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1708 provider auditor jobs found

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WM
Enterprise Provider Compliance Auditor-Educator (Morgantown, WV)
WVU Medicine Morgantown, WV, USA
Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and educations associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remains in compliance with all federal healthcare program rules, regulations, administrative requirements and guidance. MINIMUM QUALIFICATIONS : EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: 1. High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ;...

Mar 10, 2026
EH
Clinical Fraud & Compliance Auditor II
Elevance Health Atlanta, GA, USA
A healthcare company is seeking a Clinical Provider Auditor II to identify potential risks associated with fraud and abuse in claims. The role requires examining claims for compliance, analyzing medical records, and collaborating with internal units. The ideal candidate will have a minimum of 3 years of medical coding experience and possess relevant certifications. The position offers a hybrid working model with competitive salary and benefits. #J-18808-Ljbffr

Mar 03, 2026
EH
Hybrid Clinical Fraud & Compliance Auditor II
Elevance Health Los Angeles, CA, USA
A leading health company in California is seeking a Clinical Provider Auditor II to identify potential fraud and abuse risks in the healthcare system. This hybrid position requires strong skills in medical coding, with responsibilities including examining claims for compliance and collaborating on internal investigations. Candidates must have a minimum of 3 years of medical auditing experience and relevant coding certifications. Join a workplace that values community health and offers competitive rewards. #J-18808-Ljbffr

Feb 26, 2026
AH
Remote Provider Network Compliance Auditor II
Alliance Health Morrisville, NC, USA
A health care organization is seeking a full-time remote PNE Targeted Reviewer II residing in North Carolina. The role involves conducting clinical reviews, analyzing claims data, and ensuring compliance with Medicaid standards. Candidates must have a Master's degree in human services and an active NC license. The position offers a salary range of $68,227 to $86,990 annually and includes comprehensive benefits like medical, dental, and flexible work schedules. #J-18808-Ljbffr

Mar 10, 2026
CNY Family Care, LLP
Full Time
 
Medical Coder and Auditor
CNY Family Care, LLP Hybrid (Initial training onsite. Hybrid schedule once/week in offce.)
CNY Family Care's commitment to excellence sets us apart and guides us as we provide care for our community. The Medical Coder and Auditor will be responsible to conduct prospective audits of coding and billing; analyze physician and provider documentation in outpatient office health records; correct evaluation and management (E/M) service levels, appropriate procedure codes, and any necessary modifiers.  Medical Coder and Auditor Responsibilities: Navigate the patient health record, office visit notes, and procedure reports in the determination of diagnoses, reason for visit, procedures, and modifiers to be coded. Code outpatient records utilizing coding books, online tools, and references, in the assignment of ICD, CPT, and HCPCS codes and modifiers. Document individual encounter audit findings and communicates results to providers. Access charge work queues to validate and assign charges. Perform all required EMR functions as efficiently as possible and according...

Mar 06, 2026
RU
Full Time
 
Healthcare Coding Compliance Auditor
Riverside University Health System Medical Center Hybrid (Riverside, CA, USA)
Riverside University Health System (RUHS)   is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department. Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences including physicians and other staff. The ideal candidate will have at least five years of progressive experience in an acute care hospital...

Mar 04, 2026
US
Full Time
 
Healthcare Compliance Audit Analyst (Must have CPC, CCS-P, or CPMA)
U.S. Urology Partners Remote
General Summary:   U.S. Urology Partners, LLC (USUP) and its physician groups are committed to promoting conduct that is responsible, ethically sound, and compliance with applicable law.  USUP’s Compliance Department (CD) fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and reimbursement of health care.  An integral function of USUP’s compliance program is auditing and monitoring compliance with billing, coding, and documentation requirements of its providers.    An CPC, CCS-P, or CPMA is required for this position.     Compliance Audit Services:   Compliance audit initiatives include physician, other providers, and facility documentation audits as well as preparation of guidance documents and tools to assist physicians and staff in appropriate billing, coding, and documentation.  The audit program looks at professional fee billing,...

Feb 03, 2026
AC
Full Time
 
System Professional Coding Provider Review and Education Manager
Anonymous Company Hybrid
Job Title: Manager Location: System Business Office Department Name: HIM - Professional Req #: 0000207266 Status: Salaried Shift: Day Pay Range: $110,681.00 - $156,337.00 per year Pay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. Job Overview: The  System Professional Coding Provider Review and Education Manager  is responsible for onboarding, educating, and reviewing medical record documentation and coding processes of the Medical Group physicians, APNs and other billing providers across all medical centers within the RWJBH enterprise. This includes onboarding education, medical record reviews, targeted education to physician groups and individual physicians, annual and quarterly...

Jan 08, 2026
PS
Lead Medical Coder and Auditor [PR0001D]
ProSidian Consulting Fort Stewart, GA, USA
Lead Medical Coder and Auditor ProSidian Consulting is looking for a Lead Medical Coder and Auditor (Full-Time) in CONUS - Fort Stewart, GA to support an engagement for a branch of the United States Armed Forces' Regional Health Command who's mission is to provide a proactive and patient-centered system of health with the focus on the medical readiness of all Soldiers and for those entrusted to the care for a medically-ready force. The Armed Forces' overall mission is "to fight and win our Nation's wars, by providing prompt, sustained, land dominance, across the full range of military operations and the spectrum of conflict, in support of combatant commanders". The Regional Health Command's Readiness Mission includes dental care of active duty Soldiers, public health services, veterinary services, and providing management and support to wounded, ill and injured Soldiers assigned to its seven warrior transition units. The ProSidian Engagement Team Members work to provide health...

Mar 12, 2026
PP
Professional Coding Auditor/Consultant
PYA P C Leawood, KS, USA
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...

Mar 12, 2026
GL
Quality Auditor Supervisor - 1st Shift
GXO Logistics Council Bluffs, IA, USA
Logistics at full potential. At GXO, we're constantly looking for talented individuals at all levels who can deliver the caliber of service our company requires. You know that a positive work environment creates happy employees, which boosts productivity and dedication. On our team, you'll have the support to excel at work and the resources to build a career you can be proud of. 1st Shift, Monday - Friday, 8:00am - 5:00pm The Quality Auditor Supervisor is responsible for overseeing and conducting internal audits to ensure compliance with quality standards, processes, and procedures. This role may involve leading a team of auditors, supporting the development audit schedules, analyzing audit findings, reporting out results, reviewing and approving corrective actions to improve processes. What you'll do on a typical day: Team Leadership: Supervise, train, and mentor a team of quality auditors. Audit Planning: Develop and execute audit schedules based on processes,...

Mar 12, 2026
FG
PB CODING AUDITOR
Forrest General Hospital Hattiesburg, MS, USA
Job Summary The PB Coding Auditor is responsible for reviewing and auditing professional fee claims to ensure accurate code assignment, documentation compliance, and adherence to federal, state, payer, and organizational guidelines. This role supports revenue integrity, compliance, and provider education through routine and targeted audits. Key Responsibilities Conduct retrospective and prospective audits of professional billing claims, including E/M services, procedures, modifiers, and diagnosis coding Validate coding accuracy against provider documentation , CPT®, HCPCS, ICD-10-CM, and payer-specific rules Identify coding errors, trends, and compliance risks, including undercoding, overcoding, and unbundling Ensure compliance with CMS guidelines, NCCI edits, LCDs/NCDs , and commercial payer policies Provide written audit findings , including clear rationale and corrective action recommendations Communicate audit results to providers, coders, and...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Juneau, AK, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Cheyenne, WY, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Carson City, NV, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
CC
Compliance Auditor/Educator - Compliance Quality
Christie Clinic Champaign, IL, USA
Compliance Auditor/Educator - Compliance Quality 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 specific samples; and as required. Meet with providers to share audit results and guidance for accuracy rate improvement. Prepare educational materials specific to new provider's specialty and assist with orientation sessions. Review...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Concord, NH, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Montgomery, AL, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Springfield, IL, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
NM
Inpatient Medical Coding Auditor
New Mexico Staffing Santa Fe, NM, USA
Inpatient Medical Coding Auditor Become a part of our caring community and help us put health first. The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Topeka, KS, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
HI
Inpatient Medical Coding Auditor
Humana Inc Jefferson City, MO, USA
Become a part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy...

Mar 12, 2026
PP
Professional Coding Auditor/Consultant
PYA P C Knoxville, TN, USA
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...

Mar 12, 2026
BC
Coding Auditor
BlueCross BlueShield of Tennessee Chattanooga, TN, USA
Coding Auditor Are you driven by precision and committed to maintaining excellence in clinical coding? The Professional and Ancillary Audit Department at BCBST is seeking a skilled Coding Auditor to join our team in conducting comprehensive claims payment quality reviews and clinical coding compliance audits. In this role, you'll play a key part in identifying improvement opportunities and ensuring our processes consistently meet the highest industry standards. The ideal candidate will have a Bachelor's degree or equivalent experience, along with a minimum of two years of professional or facility inpatient/outpatient coding and auditing experience. An active AHIMA or CPC certification is required, or the ability to obtain CPC within one year of hire. Experience with Facets is a plus. We are looking for a candidate who is excited and interested in leveraging Enterprise-AI approved tools in their daily work. Join us in helping elevate healthcare quality and compliance! Job...

Mar 12, 2026
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