1409 professional pre pay medical coding auditor jobs found

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...

Requisition number: 2371422 Job category: Medical & Clinical Operations 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...

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...

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...

Description Risk Adjustment Coding Auditor The Impact you will have The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. Your Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting Verifies and ensures the accuracy, completeness,...

Description MaineHealth Corporate Professional - Nonclinical Req #: 75482 Summary: The Clinical Coding and Compliance Auditor role is responsible for the accurate assignment of ICD and CPT codes of diagnoses and procedures for outpatient medical records in multiple outpatient settings. Required Minimum Knowledge, Skills, and Abilities (KSAs) Education: Associate's Degree in a science field preferred. Completion of an accredited program through AHIMA or AAPC preferred. License/Certifications: RHIT, RHIA, CCS, CCA, CPC, CPC-H, or CIRCC credential preferred. Experience: Two years of multi-specialty, preferably surgical coding experience, with CPT/ICD-10-CM/HCPCS/modifier coding for physician professional charges and a minimum of two years' experience in an acute care facility as an ASU Clinical Coder required. Additional Skills/Requirements Required: Experience coding E/M's, Outpatient Hospital Clinics, OBV, ASU, Professional Surgical CPT's, ED's, cardiac...

*Risk Adjustment Coding Auditor* Overview We are seeking a detail-oriented *Risk Adjustment Coding Auditor* to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement. The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models. Key Responsibilities * Perform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy. * Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses. * Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting. * Evaluate coding...

Job Description Job Description Location: Miami, FL (On-site preferred; Hybrid/Remote may be considered) Employment Type: Part-Time (25–35 hours per week) About the Position We are seeking an experienced Senior Medical Coding Auditor (CPC) to join our growing multi-specialty medical practice specializing in Primary Care and Gynecology . The ideal candidate will be responsible for reviewing clinical documentation before claims are submitted to ensure accurate coding, appropriate E/M level selection, documentation compliance, and optimal reimbursement while maintaining full regulatory compliance. This position works closely with providers, clinical staff, and the billing department to improve documentation quality, reduce claim denials, maximize appropriate reimbursement, and ensure coding accuracy. Primary Responsibilities Review approximately 300 provider notes per week for coding accuracy and documentation compliance prior to claim submission. Validate...

Job Description Job Description The Revenue Cycle Management CPC Auditor is responsible for conducting comprehensive audits across all phases of the revenue cycle to ensure accuracy, compliance, and optimal reimbursement. This role is critical in identifying revenue leakage, reducing denials and strengthening internal controls and staff productivity requirements. The Auditor will evaluate charge capture, coding accuracy, documentation integrity, billing workflows, payment posting, denial follow-up, Appeals, and AR follow-up for RCM, clinical, and provider teams to drive continuous process improvement. *This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA. What you will do: Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including:  Charge entry and charge capture accuracy  CPT, HCPCS, and ICD-10 coding compliance  Modifier usage  Workers’...

*Description* Risk Adjustment Coding Auditor The Impact you will have The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. Your Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting Verifies and ensures the accuracy,...

Position Description & Qualifications Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program Branch (MCPB). The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime. The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission. Medical Coding Auditing consists of a systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards. The auditing task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and...

Job Description The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. Your Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting Verifies and ensures the accuracy, completeness, specificity and...

Position Description & Qualifications Serco is excited to continue our support to the Defense Heath Agency (DHA) Medical Coding Program Branch (MCPB). The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime. The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission. Medical Coding Auditing consists of a systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards. The auditing task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and...

Description Risk Adjustment Coding Auditor The Impact you will have The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise. Your Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting Verifies and ensures the accuracy, completeness,...

The Revenue Cycle Management CPC Auditor is responsible for conducting comprehensive audits across all phases of the revenue cycle to ensure accuracy, compliance, and optimal reimbursement. This role is critical in identifying revenue leakage, reducing denials and strengthening internal controls and staff productivity requirements. The Auditor will evaluate charge capture, coding accuracy, documentation integrity, billing workflows, payment posting, denial follow-up, Appeals, and AR follow-up for RCM, clinical, and provider teams to drive continuous process improvement. *This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA. What you will do: Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: Charge entry and charge capture accuracy CPT, HCPCS, and ICD-10 coding compliance Modifier usage Workers' compensation billing rules and state-specific...

Location: Miami, FL (On-site preferred; Hybrid/Remote may be considered) Employment Type: Part-Time (25–35 hours per week) About the Position We are seeking an experienced Senior Medical Coding Auditor (CPC) to join our growing multi-specialty medical practice specializing in Primary Care and Gynecology. The ideal candidate will be responsible for reviewing clinical documentation before claims are submitted to ensure accurate coding, appropriate E/M level selection, documentation compliance, and optimal reimbursement while maintaining full regulatory compliance. This position works closely with providers, clinical staff, and the billing department to improve documentation quality, reduce claim denials, maximize appropriate reimbursement, and ensure coding accuracy. Primary Responsibilities Review approximately 300 provider notes per week for coding accuracy and documentation compliance prior to claim submission. Validate appropriate Evaluation & Management (E/M)...

Position Description The Documentation and Coding Auditor supports the billing compliance program by helping prevent, detect, and respond to billing, coding, reimbursement, and documentation risks. This role conducts proactive monitoring, auditing, education and risk assessment activities while also responding to identified concerns, audit findings, regulatory changes, and reported compliance issues. Major/Essential Functions Plan and perform proactive compliance activities, including risk-based audits, pre-bill or concurrent reviews, data monitoring, targeted education, policy or template reviews, and department consultations. Identify and address billing compliance risks before issues escalate by using audit trends, payer updates, denial patterns, regulatory changes, stakeholder feedback, and risk assessment results. Partner with departments before new services, workflows, locations, provider groups, or documentation tools are implemented to assess and reduce...

Medical Coding Auditor Responsible for the creation and maintenance of audit and education programs that will ensure success for all staff and employed providers based on their specific needs and support accurate, compliant coding practices for ECU Health Physicians in accordance with coding guidelines. Conducts internal auditing of medical coding activities using concurrent, prospective and retrospective models as appropriate and/or required. Reviews electronic health information to determine accuracy of coding, billing and documentation, including validation of ICD10CM, CPT, HCPCS and modifier assignment related to medical provider professional Part B services according to regulatory and institutional policy. Reports findings, both written and verbal, to leadership as necessary to include provision of corroborating regulatory or policy guidance. Maintains documentation of all audit activities and communicates the findings with leadership. Utilizes findings to generate topics...

Description MaineHealth Corporate Professional - Nonclinical Req #: 75482 Summary: The Clinical Coding and Compliance Auditor role is responsible for the accurate assignment of ICD and CPT codes of diagnoses and procedures for outpatient medical records in multiple outpatient settings. Required Minimum Knowledge, Skills, and Abilities (KSAs) Education: Associate's Degree in a science field preferred. Completion of an accredited program through AHIMA or AAPC preferred. License/Certifications: RHIT, RHIA, CCS, CCA, CPC, CPC-H, or CIRCC credential preferred. Experience: Two years of multi-specialty, preferably surgical coding experience, with CPT/ICD-10-CM/HCPCS/modifier coding for physician professional charges and a minimum of two years' experience in an acute care facility as an ASU Clinical Coder required. Additional Skills/Requirements Required: Experience coding E/M's, Outpatient Hospital Clinics, OBV, ASU, Professional Surgical CPT's, ED's, cardiac...

Summary The Health Information Section (HIMS) Coding Auditor is responsible for coding and provider audits. Overseeing the appropriate coding assignment of ICD-10 CM, CPT-4, and HCPCS codes and various other duties assigned. Incumbent will also complete any coding assigned. **REMOTE WORK: Position is remote work eligible and is currently on an extension for the return-to-office mandate**. Learn more about this agency Duties Help Duties of the Medical Records Technician (Coder) Auditor include but are not limited to: Performs weekly or monthly audits of outpatient encounters. Reviews results of external audits and prepares education and/or audit responses. Performs monthly audits related to VHA Directives to include in-house and contract coding audits, EPRP reviews, revenue related/CPAC audits and other coding risk areas identified by Compliance, CPAC, VISN, external auditors medical center leadership and HIMs. Researches current guidelines related to...

Job Summary and Responsibilities As a Coding Auditor, you will be a central figure ensuring accurate and timely reimbursement by proactively resolving medical coding claim defects before billing. You will play a vital role in optimizing our revenue cycle and maintaining financial integrity. Every day, you will meticulously research and review coding-related claim denials, providing expert guidance on corrections to prevent future issues and recover lost revenue. You will also proactively address pre-billing resolution of coding defects, safeguarding against reimbursement impacts. To be successful in this role, you will combine a robust understanding of medical coding and reimbursement methodologies, exceptional analytical skills, and meticulous attention to detail. You will demonstrate a proactive problem-solving approach, driven by a commitment to maximizing financial accuracy and efficiency. Job Requirements Required High school diploma or equivalent...

Lead Medical Coder and Auditor [PR0001D] Full‑time ProSidian is looking for “Great People Who Lead” at all levels in the organization. Are you a talented professional ready to deliver real value to clients in a fast‑paced, challenging environment? ProSidian Consulting is looking for professionals who share our commitment to integrity, quality, and value. ProSidian is a management and operations consulting firm with a reputation for its strong national practice spanning six solution areas including Risk Management, Energy & Sustainability, Compliance, Business Process, IT Effectiveness, and Talent Management. We help clients improve their operations. Linking strategy to execution, ProSidian assists client leaders in maximizing company return on investment capital through design and execution of operations core to delivering value to customers. Visit www.ProSidian.com or follow the company on Twitter at www.twitter.com/prosidian for more information. ProSidian Seeks a Lead...

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...