130 senior specialist coding auditor jobs found

Job Description Job Description Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: You will support issue resolution in the Oscar claim environment. You will be responsible for the end-to-end claims repayment quality, process improvement and supporting root cause analysis . You will report into the VP, Payment Integrity. Work Location: This is a remote position, open to candidates who reside in: Tempe, Arizona; Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; New York City, New York; Philadelphia, Pennsylvania; Salt Lake City, Utah. While your daily work will be completed from your...

Job Description Job Description Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri;...

Siu Coding Auditor Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About The Role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our...

Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. If you live...

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 a 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 payers. Researching...

42910BR Extended Job Title: Medical Coding Auditor Org Level 1: Texas Tech Unv Hlth Sci Ctr El Paso Position Description: Responsible for auditing medical records to ensure accurate coding and compliance with regulatory requirements. This role ensures continuous quality improvement in coding practices while maintaining compliance with healthcare laws and organizational policies. The Medical Coding Auditor collaborates with practice, providers, and other departmental leaders to provide education on medical coding and documentation based on audit findings and as required by current CMS regulations. Work directly with the Medical Coding Auditor Manager to implement best practices to maximize revenue, improve coding accuracy and assure regulatory requirements are met. Requisition ID: 42910BR Travel Required: Up to 25% Major/Essential Functions: Conduct reviews and audits of medical records for coding accuracy (ICD-10-CM, CPT, HCPCS) and...

General Information Press space or enter keys to toggle section visibility Work Location: Los Angeles, CA, USA Onsite or Remote Flexible Hybrid Work Schedule Monday-Friday, 8:00am-5:00pm PST Posted Date 12/10/2025 Salary Range : $86400 - 184800 Annually Employment Type 2 - Staff: Career Duration Indefinite Job # 27889 Primary Duties and Responsibilities Press space or enter keys to toggle section visibility Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization. Reporting to the Compliance Manager, MAPD Audit, you will contribute to the organization's audit work plan,...

Data Quality Senior Medical Coder - Remote Full-time Shift: Day Shift Status: Full Time More Than Just Care,It’sCommunity 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 beMunson 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...

Compliance Auditor, MAPD Support compliance excellence at UCLA Health by joining our team as a compliance auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct risk adjustment data validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization. Reporting to the compliance manager, MAPD audit, you will contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide regulatory readiness and operational improvement. This position calls for a strong foundation in CMS guidelines, managed care compliance, and effective collaboration with both internal teams and external partners. In this role, you will: Conduct compliance audits related to operational functions, vendor performance, data validation, RADV, triennial review, pre-delegation...

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...

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 a 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 payers....

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...

Overview This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. The Senior Compliance Coding Auditor will have dotted line reporting to the Chief Compliance & Risk Officer. Responsibilities Essential Functions: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements. Identify coding discrepancies and formulate suggestions for improvement. Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. Work with medical staff department to identify and assist providers with coding....

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for a dynamic person to join us, working with our highly skilled Medical Coding Team to fill the role of Medical Coding Auditor & Educator.We are a 100% remote team supporting our clients across the United States! See us at.The ideal applicant will be a subject matter expert in both Facility and Profee medical coding auditing.Job Focus :The Senior Coding Auditor may be responsible for a variety of duties and obligations, depending on the client and assignment.These responsibilities may include inpatient / outpatient / professional fee facility auditing, denial management, coding, implementation specialist, job aid creation, training, and specialty coding.The position may also be responsible for management of the audit team and project management.All coding and auditing are performed within the scope of regulatory and compliance law expectations.Auditing Responsibilities :May include conducting inpatient,...

Candidates must reside either in Washintgon or Oregon to be considered for this position. 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...

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Monday-Friday Shift Start Time 8:00 AM Shift End Time 4:30 PM Worker Sub-Type Regular Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's. Job Description The Physician Coding Educator provides education in coding and billing compliance to physicians, physician assistants, nurse practitioners, and clinical service auxiliary providers to improve the workflow and promote overall clinical...

The Medical Group Compliance Auditor Senior is responsible for providing audit, coding support and guidance to physicians, APPs, residents and support staff. This role ensures that all coding, billing and documentation complies with federal and/or state regulations, private payer health care program requirements as well as the Compliance and Operations Policies of the organization. This job assists with the development and implementation of educational and training programs as well as coding tools and resources to help achieve organization?s goal of consistent, complete and accurate coding and documentation. Essential Job Function Capable of working independently to conduct regularly scheduled compliance reviews for assigned providers, practices, and focused review areas within designated time frames. Provides mentorship and guidance to the more junior Medical Group Compliance Auditor during the audit completion process. Performs Reviews clinical documentation to...

We do Consulting Differently The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Auditor at either the Consultant or Managing Consultant level. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. The work of a Healthcare Compliance Auditor will involve execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular...

Job Description General Purpose of Job :   Ensure Revenue Cycle Coding and Billing are compliant with State and Federal regulations.  Respond to and Investigate compliance issues within Revenue Cycle.   Lead and/or coordinate audit activity with governmental audits.   Essential Duties : This job description is intended to cover the minimum essential duties assigned on a regular basis.  Team members may be asked to perform additional duties as assigned by their leader.  Leadership has the right to alter or modify the duties of the position. Ensures conformance with applicable laws, regulations and Medicare/Medicaid reimbursement rules to ensure UMHS is in compliance with federal, state and/or local regulations. Monitors, analyzes and reports on laws, regulations, audits and industry standards that impact the organization. Develops and maintains Professional and Hospital billing issues on the Revenue Cycle Compliance Work Plan. Reviews the OIG Work Plan,...

Position Type Full Time Description Work Where You Matter! At St. Croix Hospice we guide patients and families through the end-of-life journey. Through compassionate care, we focus on our patient’s quality of life, empowering them to make the most of their time with dignity, comfort and respect. If you are ready to be part of an extraordinary team of caregivers, then come work where you matter. Compliance Auditor (Clinical) Position Overview The Compliance Auditor is responsible for assisting with the development and implementation of the compliance audit program to ensure regulatory adherence, risk mitigation and operational integrity. This role ensures that St. Croix Hospice complies with federal and state laws and regulations and internal policies by identifying potential risks and working cross-functionally to implement corrective actions. The Compliance Auditor will lead risk assessments, internal audits and compliance investigations while collaborating with leadership...

Job Description The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines...

Work Where You Matter! At St. Croix Hospice we guide patients and families through the end-of-life journey. Through compassionate care, we focus on our patient's quality of life, empowering them to make the most of their time with dignity, comfort and respect. If you are ready to be part of an extraordinary team of caregivers, then come work where you matter. Compliance Auditor (Clinical) Position Overview The Compliance Auditor is responsible for assisting with the development and implementation of the compliance audit program to ensure regulatory adherence, risk mitigation and operational integrity. This role ensures that St. Croix Hospice complies with federal and state laws and regulations and internal policies by identifying potential risks and working cross-functionally to implement corrective actions. The Compliance Auditor will lead risk assessments, internal audits and compliance investigations while collaborating with leadership to mitigate risks and strengthen...

Job Title : Inpatient Facility Medical Coder Location : Clackamas, OR, US Pay Rate : USD $27.26 - $39.37 / hr +Benefits JOB DESCRIPTION : 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...