1487 provider coding compliance auditor jobs found

Baylor Scott & White Health (BSWH) is seeking a Provider Coding Compliance Consultant to support the organization's compliance program. The role reports to the Coding Compliance Manager and helps develop, implement, and maintain BSWH policies to ensure adherence to federal, state, and local laws and regulations. The position involves identifying audit projects, conducting provider service audits, generating reports with actionable guidance, obtaining corrective action plans, and coordinating #J-18808-Ljbffr

Baylor Scott & White Health (BSWH) is seeking a Provider Coding Compliance Consultant to join the Compliance team. The role reports to the Coding Compliance Manager and supports developing and maintaining BSWH policies to ensure adherence to federal, state, and local laws and regulations. The position offers a pay range from $30.52/hour ($63,481/year) up to $45.79/hour ($95,243/year), depending on qualifications and experience. #J-18808-Ljbffr

Baylor Scott & White Health (BSWH) seeks a Provider Coding Compliance Consultant to support the compliance program. The role reports to the Coding Compliance Manager and works with the Compliance VP/Director to develop, implement, and maintain BSWH policies in line with federal, state, and local laws. The position emphasizes auditing provider services, documenting findings, and improving compliance effectiveness. Strong communication and CPT/ICD-10-CM expertise are essential. #J-18808-Ljbffr

Baylor Scott & White Health (BSWH) is committed to an effective compliance program. The Provider Coding Compliance Consultant reports to the Coding Compliance Manager and works under the Compliance Vice President or Director. They perform activities related to developing, implementing, and maintaining BSWH policies. These activities ensure adherence to federal, state, and local laws and regulations. The pay range for this position is $30.52/hour ($63,481/year) for entry-level to $45.79/hour #J-18808-Ljbffr

Baylor Scott & White Health is seeking a Provider Coding Compliance Consultant to support the Coding Compliance Manager and VP/Director. You will help develop, implement, and maintain BSWH policies ensuring adherence to laws and regulations across the system. Responsibilities include auditing projects, educating providers on compliance trends, and coordinating corrective actions. Strong communication, detail orientation, and CPT/ICD-10-CM knowledge are essential. #J-18808-Ljbffr

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: High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ; Associate’s Degree AND Five (5) years experience in multi-specialty coding, E&M coding, procedural/surgical coding. Current certification in one of the following: Certified Professional Coder (CPC)through the American Academy of Professional Coders (AAPC) Registered Health...

West Virginia University Health System is seeking an Enterprise Compliance Auditor/Educator to support ongoing auditing, monitoring, and education across WVUHS and affiliates. The role ensures provider organizations meet CMS, state, and payer regulations, with emphasis on documentation, coding accuracy, and medical necessity. The incumbent will lead audits, prepare comprehensive reports, and deliver education programs for physicians, APPs, and staff. #J-18808-Ljbffr

Overview The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team. Essential Duties Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed Reviews...

Position Description Performs coding and documentation quality audits, provides feedback to coding and reimbursement specialists, coders, and educates them. This job has no supervisory responsibilities. Major/Essential Functions This position is based in Lubbock; however, weekly travel to and from Amarillo will be required for training. 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 billing, coding, documentation, supervision, and reimbursement risks. Maintain or...

Overview Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states. Position Summary The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team’s broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement...

Job Title: Coding Auditor Location: Reno, NV Position Overview: The Coding Auditor is tasked with coordinating the auditing schedules of the coding staff to ensure quality and proficiency, thus ensuring compliance with coding/auditing standards and documentation quality. The primary challenge is to guarantee accurate reimbursement is achieved through adherence to high-quality coding standards. This role involves auditing information coded from provider documentation and patient records within designated time frames, facilitating the billing process, ensuring accurate reimbursement, and promoting compliance. The incumbent must document and report all findings to Coding Leadership. Key Responsibilities: Coordinate coding staff auditing schedules to ensure quality and proficiency. Audit information coded from provider documentation and patient records within designated time frames. Document and report all auditing findings to Coding Leadership. Address appeals...

West Virginia University Health System is seeking an Enterprise Compliance Auditor/Educator to support ongoing auditing, monitoring, and education across WVUHS and affiliates. The role ensures provider organizations meet CMS, state, and payer regulations, with emphasis on documentation, coding accuracy, and medical necessity. The incumbent will lead audits, prepare comprehensive reports, and deliver education programs for physicians, APPs, and staff. #J-18808-Ljbffr

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: High School Diploma or Equivalent AND Seven (7) Years of experience in multi-specialty coding, E&M coding, procedural/surgical coding OR ; Associate’s Degree AND Five (5) years experience in multi-specialty coding, E&M coding, procedural/surgical coding. Current certification in one of the following: Certified Professional Coder (CPC)through the American Academy of Professional Coders (AAPC) Registered Health...

Compliance Auditor Under general supervision, performs risk-based audits of clinical documentation, coding, and billing records to ensure that documentation supports services billed and complies with applicable regulatory and organizational requirements. This position independently validates documentation and coding compliance, identifies areas of compliance risk, and supports internal audit activities and external audit readiness across hospital-and provider-based settings. This role is outcome-driven and requires the ability to independently manage audit workload, documentation, and deadlines. • Performs risk-based audits of clinical documentation, physician, technical, and specialty billing and payment records by analyzing medical records, coding records, and health system bills to validate that documentation supports services billed and complies with applicable regulations and guidelines. • Evaluates the accuracy and appropriateness of coding, billing, and documentation...

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: Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors...

DaMar Staffing seeks a Coding Compliance Specialist to support coding, audit, and compliance across clinical services. You will ensure accurate code assignment, adhere to FQHC billing and reimbursement regulations, and contribute to risk mitigation through provider education and ongoing audits. The role involves travel to InclusivCare locations for onsite audits, education, and operational support, with focus on HIPAA and payer policy compliance. #J-18808-Ljbffr

Overview Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states. POSITION SUMMARY: The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team's broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard...

Ranked one of Tennessee’s top places to work, MHC is a rare and special place where outstanding company culture is intentional. Where clients and associates are treated the same, as equals. Mental Health Cooperative, Inc. (MHC) was formed in 1993 to serve individuals with severe and persistent mental illness. Since then, we have expanded our services to children and adolescents with severe emotional disorders across Middle and East Tennessee. Our sole purpose is to support and treat those challenged with serious mental illness and poverty. Although based out of Nashville, we serve several communities across middle and East Tennessee with satellite offices in Antioch, Gallatin, Dickson, Columbia, Cleveland, Murfreesboro, Clarksville, Cookeville, Chattanooga, and Memphis. If you are interested in joining a team that is caring, collaborative, innovative and energizing this might be a great place for you! Job Title: Compliance Auditor Department: Compliance Reports To: Director of...

Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed....

Physician Coding and Auditing SpecialistResponsible for conducting independent physician coding and auditing reviews to ensure the accuracy, completeness, and compliance of medical record documentation supporting codes selected by providers and/or coders. This role ensures compliance with CMS guidelines, CPT, HCPCS, and ICD-10 code sets, while supporting providers through ongoing physician coding education, auditing feedback, compliance guidance, and training initiatives.This position plays a key role in physician documentation improvement, coding compliance, audit readiness, and provider education across the organization.Hybrid Work Expectations:To ensure collaboration, provider engagement, and training effectiveness, this position follows a hybrid work model with the following expectations:Onsite Expectations:Mandatory in-office presence at least 1 day per week (Wednesday).Additional in-office days may be required for:Training sessionsProvider meetingsDepartment meetingsSome...

We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Think you've got what it takes? Job Duties & Responsibilities • Assess the treatment plan, clinical information, and medical necessity of all requested services • Utilizes established criteria to appropriately review billed services within established timeframe required. • Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. • Refers case failing medical...