9 quality assurance nurse auditor nurse analyst coding auditor jobs found

Description ESSENTIAL DUTIES AND RESPONSIBILITIES Review and analyze clinical documentation to assign appropriate ICD-10, CPT, and HCPCS codes. Ensure coding accuracy and compliance with federal regulations, payer requirements, and clinic policies. Collaborate with providers, nurses, and clinical staff to clarify documentation when needed. Abstract relevant information from patient records to support accurate coding and billing. Enter and verify codes in the electronic health record (EHR) or billing software system. Identify and resolve coding errors, rejections, and denials in partnership with the billing team. Maintain current knowledge of coding guidelines, payer rules, and compliance standards (including HIPAA). Participate in regular audits and quality assurance activities to ensure documentation supports billed services. Assist with staff education and training related to coding and documentation best practices. Protect patient confidentiality and maintain the security of...

Embedded Medical Coder We are seeking a detail-oriented and certified Embedded Medical Coder to join our healthcare team. This role involves working directly within a clinical or administrative unit to ensure accurate and compliant coding of medical procedures, diagnoses, and services. The ideal candidate will be embedded in day-to-day operations, collaborating closely with physicians, nurses, and billing staff to support efficient documentation and reimbursement processes. Key Responsibilities: Review and analyze patient medical records to assign appropriate ICD-10, CPT, and HCPCS codes. Ensure coding accuracy and compliance with federal regulations, payer policies, and internal standards. Collaborate with healthcare providers to clarify documentation and resolve coding discrepancies. Submit coded data to billing systems to initiate insurance claims and support reimbursement. Maintain and update patient data for long-term tracking and reporting. Participate in audits and...

Registered Nurse - Diagnosis Related Group (DRG) Coding Auditor Principal - Carelon Payment Integrity Anticipated End Date: 2025-04-21 Overview 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. Location Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint. Responsibilities Analyze and audit claims by integrating advanced or convoluted medical chart coding principles (found in the Official Coding Guidelines, Coding Clinics, and the ICD‑10 Alphabetic and Tabular Indices), complex clinical guidelines, and maintaining objectivity in the performance of medical audit activities. Draw on extremely advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to...

Job Description Job Description OnPoint Medical Group is searching for an outstanding Certified Professional Coder to join our team! Come join a great group of medical professionals as our network continues to grow! OnPoint Medical Group is a physician-led network of skilled Primary and Urgent care providers who are committed to expanding access to quality healthcare in the most effective and affordable manner possible. Our "Circle of Care" has one primary goal – to ensure the health and wellness of members and their families. We do this by providing access to a comprehensive menu of medical services from one unified physician group in their neighborhoods. With doctors, nurses, specialists, labs and medical records all interlinked and coordinated, patient care has never been in better hands. About the Role: The Certified Professional Coder (CPC) plays a critical role in the healthcare industry by accurately translating medical diagnoses, procedures, and services into...

Virtua Health Billing Specialist At Virtua Health, we exist for one reason to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between we are your partner in health devoted to building a healthier community. If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment. In addition to five hospitals, seven emergency...

Blackfish Federal, LLC is committed to supporting economic development in Historically Underutilized Business Zones (HUBZones). Candidates residing in a designated HUBZone are strongly encouraged to apply. To check if your address qualifies, please visit the official HUBZone Map provided by the U.S. Small Business Administration . Position Description: This position is responsible for reviewing, prioritizing, and analyzing adverse medical events related to medical devices that are submitted on MedWatch reporting forms via hard copy or electronically to our customer, the Food and Drug Administration (FDA). Additionally, this position is responsible for processing and coding a variety of reports from device manufacturers (MFR), importers, user facilities, health care professionals, and customers. While Analyst Coders may be assigned to perform the primary functions shown above, they will also be cross-trained to perform secondary duties according to business needs. Required...

Overview At HeiTech Services, our employees are our biggest assets. HeiTech Services is dedicated to attracting highly skilled and motivated professionals. We value our employees. We offer our employees challenging opportunities that facilitate professional growth and development while also providing the support you need to succeed. We are committed to your success because we understand that our employees are the driving force behind HeiTech Services’ continued growth. Our mission is to help the Federal Government keep Americans safe. Position Description This position is responsible for reviewing, prioritizing, and analyzing adverse medical events related to medical devices that are submitted on MedWatch reporting forms via hard copy or electronically to our customer, the Food and Drug Administration (FDA). Additionally, this position is responsible for processing and coding a variety of reports from device manufacturers (MFR), importers, user facilities, health care...

Overview Payment Integrity Nurse Coder RN III role at L.A. Care Health Plan . Responsibilities The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs quality audits to include validation of accuracy and completeness of ICD, Rev...

Payment Integrity Nurse Coder RN III (Job ID: 12330) Location: Los Angeles, 90017 Shift: Full Time Pay Range: $102,183.00 (Min.) – $132,838.00 (Mid.) – $163,492.00 (Max.) Job Description The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise and judgment in the application of medical and reimbursement policies within the claim adjudication process. The role involves medical record review for Payment Integrity and Utilization Management projects, serving as a subject‑matter expert (SME), performing quality audits, validating coding accuracy and completeness, and guiding Payment Integrity initiatives, including concept and cost avoidance development. Additionally, the position trains and mentors Payment Integrity Nurse Coder, RN staff, acting as a resource and mentor for fellow employees. Qualifications At least 8 years of clinical RN experience. At least 3 years of experience in utilization...