377 risk adjustment medical coding auditor jobs found

Title: Risk Adjustment Coding Auditor Location: Remote Job Type: Contract (6 months) Compensation: $35.00 – $38.00 per hour Industry: Health Insurance About the Role Our firm is partnering with a leading nonprofit health insurance organization that serves members across commercial, Medicare, and Medicaid health plans. We are seeking an experienced Risk Adjustment Coding Auditor to help ensure the accuracy, integrity, and compliance of clinical coding and documentation used in risk adjustment programs. In this role, you will support accurate reimbursement and regulatory compliance by conducting detailed coding audits, identifying documentation gaps, and providing expert guidance on risk adjustment coding practices. This position is ideal for a coding professional with strong HCC auditing experience who is passionate about data accuracy, compliance, and continuous improvement. Job Description As a Risk Adjustment Coding Auditor, you will evaluate coded clinical data to ensure...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll Work With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

JOB DESCRIPTION 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....

Metaintro, Inc. seeks an experienced Risk Adjustment Auditor to review inpatient and outpatient medical records for HCC support. Requires 5+ years in risk adjustment auditing with CMS/HHS RADV focus, CRC certification, and advanced Excel skills. Must be able to work remotely and meet strict accuracy targets. Responsibilities include chart reviews, coding accuracy reviews, and client communications to ensure compliant and timely claim payments. Strong knowledge of ICD-10 guidelines is essential. #J-18808-Ljbffr

The Marwood Group is a healthcare advisory services firm headquartered in New York City with offices in Washington, DC, and London. The Healthcare Advisory Group advises and consults with the firm’s private equity and corporate clients on healthcare policy, strategy, and market analysis issues. Areas of focus include Medicare, Medicaid, commercial insurance, worker’s compensation, and clinical compliance. Marwood operates at the intersection of Wall Street and Washington, with experienced professionals from top banking, consulting, and healthcare operations firms, as well as senior political and governmental positions. The Advisory Group is currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely. Principal duties and responsibilities: Perform remote billing and coding audits to ensure client coding practices are compliant with regulations and coverage policies for both government and commercial payors....

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.For physician billing, collaborates with billing department to ensure all bills are satisfied. For hospital, routes to billing charge entry errors and/or...

Coding Auditor Senior Candidates must reside either in Washington or Oregon to be considered for this position. Essential Responsibilities: Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as needed for proper Ambulatory Payment...

Where You'll Work With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Job Summary and Responsibilities As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to...

The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team. Essential Duties Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed Reviews audit findings...

GHR Travel Nursing seeks a Remote Professional Fee Coding Auditor specializing in HCC risk adjustment, physician coding, and primary care documentation. The role focuses on retrospective medical record audits, identifying coding opportunities, and delivering actionable recommendations to support compliant reimbursement. The engagement runs quarterly with 2-week initial duration, 8-hour days, and remote collaboration across Baltimore, MD, aiming for timely preliminary findings and consistent #J-18808-Ljbffr

Location Miramar, Florida Summary Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance. Responsibilities Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Research electronic medical record for any additional diagnoses documented to meet medical necessity. Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and assign anesthesia procedure codes (hospital) following specific payer requirements. Reads and interprets all provider documentation which includes all dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to...

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.Job Summary and ResponsibilitiesAs our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to ensure...

Remote Professional Fee Coding Auditor - HCC & Risk Adjustment Remote Healthcare Coding Audit Project | Baltimore, Maryland Connection Join a focused healthcare revenue integrity initiative as a Professional Fee Coding Auditor specializing in HCC risk adjustment, physician coding, and primary care documentation. This remote medical coding audit opportunity is ideal for an experienced coding professional who can conduct retrospective medical record audits, identify coding and documentation opportunities, and provide actionable recommendations that support accurate reimbursement, regulatory compliance, and improved clinical documentation. This remote engagement supports healthcare operations connected to Baltimore, Maryland, a dynamic and accessible city known for its strong healthcare community, historic neighborhoods, and vibrant waterfront culture. Remote Coding Audit Job Details Work Arrangement: Remote Engagement: Quarterly Professional Fee coding audit...

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 to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance. Responsibilities: Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Research electronic medical record for any additional diagnoses documented to meet medical necessity. Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and...

GeBBS Healthcare Solutions is a leading provider of Revenue Cycle Management (RCM) and Risk Adjustment services, helping healthcare organizations optimize operations, improve financial performance, maintain compliance, and enhance the patient experience. Recognized as a KLAS® Top Performer, GeBBS combines innovative technology, industry expertise, and a commitment to excellence to deliver measurable results for clients across the healthcare industry. We are dedicated to being a trusted healthcare partner by upholding the highest standards of quality, information security, and compliance. At GeBBS, we foster a collaborative and growth-oriented culture where employees are empowered to develop their skills, advance their careers, and make a meaningful impact in transforming healthcare. Remote (United States) | Part-Time (20 hours/week) Work Hours: Weekdays between 6:00 AM-6:00 PM PT Compensation: $36.00/hour during production Position Overview GeBBS...