• DRG Coding Auditor

    Elevance Health (Woburn, MA)
    …for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ _​_ _This...and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical… more
    Elevance Health (07/22/25)
    - Related Jobs
  • HCC Risk Adjustment Auditor - Full Time…

    Datavant (Boston, MA)
    …adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation into precise codes that reflect the complexity and ... We're Looking For:** As an HCC (Hierarchical Condition Category) Auditor you will review medical records that have been...a diagnosis level + Answer rebuttals entered on the auditor by coders and or auditors + Participate in… more
    Datavant (08/01/25)
    - Related Jobs
  • Coding Auditor Educator

    Highmark Health (Boston, MA)
    …Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier ... Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding… more
    Highmark Health (05/09/25)
    - Related Jobs
  • Compliance Auditor -Per Diem-Day Shift

    Baystate Health (Springfield, MA)
    …the work is administrative. **Job Responsibilities:** **1)** Performs detailed reviews of clinical documentation for provider services using MDAudit based on ... Radiology coding; applicable use of all carrier guidelines and review of clinical documentation . **5)** Receives and screens incoming correspondence, reports,… more
    Baystate Health (06/23/25)
    - Related Jobs
  • Operations Associate Cardiac Monitor Tech, Part…

    Baystate Health (Springfield, MA)
    …all business functions related to processing patient information, managing documentation , organizing patient medical record and facilitating smooth unit operations. ... visitors to unit and also as a business partner to the department and clinical staff. Orients patients and families to the unit, answering routine questions. Able to… more
    Baystate Health (07/30/25)
    - Related Jobs
  • Operations Associate, Full Time Days, No Weekends

    Baystate Health (Springfield, MA)
    …all business functions related to processing patient information, managing documentation , organizing patient medical record and facilitating smooth unit operations. ... also as a business partner to the department and clinical staff. Orients patients and families to the unit,...C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples and Kronos access if… more
    Baystate Health (08/02/25)
    - Related Jobs
  • Auditing & Compliance Director - Software as…

    Wolters Kluwer (Waltham, MA)
    …action (CAPA)plans, with oversight of complaint trending, post-market surveillance, clinical evaluation, design control, and risk management activities. You will ... also work cross functionally within the business teams in Legal, Regulatory, Clinical , Marketing, and Product Development and within the broader Wolters Kluwer… more
    Wolters Kluwer (06/11/25)
    - Related Jobs
  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements ... Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary coding configuration… more
    Commonwealth Care Alliance (05/28/25)
    - Related Jobs