelligence solution that monitors and automates the entire EMS revenue lifecycle. Digitech leverages its proprietary technology to offer fully outsourced services that maximize collections, protect compliance, and deliver results for clients. Summary: The Billing Specialist I will utilize master billing guides and other process instructions to review PCR to ensure medical necessity, reasonableness, level of service, ICD10 coding and mileage is correct. This role is fundamental in Digitech's revenue cycle management process and ensures that claims are coded and billed accurately and timely. The selected Billing Specialist I will maintain a...

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...

HIM/RHC Certified Coders are responsible for reviewing, validating, and analyzing procedural coding and charging for Hospital, Ambulatory Surgical Department, Emergency Department, ancillary departments, and Clinic Services. The primary focus of the position is procedural and charge accuracy, including review of CPT and HCPCS codes, modifiers, units, revenue codes, charges, and supporting clinical documentation. Coders compare documented procedures and services with the charges and codes submitted for billing to identify missing, incorrect, duplicate, unsupported, or otherwise discrepant charges that may affect reimbursement or revenue integrity. The position researches ICD 10, CPT, HCPCS, modifier, payer, billing, and reimbursement requirements; performs charge and coding audits; analyzes procedural claim edits and denials; and works with clinical departments, Patient Financial Services, Charge Capture, and other Revenue Cycle staff to research and resolve discrepancies. ICD-10...

Coding Auditor AllCare Health | Quality Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members. This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes. Essential Duties Ensures the accuracy and...

Job TitleValidates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position in New York.Job Responsibility1. Leverages clinical expertise to identify and validate DRG code assignment.2. Full review of CDI suggested code changes.3. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization.4. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations.5. Applies coding rules and regulations to the validation review process.6. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions.7. Communicates DRG changes and rationale to the coding and CDI staff.8. Identifies appropriate coding...

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:...

Coding Auditor SeniorCandidates must reside either in Washington or Oregon to be considered for this position.Essential Responsibilities:Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as needed for proper Ambulatory Payment...

Inpatient Facility Medical Coder (40h Day)RemoteClackamas, ORCandidates must reside either in Washington or Oregon to be considered for this position.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);...

Coding Auditor, FacilityOnsiteClackamas, ORTo 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 Healthcare organization/institutional coding...