Top 1387 Certified Medical Coder Jobs

SIU Code Auditor
Fallon Health —Worcester, MA
- $87,500 a year
- Full-time
- Writing skills
- Mid-level
- 3 years
Certified Medical Coder/Biller
Precision Vein & Vascular LLC —Salt Lake City, UT
- $24 - $30 an hour
- Full-time
- Background check
- Mid-level
- Organizational skills
- Health insurance
- Dental insurance
Quick Apply
Senior Medical Coding Specialist
Choices Women's Medical Center —Jamaica, NY
- From $85,000 a year
- Part-time
- Surgery
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Quick Apply
Coder Abstractor Certified
St. Joseph's Health —New Jersey
- $30.88 - $47.86 an hour
- Part-time
- Mid-level
- Analysis skills
- Children
- 403(b) matching
- Paid holidays
Outpatient Coding Manager
Choices Women's Medical Center —Jamaica, NY
- From $85,000 a year
- Part-time
- Management
- Surgery
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Certified Coder
Jefferson City Medical Group (JCMG) —Remote
- $20.56 - $25.19 an hour
- Full-time
- Remote
- Customer service
- Computer literacy
- Mid-level
- Profit sharing
- Paid holidays
Quick Apply
3d
Medical Coder
MedHQ, LLC —Remote
- Full-time
- Mid-level
- Analysis skills
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
Medical Oncology Coder
Managed Resources, Inc (MRI) —Remote
- $28 - $32 an hour
- Part-time
- Remote
- Microsoft Word
- 5 years
- HIPAA
- Paid holidays
- Health insurance
Orthopedics Coder
Managed Resources, Inc (MRI) —Remote
- $28 - $32 an hour
- Part-time
- Remote
- 5 years
- Research
- Mid-level
- Paid holidays
- Health insurance
Certified Coder
Toney HealthCare Consulting, LLC —Remote
- From $50 an hour
- Full-time
- Remote
- 5 years
- HIPAA
- Analysis skills
- Health insurance
Quick Apply
Certified Professional Coder
OpTech LLC —East Hartford, CT
- $25 - $27 an hour
- Full-time
- Hybrid work
- Anatomy knowledge
- Research
- Mid-level
Quick Apply
6d
Inpatient Coding Specialist - FT - SIGN ON BONUS ELIGIBLE
e4health —Remote
- From $35 an hour
- Full-time
- Remote
- Mid-level
- US work authorization
- Organizational skills
- Disability insurance
- Health insurance
Quick Apply
Medical Coder 3
Iannarino Fullen Group —Columbus, OH
- $24.75 an hour
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
3d
Certified Coder (PRN)
Jefferson City Medical Group (JCMG) —Remote
- $20.56 - $25.19 an hour
- Seasonal
- Remote
- Customer service
- Computer literacy
- Mid-level
Quick Apply
PRN Professional Fee Coder
Santiam Hospital & Clinics —Remote
- $22.59 - $33.47 an hour
- PRN
- Hybrid work
- Customer service
- HIPAA
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Coder Professional-3
Sarah Bush Lincoln Health Systems —Illinois
- $22.72 - $35.22 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
Certified Outpatient Medical Coder - Remote (AZ, CA, CO, FL, GA, IL, LA, MI, NH, NM only)
MT. GRAHAM REGIONAL MEDICAL CENTER INC. —Remote
- $22.00 - $29.58 an hour
- Full-time
- Remote
- 18 years or older
- Anatomy knowledge
- Bachelor of Science
Quick Apply
DRG Clinical Validation Nurse
MedReview —Remote
- $85,000 - $95,000 a year
- Full-time
- Remote
- Anatomy knowledge
- RN License
- Computer literacy
- Commuter assistance
- Health insurance
Quick Apply
Coding Specialist
Infinx —Remote
- $25 - $30 an hour
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Quick Apply
Medical Coding Specialist - Profee Surgery Coder
MedHQ, LLC —Remote
- Full-time
- Surgery
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply

I want to receive the latest job alert for Certified Medical Coder

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Certified Medical Coder jobs near

SIU Code Auditor

Fallon Health -
Worcester, MA

Apply Now

Job Details

Full-time
$87,500 a year

Qualifications

Health insurance knowledge
Centers for Medicare & Medicaid Services (CMS) billing regulations

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services, and may include some behavioral health care services to identify potential over-payments and suspected fraud waste and abuse. Serve as a clinical and code liaison for fraud, waste and abuse team while identifying areas of vulnerability and risk.

Responsibilities:

Primary Job Responsibilities (include duties that represent 5% or more of employee's time)

The Internal Audit Department (IA) at Fallon Health serves as the company’s designated Special Investigation Unit (SIU) for fraud, waste, and abuse (FWA) activity. The department reports administratively to the Chief Compliance Officer and functionally to the Audit & Compliance Committee, and it plays a central role in detecting, reviewing, and addressing potential fraud, waste, and abuse.

In this role, the SIU Code Auditor is responsible for reviewing medical records, identifying coding and billing concerns, supporting investigations, and communicating findings and recommendations to internal and external stakeholders. This also includes tracking of cases assigned and maintaining documentation to department standards and assisting with reports due to both internal and external partners.

Coding and audit review: Perform detailed reviews and audits of medical records to verify the accuracy of coding and charges for services provided. Review provider documentation and professional services using ICD-10, CPT, HCPCS, and applicable federal, state, local, payer, Medicare, Medicaid, LCD, NCD, and internal policy requirements.
Investigative support: Review clinical and coding investigative summaries, including those prepared by external parties, to support findings of potential fraud, waste, or abuse. Provide feedback and recommendations to investigators and management.
Pattern and risk identification: Identify aberrant billing patterns, trends, and indicators of fraud, waste, or abuse. Recommend providers for further review, conduct root cause analysis as needed, and suggest process or program improvements to leadership.
Provider and stakeholder collaboration: Meet with providers to discuss audit findings and improvement opportunities. Work closely with clinical teams, coding teams, Medical Directors, external partners, and providers to support accurate billing and effective case resolution.
Reporting, education, and regulatory support: Assist with claim denial reporting, respond to regulatory agency complaints, support required fraud reporting to state and federal agencies, and recommend to members, providers, or employee education based on findings.
Case management and professional standards: Manage daily case review assignments with a strong emphasis on quality, provide regular updates to department leadership and senior management, maintain current knowledge of coding guidelines related to professional services, and perform other duties as assigned.
Core work style expectations: Communicate effectively in writing and verbally, demonstrate strong listening skills, work independently, and consistently meet deadlines.
Reports and Metrics: Communicate results to the team and help maintain and update key departmental reports and metrics.
Administrative Functions: Perform administrative tasks that support daily operations, case tracking, documentation, and overall departmental workflow; including incoming and outgoing emails.

Qualifications:

Education

Bachelor’s degree preferred or equivalent experience, and prior experience in healthcare

License/Certifications

Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) is required. Clinical Experience is preferred.

Certified Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA) are a plus.

Experience:

3-4 years of relevant experience.
Demonstrated proficiency in medical record audits and analysis and ICD-10CM/CPT coding methodology, HCPCS Coding systems and guidelines and knowledge and understanding of medical terminology.
Knowledge of billing and other coding edits, as well as Centers for Medicare and Medicaid Services (CMS) local and national coverage determinations, and managed billing regulations.
Strong quantitative, analytical, interpersonal, written and communication skills
Understanding in fraud, waste abuse regulations, or any combination of education and experience, which would provide an equivalent background

,,Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $87,500 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

#P01

Apply Now

Refine Your Search

Certified Medical Coder jobs

SIU Code Auditor

Certified Medical Coder/Biller

Senior Medical Coding Specialist

Coder Abstractor Certified

Outpatient Coding Manager

Certified Coder

Medical Coder

Medical Oncology Coder

Orthopedics Coder

Certified Coder

Certified Professional Coder

Inpatient Coding Specialist - FT - SIGN ON BONUS ELIGIBLE

Medical Coder 3

Certified Coder (PRN)

PRN Professional Fee Coder

Coder Professional-3

Certified Outpatient Medical Coder - Remote (AZ, CA, CO, FL, GA, IL, LA, MI, NH, NM only)

DRG Clinical Validation Nurse

Coding Specialist

Medical Coding Specialist - Profee Surgery Coder

I want to receive the latest job alert for Certified Medical Coder

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected