159 senior specialist coding auditor jobs found

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

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

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0 million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not‑for‑profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities The Inpatient Coder Auditor reviews and analyzes documentation present in the medical record for Inpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software. The Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International...

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0 million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not‑for‑profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities The Inpatient Coder Auditor reviews and analyzes documentation present in the medical record for Inpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software. The Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International...

Description Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring/auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD-10-CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. Monitors professional fee...

Certified Medical Coding Auditor (CPC or CCS-P) Join to apply for the Certified Medical Coding Auditor (CPC or CCS-P) role at Accelerated Urgent Care Certified Medical Coding Auditor (CPC or CCS-P) 2 weeks ago Be among the first 25 applicants Join to apply for the Certified Medical Coding Auditor (CPC or CCS-P) role at Accelerated Urgent Care About Us Simply put, our purpose at Accelerated Urgent Care is to get you quality care when you need it. We aim to foster a supportive environment where our team members can develop their careers. To promote this goal, we’ve built a diverse and driven team of employees who are all eager to learn from one another and reach Accelerated Urgent Care’s mission of delivering exceptional healthcare to the patients and communities that we are privileged to serve. We are ... a fast-growing company that doubles in size year after year since 2012! Recognized as Kern County’s Top Urgent Care center 6 years in a row! Dedicated to our employees’ career...

***To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia*** The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility)...

Senior Coding Compliance Auditor and Educator Join to apply for the Senior Coding Compliance Auditor and Educator role at Tryon Medical Partners Senior Coding Compliance Auditor and Educator 3 days ago Be among the first 25 applicants Join to apply for the Senior Coding Compliance Auditor and Educator role at Tryon Medical Partners Get AI-powered advice on this job and more exclusive features. General Job Summary : The Senior Coding Compliance Auditor and Educator will be responsible for auditing outpatient professional services documentation ensuring compliance with coding and billing guidelines, identifying areas for improvement, and providing training to clinicians and coders to support accuracy, compliance, and adherence to industry standards. This role involves both auditing medical records and educating coders, providers, and staff on professional coding guidelines and best practices. (this is a full-time position that will support our Compliance team, Monday to Friday 8 am...

Job Summary The Senior Coding Auditor performs detailed audits of medical cases to ensure accuracy of assigned codes, charges, availability of documented medical records, medical accounts, and compares the cases with the itemized bill and overall procedures. The Senior Coding Auditor reviews and audits current and retro accounts, and reports audit outcomes regarding charge errors, percentage of savings or losses for the facility, data processing errors, the performance of the hospital charging system as well as documentation and justification within the medical record and itemized bill. Works cooperatively with the Associate Directors/Director in the identification of process improvement initiatives related to the coding and charging of hospital services. The Senior Coding Auditor provides guidance and support to the Coding Auditors as requested or required. The Senior Coding Auditor also assists with quality assurance reviews, data analysis, workload monitoring and distribution,...

Position Summary Responsible for working with and providing on‑going coding and documentation education (quarterly, annually and ad‑hoc) for physicians, coders, ancillary department staff, clinical documentation improvement (CDI), and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services. Essential Functions and Responsibilities As Assigned Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following coding guidelines and directives. Validates Present on Admission (POA) indicators according to guidelines and identifies any missing or inappropriate queries to providers. Uses payment methodology to audit outpatient and/or inpatient facility coding and billing, MS‑DRG or APC assignment,...

Job Description - Sr Compliance Auditor (301657) Job Description Sr Compliance Auditor - 301657 Description Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider‑coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties Conduct audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise...

Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider‑coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring/auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Key Responsibilities Conduct audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serve as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Florida AHCA / Medicaid, and CMS regulatory requirements. Monitor professional fee vendor‑coding...

Medical Records Specialist Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service. CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities. As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing...

Title: Certified Coding Specialist/Auditor Team Lead Location: Columbia, SC Status: Full-Time Who Are We? Part of the Novant Health family based in North Carolina, Novant Health Urgent Care (formerly Doctors Care) provides exceptional healthcare through our network of more than 50 urgent care centers and 20 physical therapy facilities across South Carolina. Our Columbia-based headquarters delivers non-medical management and administrative services to support these locations. For decades, we have been committed to delivering exceptional, convenient, and affordable healthcare experiences to families and communities throughout the Palmetto State. What Do We Offer? Competitive wages Generous PTO that increases with tenure 403B Health, dental, vision insurance Flexible Spending Account Short term and Long term Disability Whole and Term Life Insurance Rewarding Careers What Are We Looking For? Novant Health Urgent Cares is currently seeking a...

\*\*\*To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia\*\*\* The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and...

Position Summary: Responsible for working with and providing on-going coding and documentation education (quarterly, annually and ad-hock) for physicians, coders, ancillary department staff, clinical documentation improvement (CDI), and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services. Essential Functions and Responsibilities As Assigned : 1. Completes quality assurance audits on inpatient and outpatient coding specialists, onboarding audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following coding guidelines and directives. 2. Validates Present on Admission (POA) indicators according to guidelines and identifies any missing or inappropriate queries to providers. 3. Uses payment methodology to audit outpatient and/or inpatient facility coding and billing,...

Job Description - Sr Compliance Auditor (301657) Job Description Sr Compliance Auditor - 301657 Description Job Summary The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider‑coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties Conduct audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise...

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: Corporate Office Columbia, SC Job Id: 8839 # of Openings: 1 Location: Columbia, SC Status: Full-Time Who Are We? Part of the Novant Health family based in North Carolina, Novant Health Urgent Care (formerly Doctors Care) provides exceptional healthcare through our network of more than 50 urgent care centers and 20 physical therapy facilities across South Carolina. Our Columbia-based headquarters delivers non-medical management and administrative services to support these locations. For decades, we have been committed to delivering exceptional, convenient, and affordable healthcare experiences to families and communities throughout the Palmetto State. What Do We Offer? Competitive wages Generous PTO that increases with tenure 403B Flexible Spending Account Short term and Long term Disability Whole and Term Life Insurance What Are We Looking For? Novant Health Urgent Cares is currently seeking a Certified Coding Specialist/Auditor Team Lead to join our team....

To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia. Overview The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. Responsibilities Reviews complex audits, performs quality assurance reviews, and mentors compliance audit team. Supports supervisor with development and maintenance of quarterly audit work plan and audit workflow processes. Recommends changes to improve business operations using professional judgement and best practices. Performs documentation/chart audits on inpatient and outpatient records and provides analysis of provider and facility records. Audits VCUHS coding and billing (DRG, CPT, HCPCS, ICD-10) based on medical record...

Sr Billing Compliance Auditor The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices. Job Specific Duties: Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD‑10‑CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. Monitors...

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...

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities The Inpatient Coder Auditor reviews and analyzes documentation present in the medical record for Inpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software.  The Inpatient Coder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International...

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...