52 registered nurse coding auditor jobs found

Revenue Cycle AuditValidates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.Job ResponsibilityLeverages clinical expertise to identify and validate DRG code assignment.Full review of CDI suggested code changesDemonstrates 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 coding changes necessary to provide the most valid documentation in compliance with Federal and State regulations.Operates under general guidance and work assignments are...

Inpatient Coding SpecialistValidates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.Job ResponsibilityLeverages clinical expertise to identify and validate DRG code assignment.Full review of CDI suggested code changesDemonstrates 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 coding changes necessary to provide the most valid documentation in compliance with Federal and State regulations.Operates under general guidance and work assignments...

Req Number 200360 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. 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 coding changes necessary to provide the most valid documentation in compliance with Federal...

Revenue Cycle AuditValidates 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 positionJob Responsibility1. Leverages clinical expertise to identify and validate DRG code assignment.2. Full review of CDI suggested code changes3. 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 appropriate coding...

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,...

Northern Light Health Home Office |US:ME:Brewer or Hybrid | Legal/Compliance/Internal Audit | Full Time Salary range- 35.92-55.13 USD Description The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits. Northern Light Health Department: Internal Audit Position is located: Cianchette Professional Blding Work Type: Full Time Salary Range : $ 35.92 - $55.13 Exempt: Yes Summary : Under the direction of the Director of Internal Audit, this position will plan and conduct audits of Northern Light Health and any of its members with a focus on clinical activities (e.g., coding, billing, safety, etc.), the safeguarding of assets, accuracy and reliability of data, and compliance with policies, procedures, and regulatory requirements to protect Northern Light Health from...

Job Title: Clinical Nurse Auditor / RN Nurse Coder (Payment Integrity) Job Type: Full-Time (40 hours/week, Monday - Friday) Schedule: Standard business hours Department: Payment Integrity & Claims Audit Location: Remote About the Role We are seeking experienced, detail-oriented Registered Nurses (RNs) with strong clinical acumen and medical coding knowledge to join our growing Payment Integrity team. In this role, you will analyze flagged claims data, review complex clinical documentation, and identify potential overpayments and billing discrepancies. You will leverage your clinical expertise to validate diagnoses, assess code assignments, and make authoritative determinations on claim validity-protecting healthcare resources while ensuring accurate reimbursement. Key Responsibilities Clinical Review & Determination: Review flagged claims (both inpatient and outpatient) to evaluate the clinical validity of billed services. Make independent clinical determinations,...

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville’s only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children’s Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will...

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate...

About Baptist HealthRecognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.Job SummaryBaptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will have a...

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will...

Healthy Careers Start Here Be part of a vision for a healthier Mississippi as a Senior Clinical Compliance Auditor . At Blue Cross & Blue Shield of Mississippi, we’re not just about providing health insurance, we are creating a strong, supportive community which encourages every Mississippian to live their healthiest life. This mission requires a talented and motivated team with diverse sets of skills and experiences, aligned with the commitment of a healthy Mississippi. By combining strong financial stewardship with a focus on the Health & Wellness of Mississippians, we invest in programs, partnerships, and innovations which drive quality care, lower costs, and healthier lives. Join our team and start a meaningful career where your work supports better health outcomes for Mississippians every day. We are seeking a Senior Clinical Compliance Auditor to act as the primary clinical reviewer of analytical findings, complaints, formal referrals, and appeals related to the...

About Baptist HealthRecognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.Job SummaryBaptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will have a...

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for a Lead Associate, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized medical bill, and UB-04 forms to ensure accuracy, compliance, and proper billing practices. This role is responsible for conducting quality assurance audits and oversight of itemized bill review activities to ensure accuracy, consistency, regulatory compliance,...

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital. Job Summary Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will...

To support a culture of continuous improvement, the full-time remote Certified Inpatient Coding Auditor will perform clinical reviews of medical records, ensuring claims coding accuracy and compliance with regulatory guidelines. Key responsibilities: Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles Ensures claims analysis complies with ethical coding standards and validates issues of medical necessity Researches reimbursement regulations and assists in developing claims audit process documentation Required qualifications: Registered Nurse with 2+ years of experience in inpatient claims, preferably NICU and maternity Inpatient Coding Certification (CCS or CIC) required, or must obtain within 6 months of hire Strong understanding of MS-DRG, AP-DRG, and APR-DRG payment systems Expert knowledge of DRG, ICD-10, CPT, and HCPCS codes Experience with appeals and familiarity with medical claims billing/payment systems

Trend Health Partners At Trend Health Partners, a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining Trend Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. Nurse Coder Drg Auditor The Nurse Coder DRG Auditor's primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments, APC assignments and/or medical necessity for inpatient level of care. This role will...

Nurse Coder Drg Auditor III TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Nurse Coder DRG Auditor III's primary responsibility is to operate as a Subject Matter Expert. Independently audit outpatient and inpatient claims applying coding guidelines while reviewing supporting medical documentation, completing appeal responses and...

Nurse Coding Auditor At Trend Health Partners, a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining Trend Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Nurse Coding Auditor is responsible for reviewing medical records, clinical documentation, itemized bills, and facility claims to validate accurate revenue codes, CPT codes, HCPCS codes, and related billing practices. This role applies coding principles, industry...

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its...

HIM Specialty Coder IIYou'll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006. And you'll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here.Billings Clinic is a community-owned, not-for-profit, physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty...

About Us You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet Recognition consecutively since 2006. And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here. Your Benefits We provide a comprehensive and competitive benefits package to all full- and part-time employees (minimum of 20 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan,...

Where You'll Work Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system. Job Summary and Responsibilities As a Senior Coder , you will ensure precise communication with...

Job Description Job Description Description: Job Role The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines. Requirements: Responsibilities will include: Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines. Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting...