37 network practice coder auditor jobs found

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...

Compliance Auditor page is loaded## Compliance Auditorlocations: SD, City - Remote SD: Remote MN: Remote WI: Remote IA: Remote ND (Central Time)time type: Full timeposted on: Posted 7 Days Agojob requisition id: R-0255424**Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.**Work Shift:8 Hours - Day Shifts (United States of America)Scheduled Weekly Hours:40Salary Range: $19.00 - $30.50**Union Position:**No**Department Details****Summary**Responsible for conducting internal audits and monitors to ensure that the organization’s processes and operations are in compliance with laws, corporate guidelines, best practices, and contractual agreements.**Job Description**Knowledgeable of general audit concepts and techniques, including the...

EMR Coding Auditor Summary/Objective: The EMR Coding Auditor (ECA) facilitates improvement in the overall quality, completeness and accuracy of medical record documentation. The individual will perform medical record reviews based on CMS Quality Standards and validating active chronic problems for each patient and communicating with the physician to ensure Hierarchical Condition Coding is met, as well as accurate and up-to- date patient problem lists are documented in the EMR. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes. The ECA reports to the Population Health Manager. It is the obligation of each Galen associate to comply with and promote the Galen mission, core values, privacy and corporate/departmental/site policies (I.E. Dress code, Time and attendance, et al). Essential Functions: Coordinate...

Job Description Job Description Description: Come and join our growing organization as a Medical Biller! Roswell Park Care Network is a recognized leader in oncology and specialty care, supporting community physician practices across New York State. We are committed to delivering exceptional patient care while advancing innovative treatment options in a collaborative and patient-focused environment. Comprehensive Benefits: Monday-Friday schedule Medical, dental, and vision coverage Employer funded Health Reimbursement Account (HRA) 401(k) with company match Generous vacation and sick time Company-paid life insurance 11 paid Holidays The Medical Biller position offers a hybrid schedule. After successfully completing on-site training, the schedule transitions to just one on-site day per week As the Medical Biller you will be responsible for entering charges and submitting medical claims to insurance companies. This role will work all open accounts...

ESSENTIAL FUNCTIONS FOR THIS POSITION Ensures that codes are assigned correctly and sequenced appropriately as per government and insurance regulations Complies with all medical coding guidelines Follows up and clarifies any information that is not clear with the rendering provider Conducts ad‑hoc audits to ensure fidelity to coding guidelines Relevant expert for Southwest Network on accurate and efficient coding practices Analyze medical records and identify documentation deficiencies NONESSENTIAL FUNCTIONS Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program. Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical, and professional guidelines adopted by Southwest Network. Other duties as assigned. WORKING CONDITIONS and DRIVING Travel between Southwest Network sites as well as in the community is required. Must have a...

Provider Liaison - Certified Professional Coder (CPC) / Certified Coding Specialist (CCS) A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description One of our direct client is looking for potential candidate with the below mentioned skills Direct Client: Immediate Interview Contract to Hire Position: Provider Liaison MUST HAVE: 5 years of experience into Project Management At least 2 years of experience after CPC or CCS certification Bachelor's degree is a must Certifications: AAPC Certified Professional...

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. Locations: Stanford Health Care - University Healthcare Alliance What You Will Do: Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with...

ESSENTIAL FUNCTIONS FOR THIS POSITION • Ensures that codes are assigned correctly and sequenced appropriately as per government and insurance regulations • Complies with all medical coding guidelines • Follows up and clarifies any information that is not clear with the rendering provider • Conducts ad-hoc audits to ensure fidelity to coding guidelines • Relevant expert for Southwest Network on accurate and efficient coding practices • Analyze medical records and identify documentation deficiencies NONESSENTIAL FUNCTIONS • Follows policies and procedures and adheres to the requirements of the Corporate Compliance Program. • Ensures confidentiality of verbal and written information in accordance with HIPAA standards and Southwest Network policy, and adheres to the legal, ethical, and professional guidelines adopted by Southwest Network. • Other duties as assigned. EDUCATION and/or EXPERIENCE, LICENSURE and CERTIFICATION • Associate degree in medical coding or...

Job Title Frontline, department-based role that supervises daily functions of assigned area(s). Provides clear direction & manages / advances people, processes, structures & / or programs that support direct / indirect care. Demonstrates behaviors in alignment with culture & creates / supports comprehensive strategies & measures progress to achieve desired outcomes. Note: "patients" refers to patients, clients, residents, participants, customers, members Essential Functions: Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Responsible for the daily operations & the oversight of staff. Supervisors work in collaboration with department managers to manage staff & department effectively. Participates in & contributes to the performance management / review process. Implements departmental plans &...

Job Description Job Description Hi, we're Oscar. We're hiring an Associate, SIU Coding Auditor to join our SIU. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Associate, Special Investigations Unit Coding Auditor executes on Oscar's anti-fraud initiatives by supporting operational and financial targets while adhering to legal and regulatory obligations. You will help execute on audit strategy by ensuring team productivity is met while ensuring quality remains high. The associate networks across all partners, and recommends enhancements to processes, policies, and procedures to support a best in class Fraud Waste and Abuse program. We ask that you have attention to detail, innovation, and ability to shift priorities to align...

Job Scope Under general supervision, the Billing Specialist is responsible for all claim submissions, verifying the accuracy of charges and patient demographic information on claim detail, conducting timely follow‑up with patients and third‑party payers, and supporting the US Oncology Compliance Program, including the Code of Ethics and Business Standards. Overview Employment Type: Full Time In‑Office Position 82 Orland Square Drive Orland Park, Illinois 60462 Benefits: M/D/V, Life Insurance, 401(k) Hourly Range $19.00 - $29.00 The US Oncology Network The US Oncology Network is a thriving organization that fosters forward‑thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes! Come join our team in the fight against cancer! About The US Oncology Network The US Oncology Network is one of the nation’s largest networks of...

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

We are hiring detail-oriented professionals to manage end-to-end revenue cycle management (RCM) for our growing network of dental and medical practices across the United States. This role offers a unique opportunity to launch a career in healthcare billing without prior experience— we provide comprehensive training, all required compliance certifications, and ongoing support. Key Responsibilities Claims Processing & Insurance Management Submit dental and medical insurance claims daily through secure clearinghouses. Post insurance payments and process Explanations of Benefits (EOBs). Process claim denials and initiate appeals with insurance companies. Manage aging reports to ensure no claims miss timely filing deadlines. Maintain accurate patient ledgers and reconciliation records. Eligibility Verification & Pre-Authorization Verify patient insurance eligibility 48–72 hours before scheduled appointments. Confirm coverage details including deductibles, copays, and...

Insurance And Medical Billing Specialist At Plastic Surgery of Tuscaloosa, our goal is to offer naturally beautiful aesthetic results. At our state-of-the-art surgical facility on Commons North Drive in the North River section of Tuscaloosa, we are proud to offer a wide range of procedures, including spa-like treatments, nonsurgical treatments, and surgical or more invasive treatments. We are dedicated to going the extra mile to ensure our patients get the results they deserve. That's why we offer cutting-edge treatments in a premier facility that is set up for more invasive techniques. Additionally, we're proud to offer treatments that you won't find elsewhere this includes specializing in tummy tucks for patients with a higher BMI. This, combined with our dedication to patient results, leads to patients visiting us from areas all over the country. We know that surgery can be an intimidating undertaking, and with our focus on personalized patient care, we will be supporting...

Overview Employment Type : Full Time In-Office Position 82 Orland Square Drive Orland Park, Illinois 60462 Benefits : M/D/V, Life Ins., 401(k) JOB SCOPE: Under general supervision, the Billing Specialist is responsible for all claim submissions, which includes verifying accuracy of charges and patient demographic information on claim detail. Responsible for timely follow-up with patients and third-party payers. Supports and adheres to The US Oncology Compliance Program, to include the Code of Ethics and Business Standards. HOURLY RANGE : $19.00 - $29.00 The US Oncology Network is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes! Come join our team in the fight against cancer! About The US Oncology Network The US Oncology Network is one of the nation's...

Employment Type: Full time Shift: Description: Purpose Frontline, department-based role that supervises daily functions of assigned area(s). Provides clear direction & manages / advances people, processes, structures & / or programs that support direct / indirect care. Demonstrates behaviors in alignment with culture & creates / supports comprehensive strategies & measures progress to achieve desired outcomes. Note: "patients" refers to patients, clients, residents, participants, customers, members? Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Responsible for the daily operations & the oversight of staff. Supervisors work in collaboration with department managers to manage staff & department effectively. Participates in & contributes to the...

The Medical Coder, RCM is responsible for ensuring coding accuracy and claim readiness prior to submission, with a focus on resolving missing or invalid order and documentation elements that drive rejections, denials, and delayed reimbursement. This role partners closely with RCM front-end teams and the broader RCM organization to strengthen clinical defensibility and coding integrity through standardized workflows, proactive quality reviews, and documentation readiness. What this role exists to do Strengthen pre-claim coding and documentation integrity to reduce avoidable rework and improve reimbursement outcomes. Who it impacts Patients, providers, Client Services, Market Access partners, and Revenue Cycle operations benefit from improved claim quality and fewer downstream delays. What success looks like Improved front-end completeness (e.g., fewer missing ICD-10, demographic, or insurance elements), improved clean-claim readiness, and fewer coding- or...

Job Type Full-time Description Come and join our growing organization as a Medical Biller! Roswell Park Care Network is a recognized leader in oncology and specialty care, supporting community physician practices across New York State. We are committed to delivering exceptional patient care while advancing innovative treatment options in a collaborative and patient-focused environment. Comprehensive Benefits: Monday-Friday schedule Medical, dental, and vision coverage Employer funded Health Reimbursement Account (HRA) 401(k) with company match Generous vacation and sick time Company-paid life insurance 11 paid Holidays The Medical Biller position offers a hybrid schedule. After successfully completing on-site training, the schedule transitions to just one on-site day per week As the Medical Biller you will be responsible for entering charges and submitting medical claims to insurance companies. This role will work all open accounts for...

Salary: $4,389.00 - $5,612.00 Monthly Location : Albany, OR Job Type: Full Time- SEIU Job Number: 26-00018 Department: Administration Program: Billing Opening Date: 04/02/2026 FLSA: Exempt Bargaining Unit: SEIU Description HEALTH SERVICES MEDICAL BILLER/CODER Administration/Billing Program (Classification 757) SEIU Represented Full-Time (37.5 hours/week) position Position Open Until Filled First review of applications will be on April 20, 2026. Any applications received after April 20 will be reviewed and considered as needed, and this posting may close at any time after that date. Linn County requires on-site work. Remote work is not available. Job Summary A person employed in this classification must possess the capability to perform the following duties to be considered for and remain in this position. The duties are essential functions requiring the critical skills and expertise needed to meet job objectives. Additional specific...

Job Description Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. BENEFITS for Full and Part-time employees who work 30 or more hours per week: We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay...

Become a part of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Outpatient Behavioral Health Coding disputes and is part of the PPI Coding Disputes Team with Humana. The Outpatient Behavioral Health Coding Auditor on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality. Will be an experienced medical coding auditor with in-depth experience in outpatient Behavioral Health coding disputes and expertise in CPT/HCPCS code...

Date Posted: 2026-03-23 Country: United States of America Location: Florida - Remote WHY JOIN FCS At Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in them. In addition to having a positive impact on the people and communities we serve, associates benefit from significant professional opportunities, career advancement, training and competitive wages. Offering competitive salaries and comprehensive benefits packages to include tuition reimbursement, 401-K match, pet and legal insurance. A LITTLE BIT ABOUT FCS Since 1984, Florida Cancer Specialists & Research Institute & Research Institute (FCS) has built a national reputation for excellence. With over 250 physicians, 220 nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research, cutting-edge technologies, and advanced treatments, we are committed to providing world-class...

Responsibilities Remote Opportunity Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve. To learn more about IPM visit Physician Services - Independence Physician Management - UHS. POSITION OVERVIEW Coder Certification Required . The Coder provides coding services and support to assigned IPM Markets/Billing Entities, as required, utilizing clinical documentation in multiple electronic health record (EHR) systems. Applies...

About the Job We are hiring detail-oriented professionals to manage end-to-end revenue cycle management (RCM) for our growing network of dental and medical practices across the United States. This role offers a unique opportunity to launch a career in healthcare billing without prior experience-we provide comprehensive training, all required compliance certifications, and ongoing support. As a Dental and Medical Biller, you will be the financial backbone of multiple healthcare practices, managing insurance claims, patient billing, eligibility verification, and appointment coordination. You will work directly with practice teams to ensure accurate, timely claim submissions and maximum revenue recovery. Key Responsibilities: Claims Processing & Insurance Management: Submit dental and medical insurance claims daily through secure clearinghouses. Post insurance payments and process Explanations of Benefits (EOBs). Process claim denials and initiate appeals with...