medical coding auditor

Personalized Health Partners

<div>Job Address:
10123 Alliance Road, Suite 320 Blue Ash, OH 45242<h1 class="jobSectionHeader"> 
Medical Coding and Billing Compliance Auditor</h1>
Location: Remote 
Department: Coding Compliance 
Reports To: Director of Coding 
Employment Type: Full-time Exempt<h1 class="jobSectionHeader">
About the Role</h1>
The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy and documentation integrity and ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. 
The Medical Coding Auditor will have a background in Physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have an extensive background and knowledge of CPT coding, ICD10CM coding, E&amp;M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access Medicare Physician Fee Schedule (MPFS) tools including status indicators and what they mean, National Correct Coding Initiative (NCCI) manual and edits, Local and National Coverage Determinations (LCD and NCD), Coding Clinic, and CPT assistant. 
The ideal candidate will have knowledge of Skilled Nursing Facility (SNF) E&amp;M coding, Behavior Health coding, telehealth coding rules, HCC payment methodologies, and other specialty coding.<h1 class="jobSectionHeader">
Key Responsibilities</h1><ul><li>
Performs Coding audits for compliance and accuracy with all coding systems outlined in the role description.</li><li>
Completes coding compliance accuracy score tracking, trending, and monitoring.</li><li>
Completes detailed coding compliance reports which include feedback and education for providers.</li><li>
Maintains excellent documentation of all reviews, methodologies employed, results, escalation needed, and monitoring.</li><li>
Provide feedback and education to billers, coders, and providers on documentation and coding practices.</li><li>
Identify trends, errors, and compliance risks, and recommend corrective actions.</li><li>
Stay current on changes to coding guidelines, payer policies, and regulatory requirements.</li><li>
Collaborate with compliance, revenue cycle, and clinical teams to support audit outcomes.</li><li>
Assist with internal and external audit requests as needed.</li></ul><h1 class="jobSectionHeader">
Qualifications</h1>
Required:<ul><li>
Education: High school diploma or equivalent required; Associate&rsquo;s or Bachelor&rsquo;s degree in Health Information Management or related field preferred.</li><li>
Certification: Current coding credential required (CPC, CEMC, CCS-P, RHIT, RHIA).</li><li>
Experience: 3+ years of outpatient coding experience required. 1+ years of audit, compliance, or quality review experienceStrong understanding of ICD-10-CM, CPT, E&amp;M, HCC, HCPCS, and official coding guidelines.</li><li>
Experience with EMR/EHR systems, encoders, and auditing tools.</li></ul>
Preferred:<ul><li>
Additional auditing certification (CPMA, CEMA, CDEO) preferred</li><li>
Leadership skills/experience</li></ul>
Skills &amp; Competencies:<ul><li>
Exceptional attention to detail and accuracy.</li><li>
Analytical Skills.</li><li>
Strong organizational skills.</li><li>
Strong written and verbal communication skills.</li><li>
Provider Education skills.</li><li>
Demonstrated ability to use technology and applications required for virtual teams.</li><li>
Ability to analyze data, identify trends, and recommend solutions.</li><li>
Knowledge of HIPAA, OIG, and other compliance regulations.</li><li>
Ability to work independently and manage multiple priorities.</li><li>
Performance Metrics</li>
Audit accuracy rate (goal<li> 95%).</li><li>
Timeliness of audit completion/productivity</li><li>
Provider and coder education effectiveness (measured by post-education improvement).</li><li>
Compliance with CMS and ICD-10-CM guidelines.</li></ul></div>

Medical Coding and Billing Compliance Auditor, Remote

EXL Service

<div>Job Description: Are you a skilled Outpatient Auditor with deep expertise in infusion services, complex surgeries, interventional radiology, and hospital-based outpatient care? Do you bring a strong commitment to coding accuracy, regulatory compliance, and appropriate reimbursement? If so, EXL Health is excited to welcome you to our remote auditing team!
As a Remote Certified Outpatient Auditor , you&rsquo;ll apply your in‑depth knowledge of CPT coding, outpatient regulatory guidelines, and APC reimbursement to review outpatient claims across a variety of clinical specialties. Your work will support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring adherence to industry standards.
This role is fully remote , with up to 10% annual travel for team meetings and occasional client onsite engagements.</div>
 <div><ul><li>Responsibilities: Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB‑04 facility coding requirements.
</li><li>Ensure accurate documentation and coding of technical components such as nursing services, equipment use, and place of service.
</li><li>Verify that facility charges and resource utilization are coded correctly and independently from provider claims.
</li><li>Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines.
</li><li>Review CPT, APC, to validate correct reporting and reimbursement.
</li><li>Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance to support compliance.
</li><li>Identify overpayments, coding discrepancies, and missed reimbursement opportunities.
</li><li>Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary platforms to analyze and process claims.
</li><li>Produce clear and concise audit findings aligned with official coding rules.
</li><li>Stay current on outpatient regulatory changes, reimbursement updates, and clinical practice trends across infusion, surgery, and radiology.
</li><li>Meet or exceed EXL productivity, quality, and compliance standards.</li></ul></div>
 <div>Qualifications: Required
<ul><li>Active credential(s) such as:
<ul><li>CCS
</li><li>RHIA
</li><li>RHIT
</li><li>CPC
</li><li>(Multiple credentials preferred)
</li></ul></li><li>Minimum 3 years of outpatient hospital and professional coding/auditing experience, including infusion, surgical, and interventional radiology cases.
</li><li>Strong understanding of CPT coding, APC reimbursement methodologies, and official coding guidelines.
</li><li>Familiarity with payer contracts and claim adjudication processes.
</li></ul>Preferred
<ul><li>Experience auditing complex outpatient surgical and interventional radiology cases.
</li><li>Advanced knowledge of infusion and injection coding regulations.
</li><li>Background in retrospective overpayment identification for hospital and professional claims.
</li><li>Proficiency with encoder tools (3M, Webstrat, Optum).
</li><li>Ability to work independently in a remote environment and manage multiple priorities.
</li><li>Strong written, verbal, and analytical communication skills.
</li><li>Proficiency in Microsoft Excel, Word, OneNote, and general computer applications.
</li></ul>What We Offer
Join a high-performing team at EXL Health committed to accuracy, compliance, and continuous improvement in healthcare auditing.
<ul><li>Collaborative environment: Work with experienced healthcare professionals who value your expertise.
</li><li>Ongoing professional development: Expand your knowledge across multiple specialties and coding domains.
</li><li>Mentorship &amp; career growth: Learn from senior auditors and leaders while advancing your career path.
</li><li>Work-life balance: Enjoy the flexibility of remote work with occasional travel to maintain team connection.
</li></ul>Your expertise makes a difference.
 
Join EXL Health to build your career, strengthen healthcare compliance, and make an impact across the industry.
Apply today to begin your journey with EXL Health!
Salary Range for this role is $70,000 - $80,000
0-10% travel may be required.
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits</div>

Outpatient Auditor III

Meds Nexus Pvt. Ltd.

<div>
 
 A Medical Billing Auditor is responsible for reviewing medical billing processes to ensure accuracy, compliance, and proper reimbursement. They identify errors, prevent revenue loss, and ensure adherence to healthcare regulations.
 
 
 
 
 
 Job Description:
 
 <ul>
 <li>
 Review and audit medical claims for accuracy and completeness
 </li>
 <li>
 Verify CPT, ICD-10, and HCPCS coding compliance
 </li>
 <li>
 Identify billing errors, fraud risks, or revenue leakage
 </li>
 <li>
 Ensure compliance with payer guidelines and healthcare regulations
 </li>
 <li>
 Analyze denied or rejected claims and suggest corrective actions
 </li>
 <li>
 Provide feedback and training to billing teams
 </li>
 <li>
 Prepare audit reports and maintain documentation
 </li>
 </ul>
 
 
 
 
 Qualification:
 
 <ul>
 <li>
 Strong knowledge of medical billing and coding systems
 </li>
 <li>
 Familiarity with insurance guidelines (Medicare/Medicaid, commercial payers)
 </li>
 <li>
 Attention to detail and analytical thinking
 </li>
 <li>
 Experience with billing software and EHR systems
 </li>
 <li>
 Good communication and reporting skills
 </li>
 </ul>
 
 
 
 
 How to apply:
 
 
 * Send your CV: careers@medsnexus.com
 
 
 * Walk-in interviews are now open &ndash; Apply today!
 
 
 * Location: Office: #1, Top Floor, Gold Mark Plaza, Asghar Mall Scheme, Asghar Mall Road, Rawalpindi
 
 
 
 
 
 Join us where expertise is valued, performance is rewarded, and growth is continuous.
 
 
 If you&rsquo;re experienced in medical billing, RCM, credentialing, or healthcare sales, 𝐌𝐞𝐝𝐬 𝐍𝐞𝐱𝐮𝐬 is the right place for your next career move
 
 
 
 
</div>

Medical Billing Auditor

Confidential

<div>
 
 We are seeking a healthcare professional with a strong medical background to support Fraud, Waste &amp; Abuse (FWA) detection, clinical audit, and Revenue Cycle Management (RCM) activities. The role focuses on identifying billing irregularities, ensuring clinical and coding compliance, optimizing reimbursement, and reducing financial leakage while maintaining regulatory and ethical standards.
 
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 
 
 Fraud, Waste &amp; Abuse (FWA)
 
 
 
 
 <ul>
 <li>
 Identify, investigate, and analyze potential fraud, waste, and abuse related to medical billing, coding, and clinical documentation
 </li>
 <li>
 Conduct pre-payment and post-payment reviews of claims to detect inappropriate utilization or billing patterns
 </li>
 <li>
 Collaborate with internal teams and external stakeholders to resolve FWA cases and recommend corrective actions
 </li>
 <li>
 Prepare detailed FWA investigation reports, findings, and root cause analysis
 </li>
 <li>
 Support implementation of FWA prevention controls and compliance initiatives
 </li>
 </ul>
 
 
 
 
 Audit &amp; Compliance
 
 
 
 
 <ul>
 <li>
 Perform clinical and coding audits (IP, OP, ER, Daycare, Pharmacy, Procedures)
 </li>
 <li>
 Validate compliance with payer contracts, medical necessity guidelines, and regulatory standards
 </li>
 <li>
 Review medical records to ensure accuracy of ICD-10, CPT, HCPCS, DRG, and modifier usage
 </li>
 <li>
 Identify documentation gaps and recommend improvements to providers and coding teams
 </li>
 <li>
 Support internal, external, and regulatory audits
 </li>
 </ul>
 
 
 
 
 Revenue Cycle Management (RCM)
 
 
 
 
 <ul>
 <li>
 Review end-to-end RCM processes, including charge capture, coding, billing, and reimbursement
 </li>
 <li>
 Analyze denials, underpayments, and revenue leakage trends
 </li>
 <li>
 Work closely with billing and coding teams to optimize reimbursement and reduce denials
 </li>
 <li>
 Support payer negotiations and contract compliance reviews
 </li>
 <li>
 Ensure adherence to turnaround times, accuracy benchmarks, and KPIs
 </li>
 </ul>
 
 
 
 
 
 Required Qualifications
 
 
 
 
 
 
 Education
 
 <ul>
 <li>
 Medical background required, such as:
 </li>
 <li>
 MBBS / MD / BDS / BAMS / BHMS
 </li>
 <li>
 B.Sc. Nursing / Allied Health Sciences
 </li>
 <li>
 Additional certification in Medical Coding, Auditing, or Compliance is preferred
 </li>
 </ul>
 
 Experience
 
 <ul>
 <li>
 3&ndash;8+ years of experience in FWA, Medical Audit, or RCM
 </li>
 <li>
 Strong exposure to health insurance, TPA, hospital, or payer environment
 </li>
 <li>
 Hands-on experience reviewing medical records and claims
 </li>
 </ul>
 
 Skills &amp; Competencies
 
 <ul>
 <li>
 Strong knowledge of clinical workflows, medical necessity, and treatment protocols
 </li>
 <li>
 Proficiency in ICD-10, CPT, HCPCS, DRG, and payer guidelines
 </li>
 <li>
 Analytical skills with the ability to detect abnormal billing patterns
 </li>
 <li>
 Excellent documentation, reporting, and communication skills
 </li>
 <li>
 High ethical standards and attention to detail
 </li>
 </ul>
 
 Preferred Certifications (Optional)
 
 <ul>
 <li>
 Certified Professional Medical Auditor (CPMA)
 </li>
 <li>
 Certified Professional Coder (CPC / CCS)
 </li>
 <li>
 Certified in Healthcare Compliance (CHC)
 </li>
 <li>
 CFE (Certified Fraud Examiner) &ndash; advantage
 </li>
 </ul>
 
 Key Attributes
 
 <ul>
 <li>
 Strong clinical judgment
 </li>
 <li>
 Investigative mindset
 </li>
 <li>
 Detail-oriented and compliance-focused
 </li>
 <li>
 Ability to work independently and cross-functionally
 </li>
 </ul>
 
 
</div>

Revenue Cycle Manager

Alignment Healthcare

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
This is a remote position. 
The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of opportunity for improvement (training, data integrity, chart reviews).
GENERAL DUTIES/RESPONSIBILITIES: 
1. Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding &amp; abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality &amp; performance improvement standards are maintained, achieved &amp; improved per department policies and procedures. 
2. Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS. 
3. Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS. This work may encompass reviews of data for reconciliation, data flow integrity, UAT testing, high cost / low risk score members, retrospective chart reviews, or other risk adjustment related data review as directed by Manager. 
4. Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff, documentation improvement, and system / process improvement. 
5. Utilizes, protects, and discloses Alignment Healthcare patients&rsquo; protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. 
6. Ensures compliance with all applicable federal, state &amp;local regulations, as well as with institutional/organizational standards, practices, policies &amp; procedures.
7. Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies. Stay current of industry coding, compliance, and HCC issues. Required to maintain relevant continuing education units (CEUs) in relation to individual coding certifications. 
8. Other duties as assigned to meet the organization&rsquo;s needs.
Job Requirements:
Experience:<ul><li>Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required</li><li>Preferred:</li></ul>
Education:<ul><li>Required: High School Diploma or GED. Completion of a Medical Coding training program.</li><li>Preferred: Bachelor&rsquo;s degree in Business Administration, health Care Management or in a related field</li></ul>
Training:<ul><li>Required: Technical School or courses that are required to become a certified coder.</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Knowledge of</li><li>
Proficient user in MS office suite &ndash; Excel, Word, Outlook</li><li>
Previous use of Epic, Allscripts, EZCap</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul>
Licensure:<ul><li>Required: Certified Coder required, CCS, CCS-P, CPC, or CRC</li></ul>
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $64,384.00 - $96,577.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

MRA Coding Auditor - Remote

CodaMetrix

<div>CodaMetrix is revolutionizing Revenue Cycle Management with its AI-powered autonomous coding solution, a multi-specialty AI-platform that translates clinical information into accurate sets of medical codes. CodaMetrix&rsquo;s autonomous coding drives efficiency under fee-for-service and value-based care models and supports improved patient care. We are passionate about getting physicians and healthcare providers away from the keyboard and back to clinical care.<h3 class="jobSectionHeader">
Overview</h3>
Reporting to the Manager, Medical Coding &amp; Audit, as a Medical Coder II or III, this role will be a key member of the team responsible for ensuring that CodaMetrix meets&mdash;and exceeds&mdash;our customers&rsquo; coding quality expectations.
The Medical Coder II or III will be responsible for leveraging their strong background in coding, billing, and auditing across service lines to review, analyze, and enhance coding processes, both internally and externally. They will play a pivotal role in improving the quality and efficiency of coding operations by collaborating closely with cross-functional teams, including Machine Learning, Product, and Customer Implementations. They will also review and validate model-generated codes, annotate and label data to support model training, identify patterns in coding errors, and provide clear explanations and insights to both internal teams and external clients.
This role requires a proven ability to communicate highly complex coding issues and solutions to a wide range of stakeholders, alongside an unwavering commitment to continuous learning, quality, and innovation in medical coding practices.
Key Responsibilities<ul><li>
Coding &amp; Documentation review<ul><li>
Serve as the internal and external Subject Matter Expert (SME) on medical coding and billing across assigned service lines.</li><li>
Review and validate model-generated CPT, ICD-10-CM, HCPCS, and E&amp;M codes</li><li>
Perform high-quality coding and auditing on inpatient, outpatient, ED, or pro-fee encounters (depending on specialty)</li><li>
Ensure documentation fully supports coding decisions in alignment with AMA, CMS, and payer guidelines</li><li>
Identify missed codes, incorrect E/M leveling, modifier errors, and insufficient documentation</li></ul></li><li>
Customer &amp; Workflow Analysis<ul><li>
Analyze and document customers&rsquo; coding practices and workflows to facilitate optimal use of the CodaMetrix product.</li><li>
Identify and share Codametrix&rsquo;s best practices for coding automation and workflow improvements with the customer.</li><li>
Present audit results to customer stakeholders and facilitate sign-off for go-live milestones.</li></ul></li><li>
Coding Quality Management<ul><li>
Assist manager with Coding Quality Assessment (CQA) projects, including work assignments, training, and quality assurance for offshore coding staff.</li><li>
Leverage CodaMetrix coding standards to drive world-class coding quality and consistency.</li></ul></li><li>
Collaboration &amp; Knowledge Sharing<ul><li>
Work with product and engineering to provide precise, consistent feedback on model training and data annotation</li><li>
Continuously improve evaluation and training materials on coding and billing to colleagues and customers.</li><li>
Share knowledge throughout CodaMetrix to build internal competencies and champion continuous improvement initiatives.</li><li>
Provide expert guidance on coding and billing questions to support Machine Learning and Product teams.</li></ul></li><li>
Compliance &amp; Professional Development<ul><li>
Proactively stay up to date with changes in medical coding and billing by maintaining relevant certifications and participating in ongoing education.</li><li>
Uphold all legal and ethical requirements, ensuring accuracy, confidentiality, and compliance in all coding and audit activities.</li></ul></li><li>
Customer Communication<ul><li>
Help explain model decisions, error analyses, and coding rationales to clients</li><li>
Support customer success and implementation teams in understanding coding outputs</li><li>
Prepare clear written summaries of coding patterns, documentation issues, or model behavior</li><li>
Represent coding accuracy and detail in client conversations, as needed</li><li>
Collaborate with cross-functional teams&mdash;such as Data Science, Product, and Customer Success&mdash;to address client needs and optimize results.</li></ul></li></ul>
Qualifications &amp; Experience<ul><li>
Current AHIMA or AAPC coding credential held for 3+ (level II) or 5+ years (level III).</li><li>
3-5 (level II) or 5+ years (level III) of coding and auditing experience with progressive growth in responsibilities.</li><li>
Strong understanding of CPT, ICD-10-CM, HCPCS, modifiers, and 2023 E/M guidelines</li><li>
Experience in one of the following specialties: Professional hospital coding; specifically in Surgery, Endoscopy, Hospitalist, Cardiology, Emergency coding</li><li>
Demonstrated ability to interpret clinical documentation and identify gaps</li><li>
Excellent communication and customer service skills, capable of effectively engaging executives, directors, data scientists, and other stakeholders with varying levels of coding knowledge.</li><li>
Ability to translate complex coding guidelines to non-clinical team members.</li><li>
Strong organizational and detail-oriented approach with a demonstrated commitment to excellence and precision.</li><li>
Critical thinking, intellectual curiosity, and creativity in problem-solving.</li><li>
Ability to thrive under time constraints in a fast-paced environment.</li><li>
Team-oriented approach with a positive and patient demeanor, fostering collaboration and continuous improvement.</li></ul>
Bonus Points<ul><li>
Experience in Radiology or Pathology</li><li>
Prior experience with ML/AI workflows</li><li>
Experience working with JIRA or other project management/ task management tools</li><li>
Familiarity with autonomous coding platforms</li><li>
Experience serving large health systems from a services or technology perspective</li></ul>
What CodaMetrix can offer you:
Learn more about our full-time employee benefits and how we take care of our team.<ul><li>
Health Insurance: We cover 80% of the cost of medical and dental insurance and offer vision insurance</li><li>
Retirement: We offer a 401(k) plan that eligible employees can contribute to one month after their first day</li><li>
Flexibility: We have a generous Paid Time Off policy, which is managed but not limited, so you can take the time you need to relax and rejuvenate</li><li>
Learning: All new hires complete our 7-week Onboarding Program where they learn about our company and each of our departments through live sessions hosted by a variety of our leaders</li><li>
Development: We provide annual performance evaluations and prioritize working with employees on what their individual growth looks like</li><li>
Recognition: We recognize the outstanding achievements of our team through annual company awards where employees have the opportunity to nominate their peers</li><li>
Office Location: A modern open plan workspace located in the bustling Back Bay neighborhood of Boston</li><li>
Additional Employer Paid Benefits: We offer employer-paid life insurance and short-term and long-term disability insurance</li></ul>
Background Check Notice
All candidates will be required to complete a background check upon acceptance of a job offer.
Equal Employment Opportunity
Our company, as well as our products, are made better because we embrace diverse skills, perspectives, and ideas. CodaMetrix is an Equal Employment Opportunity Employer and all qualified applicants will receive consideration for employment.
Don&rsquo;t meet every requirement? We invite you to apply anyway. Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At CodaMetrix we are committed to building a diverse, inclusive and authentic workplace and encourage you to consider joining us.
Compensation Range: $75K - $115K</div>

Medical Coder II/III

Oregon Health & Science University

<div>Department Overview:

The Coding Trainer is responsible for constructing and implementing coding training programs for coding specialists. Creates presentations, develops learning material, handbooks and other training materials as needed. Conducts regular audits to ensure understanding and retention of basic and advanced coding concepts. Represents Enterprise Coding as coding expert in specialty projects.
Function/Duties of Position:
<ul><li>Trains and instructs coders on CPT, Diagnosis, modifiers, CCI edits and documentation requirements as appropriate regarding all industry standards for each clinical department across OHSU.</li><li>
Reviews, develops, modifies, and/or adapts relevant training materials, presentations and curriculum.</li><li>
Audits medical record documentation to identify under-coded and up-coded services; prepares reports of findings and meets with coders and leadership to provide education and training on accurate coding practices and compliance issues both for coders currently in training and ongoing audits for all coders.</li><li>
Leads cross training efforts for coders learning new subspecialties.</li><li>
Review and respond in a timely manner to trainee questions and offer support.</li><li>
Regularly communicates status of ongoing training projects as well as outcomes and challenges to leadership.</li><li>
Provides second-level review of documentation and coding for difficult/advanced services to ensure accurate and compliant charge submission.</li><li>
Participates in process improvement through identification of provider or coder trends (documentation and coding) as well as workflow evaluations.</li><li>
Provides coding audits and detailed assessments for annual performance appraisals.</li><li>
Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.</li><li>
Presents findings and material to the coding department to ensure ongoing education and compliance of all coders in Enterprise Coding.</li><li>
Meets/communicates with Provider Educators to ensure that education is uniform and consistent for both providers and coders for any given area.</li><li>
Assists Leads with coding e-mail queries for difficult scenarios.</li><li>
Researches, analyzes, and responds to inquiries for challenging coding scenarios regarding compliance, inappropriate coding, denials, and billable services.</li><li>
Participates in recruitment process including evaluation of resumes, interviews and correction/analysis of coding assessment test.</li><li>
Meets with the Coding &amp; Compliance department as needed to discuss concerns, make plans for processes/procedures.</li><li>
Participates in required huddles with leadership team to communicate ongoing training needs.</li><li>
Participates in advisory team meetings to discuss coding guidelines and best practices for consistent coding across Depts/Service Areas.</li><li>
Other duties as assigned.</li></ul>
Required Qualifications:
<ul><li>
Associates degree in Healthcare, Business or related field plus 5 years of production coding experience; OR
</li><li>Equivalent combination of education and experience.</li><li>
Detailed knowledge of medical coding systems, procedures, and documentation requirements.</li><li>
Knowledge of auditing concepts and principles.</li><li>
Certification in CPC, CPC-H, RHIT, or RHIA.</li></ul>
Preferred Qualifications:
<ul><li>Completed coding education and certification from an accredited institution such as AHIMA or AAPC (CPC, CPC-H, RHIT, RHIA).</li><li>
Solid understanding of 2023 E/M guidelines.</li><li>
Specialty coding experience in a variety of specialties including but not limited to, OB/GYN, GI, ENT, Pulmonary, Endocrinology, Pediatric Medicine, Hospitalists and Telemedicine.</li><li>
Ability to analyze and solve problems.</li><li>
Ability to develop and implement a training plan.</li><li>
Excellent oral, written, communication, and analytical skills.</li><li>
Ability to use independent judgment and to manage and impart confidential information.</li><li>
Ability to set priorities and meet deadlines.</li><li>
Strong communication and interpersonal skills.</li><li>
Knowledge of legal, regulatory, and policy compliance issues related to medical coding procedures and documentation.</li><li>
Knowledge of current and developing issues and trends in medical coding procedures requirements.</li></ul>
Additional Details:

Benefits<ul><li>
Healthcare for full-time employees covered 100% and 88% for dependents.</li><li>
$50K of term life insurance provided at no cost to the employee.</li><li>
Two separate above market pension plans to choose from.</li><li>
Vacation - up to 200 hours per year dependent on length of service.</li><li>
Sick Leave - up to 96 hours per year.</li><li>
9 paid holidays per year.</li><li>
Substantial Tri-Met and C-Tran discounts.</li><li>
Employee Assistance Program.</li><li>
Childcare service discounts.</li><li>
Tuition reimbursement.</li><li>
Employee discounts to local and national businesses.</li></ul>
Why apply to OHSU?: We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu</div>

Coding Auditor/Trainer (Coding Coordinator)

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