Coding Quality Auditor

Accountabilities

• Review Diagnosis Related Group (DRG) assignments for selected Medicare and Medicaid inpatient cases, including Hospital-Acquired Conditions (HACs), Patient Safety Indicators (PSIs), target diagnoses, mortality cases, and dual diagnoses, to support accurate reimbursement, research, statistics, and regulatory compliance.

• Review and resolve coding-related edits, including nosology, Exihauser, PSI, HAC, and other quality indicator requirements.

• Analyze physician documentation in medical records to establish clinical correlation and coding accuracy, and query physicians when documentation is inadequate, ambiguous, unclear, or does not support straightforward code assignment.

• Provide guidance and education to inpatient coders regarding review findings, coding changes, applicable coding clinics, and official coding guidelines.

• Apply appropriate reason, tracking codes, and rationale in the 3M coding system when required for DRG mismatches identified in Clinical Documentation Improvement-reviewed cases.

• Provide guidance and educational input to Clinical Documentation Specialists regarding coding guidelines, documentation requirements, and applicable coding clinics.

• Perform monthly data analysis and statistical reporting related to DRGs, public reporting, and HAC compliance, and present findings to appropriate compliance leadership.

• Identify documentation improvement opportunities that can support better patient care, coding accuracy, reimbursement, and quality outcomes.

• Apply Present on Admission (POA) indicators to inpatient charts and escalate identified concerns to the appropriate supervisor or department manager.

• Enter diagnosis and procedure codes and abstract relevant chart information into the 3M coding system to support accurate DRG assignments.

• Support education sessions for coding staff and provide feedback to inpatient HIM leadership and coding management.

• Assist with chart completion activities to help meet Discharged Not Final Billed (DNFB) goals.

• Participate in special projects, including internal audits and reviews of contract coding activities, as needed.

• Create spreadsheets, summaries, and reports documenting audit findings and quality trends.

• Participate in coding education and professional development sessions to remain current with evolving standards.

• Assist coding staff with complex cases or other operational needs when required.

• Stay current with coding guidelines, reimbursement reporting requirements, emerging technologies, procedures, and applicable CMS-approved clinical trials.

• Follow official coding guidelines and the Standards of Ethical Coding established by the American Health Information Management Association.

• Perform additional duties and projects as assigned while maintaining applicable organizational standards and professional expectations.

Requirements:

• Hold an associate's degree or higher, or have equivalent coding experience of approximately 2–4 years.

• Bring at least 5 years of inpatient coding experience within a complex healthcare environment.

• Have a minimum of 2 years of experience performing quality improvement audits.

• Demonstrate thorough knowledge of ICD-10 coding and DRG methodologies.

• Possess strong knowledge of clinical coding review processes and data collection requirements.

• Have experience analyzing coding data and supporting quality, reimbursement, and regulatory reporting initiatives.

• Demonstrate strong computer skills, including proficiency with Microsoft Office and Google Workspace or comparable productivity platforms.

• Possess excellent written, verbal, interpersonal, and communication skills.

• Be highly detail-oriented and capable of analyzing complex clinical documentation and coding discrepancies accurately.

• Demonstrate the ability to work independently while collaborating effectively with physicians, coders, clinical documentation specialists, compliance teams, and leadership.

• Hold a Certified Coding Specialist (CCS) certification.

• Be comfortable working a fully remote evening schedule from 11:00 a.m. to 7:30 p.m.

• Be available to work one weekend day every week, either Saturday or Sunday.

Benefits:

• Starting minimum annual salary of $97,011.20 USD.

• Full-time position with benefits.

• 100% remote work arrangement.

• Evening schedule from 11:00 a.m. to 7:30 p.m.

• One weekend day required each week, with no on-call requirement.

• No holiday work required.

• Health, dental, and vision benefits.

• Paid leave.

• Tuition reimbursement.

• Retirement benefits.

• Potential eligibility for performance-based incentives, bonuses, or shift differentials where applicable.

• Opportunity to contribute to inpatient coding quality, documentation improvement, reimbursement accuracy, and healthcare compliance.

• Ongoing exposure to clinical coding standards, quality auditing, data analysis, and evolving healthcare reimbursement requirements.