744 provider auditor jobs found

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

Provider Auditor This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Provider Auditor conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. How you will make an impact: Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical notes, and provider contracts. Verifies dollar amount on claim...

1 week ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Lensa is the leading career site for job seekers at every stage of their career. Our client, BayCare Health System, is seeking professionals in Atlanta, GA. Apply via Lensa today! BayCare is currently in search of our newest Team Member who is passionate about providing outstanding customer service to our community. We are looking for an individual seeking a career opportunity with one of the largest employers within the Tampa Bay area. Position Details Location: Fully Remote (must reside in the state of Florida, Georgia, North Carolina, or South Carolina) Status: Full Time (non-exempt) Shift: 7:00 AM to 3:30 PM Days: Monday through Friday The Medical Records Outpatient Coder II will work remotely on a full-time basis. Sign on bonuses available! Responsibilities The Medical Records Coder II assigns diagnosis and procedural codes using ICD-10-CM, ICD-10-PCS, and CPT-4...

20 hours ago Be among the first 25 applicants Job Description & Requirements PRN IP Coder StartDate: 6/10/2025 Pay Rate: $30.00 - $40.00 PRN Remote IP Coder Job Summary Under indirect supervision, is responsible for accurate coding of all inpatient services, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record at an Acute Care Health System. All work is carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic), ICD-10-CM/PCS, Centers for Medicare and Medicaid Services (CMS). Essential Functions And Responsibilities Must possess a thorough knowledge of ICD-10-CM/PCS coding principles and applications as they relate to acute care hospital coding and grouping Production expectations are 2 Per hour Epic Experience Required 3M preferred Thorough knowledge of Official Coding Guidelines and payer specific requirements When services/diagnoses...

Employment Type: Full time Shift: Day Shift Description: The Coding Auditor & Educator performs medical record audits including analysis of medical record documentation; validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). Monitor's accuracy of centralized coder's charge capture and coding with proper ICD-10, CPTs, HCPCs, as well as proper modifiers, adhering to local ministry and Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Conducts ongoing reviews of patient medical record documentation and procedural and diagnosis coding by each practitioner. Educates practitioners on coding, documentation, and compliance matters. SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE: 1. CPC, RHIT, CRC or CDEO accreditation is...

Job Description Job Description PYA is seeking a Professional Coding Auditor/Consultant to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue Integrity team in a professional coding auditor role . RESPONSIBILITIES: Responsible for the accurate review of PYA clients’professional fee coding per industry coding audit standards, support of the management team with project management tasks, support of the verbal and written reporting to the client, and conducting provider coding and documentation education ( generally, conducted remotely ). Coding auditing of complex services rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare, medical necessity, and NCD/LCD requirements. Professional coding auditing expertise in multiple specialties is required, including strength...

Description The Revenue Integrity team within UI Health Care's Finance and Accounting Services has a new opportunity for a skilled Quality Assurance Coding Auditor to join the team. Under the direction of the Coding Quality Assurance & Education Manager, the Quality Assurance Coding Auditor conducts professional, facility, clinic, external vendor, coder, system, and denial coding audits. The role is responsible for creating, reviewing, and updating department processes, guidelines, and standards in adherence to regulatory changes and organizational compliance laws and regulations. This position will also identify, create, and provide individual or group education for clinical staff, providers, and coders. The Quality Assurance Coordinator liaises with Clinical Departments, Patient Financial Services, Revenue Integrity, clinical staff, and provider relations. Hybrid within Iowa: This position is eligible for a combination of on-campus and remote work. Remote work must...

Job Description Job Description PYA is seeking a Professional Coding Auditor/Consultant to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue Integrity team in a professional coding auditor role . RESPONSIBILITIES: Responsible for the accurate review of PYA clients’professional fee coding per industry coding audit standards, support of the management team with project management tasks, support of the verbal and written reporting to the client, and conducting provider coding and documentation education ( generally, conducted remotely ). Coding auditing of complex services rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare, medical necessity, and NCD/LCD requirements. Professional coding auditing expertise in multiple specialties is required, including strength...

Job Description Job Description The Senior Compliance Auditor  supports Umpqua Health Alliance’s compliance with the Oregon Health Authority (OHA) Coordinated Care Organization (CCO) contract by overseeing key audit, monitoring, and regulatory functions. This position plays a central role in coordinating external audits, maintaining compliance with applicable state and federal Medicaid regulations, and implementing corrective actions resulting from regulatory findings. The role requires a CHC certification and at least five years of healthcare compliance or audit experience, preferably in a Medicaid managed care environment. Essential Duties and Responsibilities: Manage and coordinate all activities related to the External Quality Review (EQR) conducted by the state’s designated External Quality Review Organization (EQRO), including document production, stakeholder coordination, timeline tracking and audit facilitation. Conduct compliance audits of provider groups...

Join to apply for the HCC Coding Auditor Senior - Health Plan Admin role at TieTalent . Get AI-powered advice on this job and more exclusive features. Summary The HCC Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures. Responsibilities include quality assurance auditing and risk adjustment code abstraction for programs such as Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This position offers onsite work with a remote option. Responsibilities Perform medical record reviews and audits, including prospective, concurrent, and retrospective workflows, to ensure accurate diagnoses for risk adjustment. Conduct code abstraction and coding quality audits to support compliance with CMS (HCC) guidelines. Review...

Job Details Job Location : Washington Regional Med. Ctr. - Fayetteville, AR Position Type : Full Time Education Level : Certification in related field Salary Range : Undisclosed Job Shift : Day Job Category : Admissions & Billing Services Description Organization Overview, Mission, Vision, and Values Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 45 clinic locations, the areas only Level II trauma...

Profee Coding Auditor (Full-Time, Monday-Friday) Join to apply for the Profee Coding Auditor (Full-Time, Monday-Friday) role at Washington Regional Profee Coding Auditor (Full-Time, Monday-Friday) 1 week ago Be among the first 25 applicants Join to apply for the Profee Coding Auditor (Full-Time, Monday-Friday) role at Washington Regional Get AI-powered advice on this job and more exclusive features. Organization Overview, Mission, Vision, And Values Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We...

Description Summary: HCC Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and 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, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an onsite position with a remote option. Responsibilities: Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk...

**DRG Coding Auditor Principal** _Virtual: This role enables associates to work virtually full-time, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered._ The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending physicians statement provided by acute care hospitals on paid DRG, especially on very complex coding cases that are paid using APS-DRG, APR-DRG, AP-DRG, MS-DRG or TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by...

Job Title: Coding Auditor SAMF Admin CBO (Full Time) Location: Fresno, Trinity Health Application Info: Join to apply. 4 days ago, among the first 25 applicants. Job Description Reporting to the Manager of Medical Group Revenue Cycle Site Operations in Fresno, this role involves performing medical record audits, analyzing documentation, validating diagnoses and procedures, and ensuring accurate coding according to CMS guidelines. The position also monitors the accuracy of charge capture and coding with ICD-10, CPT, HCPCS, and proper modifiers, adhering to local policies. The auditor partners with leadership to improve HCC and risk adjustment capture through provider and coder education. Responsibilities include ongoing review of medical records, coding, and practitioner education in documentation and compliance. Employment Details Type: Full-time Shift: Day Shift Pay Range: $31.99 - $43.19 Minimum Qualifications High school diploma or equivalent At least 2 years...