796 quality medical auditor jobs found

Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4:30PM Contract length: 4 months assignment with possible conversion Job Summary: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Day to Day: 75% Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings...

A healthcare auditing firm is seeking a Quality Medical Auditor to conduct validation reviews related to medical coding and compliance. The ideal candidate will have an Associate Degree in Nursing or Health Information Management and at least 3 years of experience in medical records management. Responsibilities include managing coding issues, creating analytical reports, and ensuring HIPAA compliance. This position is primarily onsite but may offer potential for remote work. #J-18808-Ljbffr

Quality Medical Auditor - Coding Specialist Join to apply for the Quality Medical Auditor - Coding Specialist role at BlueCross BlueShield of South Carolina . Summary Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate...

Job Title Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary...

Job Description Job Description Medical Coder - CPC W2H Contract to Hire Pay rate: $36/hr Location: Columbia South Carolina Join our dynamic healthcare team as a Quality Medical Auditor and play a critical role in ensuring the accuracy and integrity of medical coding and billing processes. You will be instrumental in validating complex diagnoses, coding accuracy, and identifying opportunities for cost savings, all while supporting compliance and legal standards. This position offers a unique opportunity for career growth in healthcare auditing, coding accuracy, and data analysis. Key Responsibilities: Conduct comprehensive validation reviews of Diagnosis Related Groups (DRGs), Adaptive Predictive Coding (APC), and Never Events (medically inexcusable outcomes) across all lines of business, ensuring coding accuracy and compliance. Develop and implement robust methodologies for case selection to identify records for validation reviews efficiently. Collaborate closely...

A healthcare organization is seeking a Medical Coder in Dallas, TX, to conduct data quality audits and ensure accurate coding assignments according to official guidelines. The ideal candidate will have a minimum of three years of experience, excellent attention to detail, and strong interpersonal skills. This position requires knowledge of medical terminology and coding standards, along with the ability to work independently in a virtual setting. #J-18808-Ljbffr

Virtua Health Coding SpecialistAt 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 departments,...

Imagine doing meaningful work in a place where peoplevacation.That’slife at Munson Healthcare - northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties. If you want a career in healthcare and alifestylemost people only dream about – with freshwater lakes, scenic trails, charming downtowns, a vibrant arts scene, and endless outdoor adventures - you might just be Munson Material. To us, that means teammates who live by our values of excellence,teamness, positivity, creativity, and a commitment to creating exceptional experiences for our patients and each other. Join a team that delivers outstanding care in one of the most beautiful regions in the country. Invested in You Grow: Tuition reimbursement, in-person and onlinedevelopment,and access to ourcareer hubto help you advance. Thrive: Full benefits, paid holidays, generous PTO, employee discounts, and freeindividualretirement counseling....

DRG Coding Auditor Principal _Virtual: _ _ ​_ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. 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 DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group...

Be Part of an Extraordinary Team 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. Build the Possibilities. Make an Extraordinary Impact. Title : DRG Coding Auditor (ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG) **Virtual: ** _ _ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates...

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...

Be Part of an Extraordinary Team 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. Build the Possibilities. Make an Extraordinary Impact. Title : DRG Coding Auditor (ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG) **Virtual: ** _ _ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates...

Lead Medical Coder and Auditor ProSidian Consulting is looking for a talented professional ready to deliver real value to clients in a fast-paced, challenging environment. ProSidian Consulting is a management and operations consulting firm with a reputation for its strong national practice spanning six solution areas including Risk Management, Energy & Sustainability, Compliance, Business Process, IT Effectiveness, and Talent Management. We help clients improve their operations. ProSidian seeks 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...

Health Ministries Clinic (HMC) is seeking a Coding Auditor (with PCP auditing experience) as a trusted expert to join our integrated care team in Newton, Kansas. This is a full-time, on-site position offering the opportunity to support patient care in a collaborative, mission-driven environment. At Health Ministries Clinic, we offer more than just primary care with a full spectrum of services including behavioral health, lab, diagnostic, pharmaceutical and dental. We are seeking an experienced Coding Auditor with a multi-speciality coding background. The Coding Quality Auditor is responsible to ensure Health Ministries Clinic's compliance with national coding guidelines, FQHC coding guidelines and regulations. The Coding Auditor plays a crucial role in minimizing coding errors and preventing fraudulent activities. The Coding Auditor is responsible to ensure accurate and consistent coding which results in appropriate reimbursement and data integrity. This role requires...

Inpatient Medical Coding Auditor Become a part of our caring community and help us put health first. The Inpatient Medical Coding Auditor reviews a variety of medical records and determines appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT). 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. The Inpatient Medical Coding Auditor confirms appropriate diagnosis related group (DRG) assignments upon appeal. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Work Style: Remote, work at...

Inpatient Medical Coding Auditor Become a part of our caring community and help us put health first. The Inpatient Medical Coding Auditor reviews a variety of medical records and determines appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT). 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. The Inpatient Medical Coding Auditor confirms appropriate diagnosis related group (DRG) assignments upon appeal. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an...