2 audit specialist jobs found

Coding Quality Review Specialist (CQR) Location: Nashville, TN (Remote / Work From Home) Employment Type: Full-Time Why This Role Is a Great Opportunity Fully remote position with a stable, full-time schedule Work on high-impact quality initiatives across multiple hospital systems Competitive compensation based on experience Join a nationally recognized healthcare revenue cycle environment Role Overview Perform internal quality reviews for inpatient and outpatient coding teams Ensure accurate, compliant coding aligned with national guidelines and internal policies Support reimbursement integrity and clinical data accuracy across hospital settings Key Responsibilities Conduct routine, pre-bill, policy-driven, and incentive-based quality audits Review inpatient MS-DRG medical records across all body systems Perform quality reviews for both inpatient and outpatient hospital coding Ensure coder adherence...

Company : Highmark Inc. Job Description : JOB SUMMARY This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including...