55 registered nurse coding auditor jobs found

Revenue Cycle Audit Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position Job Responsibility 1. Leverages clinical expertise to identify and validate DRG code assignment. 2. Full review of CDI suggested code changes 3. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5. Applies coding rules and regulations to the validation review process. 6. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7. Communicates DRG changes and rationale to the coding and CDI staff. 8. Identifies...

Job Title Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Qualifications Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis (REQUIRED), COS-C Certificate for OASIS Specialist-Clinical (PREFERRED). Job Responsibility Leverages clinical expertise to identify and validate DRG code assignment. Full review of CDI suggested code changes Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. Applies coding rules and regulations to the validation review process. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. Communicates DRG changes and rationale to the coding and CDI staff....

divh2Job Title/h2pValidates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record./ph3Qualifications/h3pSeeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis (REQUIRED), COS-C Certificate for OASIS Specialist-Clinical (PREFERRED)./ppJob Responsibility/pulliLeverages clinical expertise to identify and validate DRG code assignment./liliFull review of CDI suggested code changes/liliDemonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization./liliAudits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations./liliApplies coding rules and regulations to the validation review process./liliReviews codes on Medicare/non-Medicare charts for compliance to rules and conventions./liliCommunicates DRG changes and rationale to the coding and...

Job Title Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position in New York. Job Responsibility Leverages clinical expertise to identify and validate DRG code assignment. Full review of CDI suggested code changes Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. Applies coding rules and regulations to the validation review process. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. Communicates DRG changes and rationale to the coding and CDI staff. Identifies...

Req Number 187131 Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis (REQUIRED), COS-C Certificate for OASIS Specialist-Clinical (PREFERRED). Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4.Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to the coding...

Req Number 176729 Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4.Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to the coding and CDI...

Acute Inpatient Coding Specialist Validates acute inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the medical record. Job responsibilities include: Leveraging clinical expertise to identify and validate DRG code assignment. Full review of CDI suggested code changes. Demonstrating comprehensive knowledge of coding guidelines and principals; performing coding audits for optimization. Auditing and reviewing Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with federal and state regulations. Applying coding rules and regulations to the validation review process. Reviewing codes on Medicare/non-Medicare charts for compliance to rules and conventions. Communicating DRG changes and rationale to the coding and CDI staff. Identifying appropriate coding changes necessary to provide the most valid documentation in compliance with federal and state...

Revenue Cycle Audit Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position Job Responsibility 1. Leverages clinical expertise to identify and validate DRG code assignment. 2. Full review of CDI suggested code changes 3. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5. Applies coding rules and regulations to the validation review process. 6. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7. Communicates DRG changes and rationale to the coding and CDI staff. 8. Identifies...

Revenue Cycle Audit Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position Job Responsibility 1. Leverages clinical expertise to identify and validate DRG code assignment. 2. Full review of CDI suggested code changes 3. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5. Applies coding rules and regulations to the validation review process. 6. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7. Communicates DRG changes and rationale to the coding and CDI staff. 8. Identifies...

Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position in New York. Job Responsibility Leverages clinical expertise to identify and validate DRG code assignment. Full review of CDI suggested code changes. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. Applies coding rules and regulations to the validation review process. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. Communicates DRG changes and rationale to the coding and CDI staff. Identifies appropriate...

Registered Nurse - Diagnosis Related Group Coding Auditor Principal – Carelon Payment Integrity 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 locations. 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 (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical records and attending physician’s statements provided by acute care hospitals on paid DRG,...

A company is looking for a Registered Nurse Coding Auditor - HCS-D, COS-C - Full Time. Key Responsibilities Validates Acute Inpatient coded charts for accurate diagnostic information and compliance Conducts coding audits and reviews Medicare/non-Medicare charts to ensure adherence to coding guidelines Communicates coding changes and rationale to coding and CDI staff, ensuring proper documentation Required Qualifications Graduate from an accredited School of Nursing Bachelor's Degree in Nursing or equivalent combination of education and experience Current License to practice as a Registered Professional Nurse in New York State Specialized certifications such as HCS-D and COS-C are required Prior CHHA Nursing experience is strongly preferred

A company is looking for a Registered Nurse Coding Auditor - HCS-D, COS-C - Full Time. Key Responsibilities Validates Acute Inpatient coded charts for accurate diagnostic information and compliance Conducts coding audits and reviews Medicare/non-Medicare charts to ensure adherence to coding guidelines Communicates coding changes and rationale to coding and CDI staff, ensuring proper documentation Required Qualifications Graduate from an accredited School of Nursing Bachelor's Degree in Nursing or equivalent combination of education and experience Current License to practice as a Registered Professional Nurse in New York State Specialized certifications such as HCS-D and COS-C are required Prior CHHA Nursing experience is strongly preferred

Join Optum Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Positions in this function investigate Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities Clinical Case Reviews - 75% Perform clinical review of professional (or facility) claims vs....

divh2Clinical Nurse Auditor Payment Integrity/h2pWe are seeking an experienced Clinical Nurse Auditor to join our Payment Integrity team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a similar credential, through AAPC or AHIMA. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential./ppHow You Will Make an Impact/pulliInvestigations and Audits: Conduct in-depth medical reviews through...

Senior Clinical Compliance Auditor At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle. The Senior Clinical Compliance Auditor serves as the primary clinical reviewer of data analysis findings, referrals, appeals and complaints related to Network Hospitals, Providers, Pharmacies, and other entities or programs suspected of inappropriate billing of claims to Blue Cross & Blue Shield of Mississippi. The incumbent is responsible for selecting, obtaining, coordinating, monitoring, and reviewing medical records and other relevant information for clinical and coding assessment and validation of related billing of services provided to Blue Cross Blue Shield Customers. The Senior Clinical Compliance Auditor collaborates with data...

Job Title Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) 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. Position Purpose: 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. Location: This is a remote position, Monday - Friday from 8:30am...

Internal Reference Number: R1050337 Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) 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 one of the most sophisticated data processing centers in the Southeast. We also have...

Overview BlueCross BlueShield of South Carolina is a leading national insurance company that has served the South Carolina community for more than seventy years. We are the largest insurance company in South Carolina, a leading administrator of government contracts, and operate one of the most sophisticated data processing centers in the Southeast. With a diverse family of subsidiary companies we deliver outstanding service to our customers and build on diverse business strengths. Position Purpose Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (serious, preventable medical errors) 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. Location This is a remote position, Monday -...

Details Client Name Parkland Health Job Type Travel Offering Nursing Profession RN Specialty Compliance Auditor Job ID 18192693 Job Title Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX Weekly Pay $2538.14 Shift Details Shift 5 Day Shifts X 8 Hrs Scheduled Hours 45 Job Order Details Start Date 05/20/2026 End Date 08/19/2026 Duration 13 Week(s) Job Description Candidates living within 60 miles of the facility will have a local rate of $72 The Compliance Nurse Auditor is responsible for conducting audits to ensure the clinical documentation contained within the patient medical record supports the reasons for treatment, coding/billing, payment or operations. Audits are designed to ensure accuracy of content and compliance with clinical best practice, system policies and procedures and applicable regulatory requirements and payor rules. The Nurse Auditor provides reports of findings,...

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer...

About the Job Registered Nurse PACU Medical Coding Auditor - Ambulatory Job Description: About Company: Since 1984, Professional Performance Development Group (PPDG) has been proudly Serving Heroes by connecting exceptional healthcare professionals with rewarding opportunities across military, federal, and commercial healthcare facilities. Guided by our core principles of excellence, integrity, and collaboration, we are dedicated to delivering high-quality staffing solutions that strengthen the delivery of patient care nationwide. Rooted in a culture of Linked Prosperity, PPDG values the success of our clients, employees, and partners alike-offering competitive compensation, comprehensive benefits, professional growth, and a cooperative workplace built on trust, respect, and service. As a proud Department of Defense Partner Employer and participant in the Military Spouse Employment Partnership (MSEP), PPDG remains committed to supporting our Nation's Finest through...

Job Title: Clinical Nurse Auditor – Payment Integrity Job Summary We are seeking an experienced Clinical Nurse Auditor to join our Payment Integrity team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a similar credential, through AAPC or AHIMA . Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential. How You Will Make an Impact Investigations and Audits...