Claims Coding Integrity Auditor
EmblemHealth, Inc.
EmblemHealth in New York seeks a Coding Integrity professional to uphold standards for claim review, policy implementation, and audit practices. You will identify inconsistencies between policies and claims and work with leadership to resolve them. You will audit suspended and appealed claims, review medical records for accurate adjudication, and provide education on CPT, ICD-10, and HCPCS coding to internal teams and provider offices. #J-18808-Ljbffr EmblemHealth, Inc.
$56.16k - $99.36k
...Responsible for upholding the standard for code review functions in the setting of claims review, grievance and appeal, and... ...; review decisions from Coding Integrity team; provide feedback, results,... ...Certified Professional Medical Auditor) (Required) Relevant Work Experience...ClaimsRemote jobWork experience placement$58k - $85k
Clinical Documentation Integrity & Claims Auditor### Clinical Documentation Integrity & Claims AuditorApply: Remote USA: Full time: Posted Yesterday... ...to ensure the accuracy of diagnostic information and coding (ICD-10 CM) by performing audits and medical chart reviews...ClaimsFull timeContract workInternshipWork at officeRemote work$28 - $33 per hour
...NY (Preferred) / Hybrid Reports to: Claims Supervisor Covet Health is a modern,... ...processing of claims based on CPT, ICD-10, POS codes, provider types, etc. (Professional,... ...ensure optimal claims processing and plan integrity. Monitors and tracks daily output,...ClaimsPermanent employmentFull timeWork experience placementWork at officeMonday to Friday$57.4k - $99k
...400 to $99,000 based on experience The Outpatient Facility Coding Auditor integrates medical coding principles and objectivity in the performance... ...meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental...ClaimsTemporary workWork at officeLocal areaRemote work$60.1k - $98.7k
...this fully remote position as a Skilled Nursing Facility auditor you will apply your expert clinical knowledge to validate the accuracy of billed charges to ensure the integrity of the paid claim including coding validation, payment accuracy, contractual requirements and...ClaimsRemote work- ...paradigm. Alaffia is a new kind of claims operations partner for health plans.... ...seeking an experienced Clinical DRG Auditor to join our Payment Integrity team. In this role, you will perform... ...reimbursement, documentation standards, and coding guidelines to identify unsupported...ClaimsRemote workVisa sponsorshipWork visaFlexible hours
$47 - $56 per hour
Overview The Sr. Auditor, Quality Assurance position is responsible... ...ensuring that the audited claims meet quality standards necessary... ...as accurate as possible. Integrates healthcare auditing principles... ...of setting, potential billing/coding issues, and quality concerns....ClaimsHourly payWork at officeRemote workFlexible hours$25.38 - $36.76 per hour
...Our work spans Medicare Advantage, fully integrated care models, primary care, care for the... ...people and communities we serve. The Claims Auditor Conduct pre-pay and post-pay audits to... ...Professional claim payment Knowledge of standard coding and reference materials used in a claim...ClaimsHourly payRemote work$70k - $85k
...premier independent healthcare payment integrity company in the US and a leader across several... ...and healthier lives for all. Medical Coding Auditor - Inpatient (Remote) Location: Remote.... ...medical chart review for all provider/claim types. Experience coding for emergency...ClaimsFull timeWork at officeRemote workHome office- ...promotes productivity, supports work‑life integration, and ensures essential face‑to‑face... ...is granted as required by law. Examines claims for compliance with relevant billing and... ...investigations and stays abreast of current medical coding and billing issues, trends and changes...ClaimsFull timeTemporary workWork at officeLocal area1 day per week
- ...Distribution and performs in-depth plan coding and testing of new and... ...loaded on the Company's claim management system against the... ...necessary, to ensure smooth integration of new plans for both WGAT and... ...experience as a medical/dental claims auditor or plan testing experience,...ClaimsWork at office
- ...algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue... ...for the last eleven years. Position Summary The Coding Denials Auditor provides analysis of coded medical services,...ClaimsRemote workFlexible hours
$55k - $75k
About Us Integrity Management Services, Inc. (IntegrityM) is an award... ...In this role, the Medicaid Auditor will be responsible for performing... ...policy compliance, billing, coding and medical record... ...determinations. Experience in reviewing claims for appropriate billing and...ClaimsRemote jobFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours$45.67 per hour
Overview This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR). Auditors in this... ...have both a strong inpatient HIM/coding background and an understanding of... ...Analyzes and Audits Claims. Integrates medical chart coding principles, clinical...ClaimsHourly payFull timeReliefWork at officeShift workNight shiftWeekend workAfternoon shift- Alaffia Health is seeking an experienced Clinical DRG Auditor to join our Payment Integrity team. In this role, you will perform inpatient DRG validation audits and clinical reviews of medical records and claims, leveraging your clinical expertise to identify unsupported...Claims
- ...community. The Compliance Analyst/Auditor serves as a regulatory... ...three (3) years of experience in coding, documentation, billing, and/... ...understanding of the False Claims Act Knowledge, Skills, and Competencies... ...confidential situations with integrity and professionalism Strong...ClaimsWork at office
$57.24k - $97.47k
...Hiring: Remote CPMA Educator & Auditor Summary: With minimal... ...following responsibilities of the Coding and documentation quality assurance... ...of denied and appealed claims and takes appropriate action... ...characterized by a sense of honesty, integrity, and the ability to inspire...ClaimsRemote jobTemporary workLocal areaShift workNight shift- ...Industry-Leading Experts and Help Shape the Future of Revenue Integrity Are you a passionate coding and revenue integrity professional who thrives on... ...bonus available** What You'll Do The DRG Revenue Integrity Auditor (DRG-A) performs comprehensive Diagnostic Related Group...Work experience placementLocal areaRemote workRelocation packageFlexible hours
- The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on inpatient charts. The DRG... ...charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal...Full timeWork experience placementRemote workRelocation package
- Nurse Auditor Coder (RN + CRC or CIC) | Clinical Claim Review | Weekdays | 100% Remote 100% Remote, U.S.-based | 109... ...defensible opinions on medical necessity, coding and billing accuracy, regulatory... ...auditing, payment or revenue integrity, clinical validation, or denials...ClaimsRemote jobHourly payContract workFor contractorsMonday to FridayShift workNight shiftWeekend workAfternoon shiftWeekday work
- ...for a Utilization Review Nurse Auditor to join their team! The... ...with the highest quality and integrity and that all work is in full... ...requires a Nursing License and Coding Certification The position is... ...carriers, law firms, third-party claim administrators and government...ClaimsLocal areaRemote workMonday to Friday
- Pre-Payment Clinical Auditor (RN/Medical Coder) | 5 Years of Experience | Remote | Contract... ...in clinical auditing, medical coding, payment integrity, or related healthcare reimbursement functions... ...to investigate complex healthcare claims, validate medical coding accuracy, and...ClaimsRemote jobWeekly payContract workImmediate startMonday to Friday
- ...currently accepting applications for an outpatient Certified Coding Auditor to work in its New York office or remotely. Principal duties... ...payor scrutiny. Familiarity with both UB-04 and CMS 1500 claims data, as well as understanding of payor remittances....ClaimsWork at officeLocal areaRemote work
- ...Top Healthcare company is hiring Medical Coding Auditors to work Remotely! The Coding Auditor conducts risk-based prospective and retrospective... ..., and modifier usage Proficiency in Epic charge review, claim/edit workflows, workqueues, coding documentation, and billing...ClaimsContract workTemporary workWork experience placementLocal areaRemote workShift work
- We are hiring nurse auditors who can commit to a minimum of 15 hours... ...opinions for payer-provider claim disputes. Our clients are law... ...opinions on medical necessity, coding and billing accuracy,... ...auditing, payment or revenue integrity, clinical validation, or denials...ClaimsRemote jobHourly payContract workFor contractorsHome officeOverseasMonday to FridayFlexible hoursShift workNight shiftWeekend workAfternoon shiftWeekday work
- ...experienced Medical Bill Reviewer to work remotely from New York. The role involves reviewing medical claims, analyzing patient records, and ensuring compliance with coding guidelines. Candidates should have at least 3 years of experience, certifications in relevant...ClaimsRemote job
- Clover Health is hiring a CPC with 3+ years of coding and auditing experience to review claims for billing and coding issues in collaboration with SIU and Clinical teams. The role leverages AI tools to flag anomalous patterns and support prepayment audits. The ideal candidate...ClaimsRemote job
- Humana Inc. is seeking an experienced Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and accurate DRG assignments. This role emphasizes MS-DRG coding, auditing, and cost-conscious payer processes in a remote work setting....ClaimsRemote job
- ...offers a full-time remote Certified Medical Auditor (SC) role focused on validating DRGs,... ...while coordinating rate adjustments with claims teams. The position requires creating monthly... ..., and serving as a resource for coding issues; a strong background in medical records...ClaimsRemote jobFull time
- Cotiviti is seeking a Senior Auditor, Quality Assurance to ensure clinical validation reviews... ...across outpatient and specialty claims. This role emphasizes adherence to procedures... ...years in healthcare auditing, and relevant coding certifications (RHIA/RHIT/CCS/CIC/CCDS/CPC...ClaimsRemote job
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