536 risk adjustment coding auditor jobs found

Risk Adjustment Coding Auditor Role type: Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required Skillset MS Suite CPC certified CRC certified 5+ years of risk adjustment experience #J-18808-Ljbffr

Vytwo Technologies Inc. seeks a Risk Adjustment Coding Auditor to perform first and second pass auditing for CMS RADV programs. The role supports a small team with two resources over a 6-month duration, ensuring accuracy and compliance in coding and documentation. The candidate should be a certified risk adjustment coder with CPC and CRC credentials and at least five years of risk adjustment experience. #J-18808-Ljbffr

Job Overview Role type: Risk Adjustment Coding Auditor. Quantity of resources: 2. Duration: 6 months. JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required Skills MS Suite CPC certified CRC certified 5+ years of risk adjustment experience Equal Opportunity Statement We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. #J-18808-Ljbffr

Role type: Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required skillset: MS Suite CPC certified CRC certified 5+ years of risk adjustment experience

CommunityCare HMO, Inc. is seeking a Clinical and Risk Adjustment Auditor in Tulsa, OK. This role involves conducting audits for clinical and risk adjustment documentation for Medicare Advantage and ACA Programs, ensuring coding accuracy and regulatory compliance. The ideal candidate will hold a coding certification, have extensive coding experience, and be proficient with CMS guidelines. The position requires strong analytical skills and a meticulous approach to auditing. #J-18808-Ljbffr

Empowering the Future of Healthcare The healthcare industry is on the brink of a paradigm shift where patients are increasingly being viewed as empowered consumers, utilizing digital technologies to better understand and manage their own health. As a result, there is a growing demand for a range of patient-centric services, including personalized care that is tailored to each individual's unique needs, health equity that ensures access to care for all, price transparency to make healthcare more affordable, streamlined prior authorizations for medications, the availability of therapeutic alternatives, health literacy to promote informed decision-making, reduced costs, and many other initiatives designed to improve the patient experience. ClinDCast is at the forefront of shaping the future of healthcare by partnering with globally recognized healthcare organizations and offering them innovative solutions and expert guidance. Our suite of services is designed to cater to a broad...

Washington Regional Medical System is seeking a Profee Coding Auditor to conduct chart reviews of medical records for clinic, outpatient, and inpatient provider claims. This role leads audit phases from planning through reporting and helps identify training needs for providers and coders to ensure accurate E/M, CPT, ICD-10 documentation and RAF scores. The ideal candidate has 3–5 years auditing experience, CPC/CRC or equivalent credentials, and a solid understanding of risk adjustment and coding #J-18808-Ljbffr

Washington Regional Medical System in Fayetteville, AR is seeking a Profee Coding Auditor for a full-time, days schedule. The role involves chart reviews across clinic, outpatient, and inpatient claims and reports to the Profee Audit Manager. The ideal candidate has 3–5 years auditing experience, CPC or CRC certification, and strong knowledge of risk adjustment, HCCs, ICD coding, CPT coding, and RAF scores. Excellent communication and analytical skills are required. #J-18808-Ljbffr

CVS Health is seeking a qualified Risk Adjustment Auditor to perform complex audits of medical records prior to CMS submission, ensuring accuracy and regulatory compliance. You will contribute to compliance reporting and mentor teammates across coding resources. The role requires extensive experience with Medicare/Commercial/Medicaid risk adjustment, ICD coding guidelines, and certifications (CPC/CCS-P/CRC). A bachelor’s degree is preferred. Full-time with a comprehensive benefits package. #J-18808-Ljbffr

Title - Coding Auditor Location - Clackamas, OR Job Type - Permanent Job Summary: To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP),...

Market leading healthcare organization is looking for a Quality Assurance Coder/ Auditor to join our team in Phoenix, AZ. This role is a 6 month contract with a strong perm possibility. Hybrid role, must be able to go into Phoenix office at least once a week, if not more. Pay rate: $25 - $30.22 an hour The Quality Assurance Coder/Auditor develops risk mitigation and provider education programs while ensuring accurate, compliant coding and documentation practices. This role reviews and analyzes medical records, performs risk adjustment and QA audits, identifies unsupported diagnoses, abstracts codes to the highest level of specificity, and provides education and feedback to providers, vendors, and stakeholders. Findings from audits, claims errors, and risk analyses are used to drive provider education, improve documentation quality, and support risk adjustment initiatives. Essential Job Functions and Responsibilities: -Comprehensive understanding of HCC coding rules,...

Job Description Job Description Job Title: Quality Assurance Coder/Auditor Location: Phoenix, AZ (1 day/week onsite) (Hybrid) Duration: Long-Term Contract Job Summary: We are seeking a Quality Assurance Coder/Auditor with strong HCC and ICD-10 coding experience to review medical records, ensure accurate risk adjustment coding, perform quality audits, and provide coding education to healthcare providers. This role supports compliance with CMS guidelines and helps improve documentation accuracy and risk mitigation. Key Responsibilities: Review and audit medical records for accurate ICD-10/HCC coding. Ensure compliance with CMS Medicare Risk Adjustment guidelines. Perform quality assurance audits and provide coding feedback. Educate providers on documentation and coding best practices. Analyze coding trends and recommend process improvements. Track audit results and prepare monthly QA reports. Required Qualifications: Strong knowledge of...

Senior Risk Adjustment Coder The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. What you will do: Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses. Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes. Inquire with clinicians the recommended HCC diagnosis for chart addendum. Collaborating with other departments to address coding updates and support risk...

Medical Coding & Risk Adjustment Auditor (Remote Contract) Location: Remote Duration: 6+ Month Contract Client: New Jersey-Based Healthcare Organization Position Summary We are seeking an experienced Medical Coding & Risk Adjustment Auditor to support a healthcare client's Risk Adjustment and Data Validation initiatives. This role is responsible for reviewing, interpreting, auditing, coding, and analyzing medical record documentation to ensure diagnosis accuracy, proper documentation, and Hierarchical Condition Category (HCC) abstraction. The position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation (RADV) audits, as well as ongoing Risk Adjustment activities across Medicare, Medicaid, and Commercial lines of business. Key Responsibilities Review, interpret, and translate CPT, HCPCS, ICD-9, and ICD-10 codes for HCC abstraction. Audit medical records for completeness, accuracy, and compliance with applicable...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities: Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Medical Coder II Red Lodge, MT, US 6 days ago Requisition ID: 1064 Salary Range: $20.83 To $28.63 Hourly Medical Coder II Status: Part Time (20 hours/week) | Non-Exempt Reports to: Health Information and Technology Manager Purpose and Scope of Position Responsible for reviewing and interpreting medical records, documents, and other patient data to assign appropriate codes for healthcare procedures, diagnoses, and services provided. These codes are used for insurance reimbursement, statistical purposes, and maintaining accurate patient records. Medical coders work closely with healthcare providers, insurance companies, and billing departments. Job Requirements Required Qualifications Education: High school diploma or equivalent. Certification: Certification from a recognized body such as the American Academy of...

Position Summary The role of the Profee Coding Auditor reports to the Profee Audit Manager. This position is responsible for chart reviews of medical records for clinic, outpatient, and inpatient provider claims. The position is responsible for management, implementation, and delivery of assigned audit phases, including planning, fieldwork, and reporting. Essential Position Responsibilities Conduct focused chart reviews, audits, risk adjustment and compliance reviews on providers and clinics, as directed by management, tracking results and identifying trends and deficiencies for follow up training for providers and coders, as necessary. Report concise and detailed recommendations to improve documentation of E/M services, CPT, specificity of ICD10 codes and RAF scores. Provide timely identification of deficiencies and educational needs to providers and coders. Support coders by performing quality assurance reviews and providing appropriate education. Create educational material and...

GeBBS Healthcare Solutions is looking for a flexible CMS HCC/Risk Validation Auditor for a seasonal project in East Haven, Connecticut. The role offers full-time opportunities at either 30 or 40 hours weekly, with flexible hours, including nights and weekends. The ideal candidate will have at least 5 years of verifiable risk adjustment coding experience and required active certification with AAPC or AHIMA. Responsibilities include reviewing member and claim data, confirming diagnoses, and adding valid risk-adjusting diagnoses. #J-18808-Ljbffr

Join to apply for the Compliance Auditor Analyst role at Upstate Medical University 5 months ago Be among the first 25 applicants Join to apply for the Compliance Auditor Analyst role at Upstate Medical University Get AI-powered advice on this job and more exclusive features. Job Summary Position Summary: Under the direction of the Compliance Officer the main duties for this position include: analysis of professional coding and billing data, review of applicable regulations or guidelines and professional coding and billing audits. Duties/Responsibilities Analysis of coding and billing data, identification of trends and aberrations. Performance of routine and investigatory audits evaluating compliance with applicable laws, regulations, coding, and billing guidelines. Interpretation of coding, billing, and regulatory standards. Preparation and completion of audit reports including recommendations, education and corrective action. Knowledge, Skills and Abilities: Strong...

Location Miramar, Florida Summary Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance. Responsibilities Enhances and maintains coding knowledge and skills. Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding. Submits daily productivity report to HIM manager by defined deadline....

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.Summary:Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.Responsibilities:Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and...

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 - University Healthcare Alliance job.A Brief OverviewThe Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment.LocationsStanford Health Care - University Healthcare AllianceWhat you will doRisk Adjustment ReviewMay perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditingReviewing medical records to ensure accurate HCC coding and...

Location 1240 39th Street,Brooklyn, NY, 11218,United States Base Pay $83,000.00 - $90,000.00 / Year Employee Type Full Time Required Degree 4 Year Degree We are seeking a detail-oriented and experienced Coder Auditor to join our dynamic team. The ideal candidate will be responsible for ensuring the accuracy and completeness of clinical data used to support risk adjustment coding for our Medicare plan. You will work closely with healthcare providers and clinical teams to identify and mitigate documentation gaps, ultimately supporting our mission to provide exceptional care to our members. Responsibilities Audit and QC the coding team’s output for accuracy and compliance with HCC/ICD-10-CM guidelines Speak directly with providers — writing and following up on provider queries for insufficient or ambiguous documentation Educate providers on documentation practices that support accurate risk adjustment coding Serve as the escalation point for complex charts and coding...

To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding directives. Ability to communicate...