Coding Auditor

About the role

Conducts post-bill coding audits to assess coding accuracy, documentation alignment, and reimbursement integrity across inpatient and/or outpatient service lines.

Performs coding validation activities, including DRG assignment, MCC/CC integrity review, modifier validation, and APC assignment review.

Applies knowledge of IPPS, OPPS, DRG, APC, ICD-10CM/PCS, CPT/HCPCS, modifier usage, and coding guidelines during audit reviews.

Identifies trends related to coding accuracy, documentation quality, service capture, and reimbursement outcomes.

Provides detailed audit findings and feedback to support accuracy improvement and standardization of coding practices.

Collaborate with the education team to translate audit results into targeted education and training initiatives.

Supports onboarding audits and competency validation for new coders.

Reinforces adherence to coding guidelines, regulatory requirements, and enterprise standards.

Participates in development of coding education materials, guidance, and training content based on audit trends.

Tracks and reports on audit outcomes, accuracy rates, and quality trends and performance improvement trends.

Responsibilities

• Conducts post-bill coding audits to assess coding accuracy, documentation alignment, and reimbursement integrity across inpatient and/or outpatient service lines.
• Performs coding validation activities, including DRG assignment, MCC/CC integrity review, modifier validation, and APC assignment review.
• Applies knowledge of IPPS, OPPS, DRG, APC, ICD-10CM/PCS, CPT/HCPCS, modifier usage, and coding guidelines during audit reviews.
• Identifies trends related to coding accuracy, documentation quality, service capture, and reimbursement outcomes.
• Provides detailed audit findings and feedback to support accuracy improvement and standardization of coding practices.
• Collaborate with the education team to translate audit results into targeted education and training initiatives.
• Supports onboarding audits and competency validation for new coders.
• Reinforces adherence to coding guidelines, regulatory requirements, and enterprise standards.
• Participates in development of coding education materials, guidance, and training content based on audit trends.
• Tracks and reports on audit outcomes, accuracy rates, and quality trends and performance improvement trends.

Requirements

• Proficient experience with EMR and CAC systems (Epic and Optum preferred).
• Strong knowledge of ICD-10-CM/PCS, and/or CPT/HCPCS coding, modifier usage and reimbursement methodologies.
• Understanding of DRG/IPPS and/or OPPS/APC reimbursement systems and coding requirements.
• Ability to perform coding audits and identify accuracy, compliance, and reimbursement trends.
• Ability to translate audit findings into clear, actionable feedback and education.
• Knowledge of coding guidelines and CMS regulatory requirements.
• Strong analytical and problem-solving skills.
• Effective communication and collaboration skills.
• Ability to manage time and meet deadlines.

Qualifications

• High School Grad or Equiv.
• Associates degree (Preferred).
• Field Of Study: Healthcare related discipline.
• 5+ years of acute care inpatient or outpatient hospital coding.
• Experience with high complexity cases.
• Experience in coding audits or quality review (Preferred).

Skills

• Certified Coding Specialist (CCS) [Required]
• Registered Health Information Administrator (RHIA) [Required]
• Registered Health Information Technician (RHIT) [Required]
• Certified Professional Coder (CPC) [Required]
• Certified Interventional Radiology Cardiovascular Coder (CIRCC) [Required]

Benefits

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule

Schedule: Full time

Pay

Pay Range: $26.29 - $48.91