164 quality compliance auditor ii jobs found

Quality Assurance/Quality Improvement Compliance Auditor Research Compliance Administrator (RCA) II The Quality Assurance/Quality Improvement (QA/QI) Compliance Auditor Research Compliance Administrator (RCA) II position will conduct random monitoring and for-cause audits of Institutional Review Board (IRB) approved studies for compliance with federal regulations, state law, AAHRPP accreditation standards, and USF policies and procedures related to the protection of human subjects in research. This position will also conduct continuous monitoring of the IRB, including conducting audits of IRB minutes and IRB records, to ensure compliance with federal regulations, AAHRPP accreditation standards and USF policies and procedures. This position requires extensive written and oral communication between the Quality Assurance/Quality Improvement (QA/QI) Program, Human Research Protection Program (HRPP)/IRB, the Conflict of Interest Program, and Principal Investigators and research teams....

NON-CLINICAL CODING AUDITOR AND TRAINER - 5525 US:NV:Carson City | Information Management | Full Time Description US:NV:Carson City Health Information Management Full Time Standard Office Hours Summary The Non-Clinical Coding Auditor and Trainer reviews services provided and compares them to EHR and billing records to determine accuracy. This position is responsible for performing quality reviews of outpatient medical records to validate the integrity of ICD-10 diagnoses and procedures as well as CPT/CPT II/PCS coded procedures. The position reviews medical records and other documentation to identify under and over coded services, prepares reports of findings and meets with management to educate on and improve coding practices. The Coding Auditor and Trainer ensures appropriate coding and maintains compliance documentation. This position ensures that billing is optimized, and errors are minimized by identifying opportunities through audit and observation; remaining...

COMPANY OVERVIEW PACS Group, Inc. is a holding company investing in post-acute healthcare facilities, professionals, and ancillary services. Founded in 2013, PACS Group is one of the largest post-acute platforms in the United States. Its independent subsidiaries operate 400 post-acute care facilities with 50,000 employees across 17 states serving over 31,000 patients daily. PACS business support division, PACS Services, provides technology and administrative support services — accounting, finance, human resources, compliance, payroll, AR/AP, legal, risk management, information technology, corporate communication, and other business advice and support — to their healthcare facilities, reducing administrative burdens so their leadership and care teams can focus on the care, well-being, and quality of life of their patients and residents. PACS is one of Utah's Best Companies to work for. It has also been recognized as one of Utah's Fastest Growing Companies for multiple years. JOB...

COMPANY OVERVIEWPACS Group, Inc. is a holding company investing in post-acute healthcare facilities, professionals, and ancillary services. Founded in 2013, PACS Group is one of the largest post-acute platforms in the United States. Its independent subsidiaries operate 325 post-acute care facilities with 47,000 employees across 17 states serving over 31,000 patients daily. PACS business support division, PACS Services, provides technology and administrative support services — accounting, finance, human resources, compliance, payroll, AR/AP, legal, risk management, information technology, corporate communication, and other business advice and support — to their healthcare facilities, reducing administrative burdens so their leadership and care teams can focus on the care, well-being, and quality of life of their patients and residents. PACS is one of Utah’s Best Companies to work for. It has also been recognized as one of Utah’s Fastest Growing Companies for multiple years.JOB...

About the job Job Title: Compliance Auditor (Fractional - US Based) Employment Type: Independent Contractor (1099). Compensation: Fixed fee per completed audit, plus approved travel expense reimbursement. Most auditors earn approximately $800-$1,600 per professional workday, depending on availability, travel efficiency, geographic coverage, and audit volume. Schedule: Flexible. Auditors control their own schedules, subject to audit completion requirements and member availability. Location: United States (Hybrid). We are currently seeking auditors in the following regions: New England: Maine, New Hampshire, Vermont, Massachusetts Northeast Coastal: Connecticut, Rhode Island, New York, New Jersey Mid-Atlantic: Pennsylvania, Delaware, Maryland, Virginia, West Virginia Southeast: North Carolina, South Carolina, Tennessee, Georgia, Mississippi, Alabama About The Opportunity: i-SIGMA seeks experienced operations, security, compliance, and risk management...

Overview Reporting to the Director of Healthcare Compliance, the Senior Compliance Coding Auditor is responsible for conducting independent coding, billing, documentation, and regulatory compliance audits across ambulatory and specialty care practices. The position supports the organization's compliance program through risk-based auditing, monitoring, provider education, investigation of billing concerns, identification of revenue integrity risks, and development of corrective action plans. The Senior Compliance Coding Auditor serves as a subject matter expert for professional fee coding, documentation requirements, government and commercial payer regulations, and healthcare compliance standards. This role partners closely with physicians, advanced practice providers, practice leadership, revenue cycle, coding, clinical operations, and executive leadership to promote compliant billing and documentation practices. Responsibilities Essential Functions: Auditing and Monitoring...

Health Information Management Miami, FL Full-Time Jackson Health System Full Time Summary The HIM Coding Compliance Auditor 1 analyzes abstracted/coded data for the purpose of ensuring accuracy and timeliness as it relates to DNFB management, quarterly AHCA data submissions and PFS communication. Responsibilities Reviews quality of coded and abstracted data assuring coding compliance within the Jackson Health System. Performs target and focused MS-DRG, APC, CPT, Case mix and Medical Necessity reviews. Identifies monitors and corrects rejected claims due to HIM coding. Works as a liaison with PFS and other internal departments to serve as a communicator/problem-solver for hindrances that prevent reimbursement. Based on new coding requirements, audit findings, RACs, MACs, etc. prioritizes and supports develops training/education protocols for UHS hospital coders in ICD-9-CM, CPT-4, APCs, Emergency Room Evaluation and Management Coding, Level II coding guidelines,...

Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealthleverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealthempowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Job Description The Clinical Compliance Auditor II is responsible for ensuring Guidehealth’s clinical operations, utilization management activities, and delegated services comply with regulatory requirements, client contractual obligations, and internal clinical standards. This role serves as a senior clinical compliance subject matter expert and performs...

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) level...

Professional Fee Coding AuditorAt NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials.This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization.PRIMARY JOB DUTIESAudit ResponsibilitiesPerforms routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee.Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer...

Job Description At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre‑billing coding edits, and reviewing post‑billing coding‑related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer‑specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. Primary Job Duties Audit Responsibilities Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer policies....

Risk Adjustment Coding Auditor II Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor! Summary/Objective: The Risk Adjustment Coding Auditor II is responsible for reviewing and analyzing patient medical records to ensure accurate coding and documentation of chronic conditions based on ICD-10-CM guidelines and CMS standards. This role supports accurate health status assessment to drive appropriate reimbursement and quality care. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support...

Job Details Job Location: Corporate Headquarters - Gary, IN 46402 SUMMARY/OBJECTIVES The Certified Medical Coder is responsible for the timely, accurate, and compliant review, abstraction, and coding of professional healthcare services provided by Edgewater Health clinicians. This position ensures that medical documentation supports the assignment of appropriate ICD-10-CM, CPT, and HCPCS Level II codes to facilitate accurate reimbursement while maintaining compliance with federal and state regulations, payer requirements, and organizational policies. The Certified Medical Coder works collaboratively with providers, clinical leadership, billing staff, and the Revenue Cycle Department to optimize documentation quality, improve coding accuracy, reduce claim denials, and maximize reimbursement. This position plays an integral role in supporting Edgewater Health's behavioral health, primary care, substance use treatment, and Federally Qualified Health Center (FQHC) billing...

Overview The HIM Coding Specialist II is required to have a full understanding and active participation in fulfilling the mission, vision and values of San Gabriel Valley Medical Center. The employee shall support San Gabriel Valley Medical Center's strategic plan and the goals and direction of the department Performance Improvement Plan (PIP). The HIM Coding Specialist II is required to ensure that all patient records are coded within the bill-hold limits (4 days). HIM Coding Specialist II is further responsible to ensure that all charts pass the SMART cycle and are adjusted as needed. The HIM Coding Specialist II must have a comprehensive knowledge of ICD-10-CM, ICD-10 PCS, CPT conventions in accordance with Official Guidelines for Coding and Reporting. The HIM Coding Specialist II is responsible for abstracting data into Evident/Thrive system using 3M encoder. Furthermore, the HIM Coding Specialist II will work internally and externally with coding staff, HIM director and...

COMPANY OVERVIEW PACS Group, Inc. is a holding company investing in post-acute healthcare facilities, professionals, and ancillary services. Founded in 2013, PACS Group is one of the largest post-acute platforms in the United States. Its independent subsidiaries operate 400 post-acute care facilities with 50,000 employees across 17 states serving over 31,000 patients daily. PACS business support division, PACS Services, provides technology and administrative support services — accounting, finance, human resources, compliance, payroll, AR/AP, legal, risk management, information technology, corporate communication, and other business advice and support — to their healthcare facilities, reducing administrative burdens so their leadership and care teams can focus on the care, well-being, and quality of life of their patients and residents. PACS is one of Utah’s Best Companies to work for. It has also been recognized as one of Utah’s Fastest Growing Companies for multiple years. JOB...

Compliance Auditor II - Compliance - 320359 The Compliance Auditor II will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws. Conducts audit activities, reporting and communicates audit findings. Works in conjunction with Compliance Director on compliance work plans, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner. Responsibilities Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with...

Risk Adjustment Coding Auditor II Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor! Summary/Objective: The Risk Adjustment Coding Auditor II is responsible for reviewing and analyzing patient medical records to ensure accurate coding and documentation of chronic conditions based on ICD-10-CM guidelines and CMS standards. This role supports accurate health status assessment to drive appropriate reimbursement and quality care. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical...

PACS Group, Inc. is seeking an experienced Clinical Compliance Auditor II to perform comprehensive clinical audits, ensure CMS and state regulatory compliance, and promote accurate documentation and billing practices. The role supports post-acute care operations with a focus on quality and compliance across sites. This is a remote role with less than 25% travel; candidates should have extensive Medicare/Medicaid experience and relevant certifications. #J-18808-Ljbffr

Remote Remote - USA Full time R2658919 If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a Stanford Health Care job. A Brief Overview Billing and Coding Compliance Auditors conduct audits and monitoring activities to identify and address compliance risks related to billing and coding practices. They review and evaluate healthcare regulatory compliance, focusing on the detection of documentation, coding, and billing errors. Responsibilities include assessing the adequacy and accuracy of documentation supporting billed services, including ICD, CPT, HCPCS, and other third-party payer codes, as well as adherence to Teaching Physician guidelines, Evaluation & Management criteria, DRG and APC assignments, medical necessity, and reimbursement accuracy. Auditors serve as a communication channel,...

SERVPRO seeks a Jr. Franchise Compliance Auditor II to evaluate franchise operations across our construction and restoration network. In this role, you’ll conduct field and remote audits, review documentation, verify adherence to SERVPRO brand, safety, and quality standards, and assess compliance with franchise agreements and regulatory requirements. You’ll prepare clear audit reports, recommend corrective actions, and collaborate with franchise owners to improve operational performance. This position offers industry training, growth opportunities, and the chance to support communities recovering from property damage. #J-18808-Ljbffr

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Inpatient/Outpatient Coding Auditor based in the United States. This fully remote role supports healthcare coding quality across multiple medical facilities within a large regional health network. You will independently audit inpatient and outpatient records for coding accuracy, documentation support, compliance, and reimbursement impact. The position combines detailed record review with reporting, quality improvement, and facility-specific education. You will evaluate complex coding across diagnoses, procedures, modifiers, DRGs, bundling rules, and reimbursement requirements. The role offers an opportunity to apply advanced coding expertise in a structured, regulated healthcare environment. You will collaborate with health information management leadership and facility stakeholders while maintaining high standards for accuracy and...

Remote Professional Fee Coding Auditor Remote Professional Fee Coding Auditor VISN 7 Health Information Management Services - Remote United States This Position Is Contingent Upon Contract Award Work Location Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 7 Health Information Management Services Remote within the United States Supporting VISN 7 medical facilities Fully remote coding and auditing services Citizenship / Access Requirements: U.S. citizenship and English-language proficiency are required for VA system access. Personnel must satisfy all VA onboarding, identity-verification, training, and access requirements applicable to the position. Security Requirements: No classified clearance is specified. The position is designated Low Risk and requires a favorable National Agency Check with Inquiries background investigation, annual VA privacy and security training, and all applicable system-access...

Remote Inpatient/Outpatient Coding Auditor Remote Inpatient/Outpatient Coding Auditor VISN 7 Health Information Management Services - Remote United States This Position Is Contingent Upon Contract Award Work Location Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 7 Health Information Management Services Remote within the United States Supporting VISN 7 medical facilities Fully remote coding and auditing services Citizenship / Access Requirements: U.S. citizenship and English-language proficiency are required for VA system access. Personnel must satisfy all VA onboarding, identity-verification, training, and access requirements applicable to the position. Security Requirements: No classified clearance is specified. The position is designated Low Risk and requires a favorable National Agency Check with Inquiries background investigation, annual VA privacy and security training, and all applicable...

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....