Inpatient Coding Quality Analyst (Auditor)
Remote · United States
Job Summary
The Inpatient Coding Quality Analyst (Auditor) is responsible for validating the accuracy, completeness, and compliance of inpatient ICD‐10‐CM/PCS coding and MS‐DRG/APR‐DRG assignment through targeted audits. The role supports regulatory compliance, reimbursement integrity, data quality, and audit readiness within a complex academic medical center. Responsibilities include conducting pre‐bill and post‐bill audits of high‐risk inpatient cases, resolving coding edits related to medical necessity, DRG validation, and NCCI, and providing actionable feedback to coding staff and CDI/Revenue Cycle partners. The analyst documents audit results, trends, and recommendations, supports denial mitigation and appeals, and serves as a coding quality educator by contributing to guidelines and standard operating procedures. Additional focus includes mortality case review and targeted audits (e.g., stroke, cardiac device cases), and collaboration with cross‐functional teams to improve coding accuracy, compliance, and operational workflows. The position is remote, full‐time (40 hours/week), with background checks and potential post‐offer checks. The role emphasizes proactive quality improvement, audit transparency, and participation in institutional quality metrics and benchmarking (Vizient, USNWR). This role requires advanced knowledge of ICD‐10 coding, DRGs/APR‐DRGs, payer-specific requirements, and ongoing education to maintain coding accuracy and compliance.
Required Qualifications
- Associate degree in Health Information Management, Health Information Technology, or a related field
- Minimum of 3–5 years of recent inpatient hospital coding experience in an academic medical center or complex acute-care hospital setting
- Demonstrated proficiency in ICD-10-CM and ICD-10-PCS coding, including validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS‐DRG/APR‐DRG assignment
- Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity, including high-severity and high-risk cases
- Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and advanced inpatient claim edit frameworks
- Experience using electronic health records (EHRs) and health information management systems, including encoder, abstracting, and audit/reporting applications
- Ability to apply independent judgment in evaluating coding, documentation, compliance risk, and audit findings
- Certification requirements (RHIA, RHIT, or CCS) and ongoing continuing education
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