Inpatient Coding Data Quality Auditor/Educator

About The Role

The primary purpose of the Inpatient Coding Data Quality Auditor/Educator is to ensure the consistent processing of claims and collection of data to optimize DRG reimbursement and produce quality data that accurately reflects the severity and intensity of hospital inpatient services. Audits inpatient coded records, provides continuing education of all inpatient coding staff and facilitates the inpatient coding work flow.

Responsibilities

• Performs daily data quality reviews on inpatient records to validate ICD-10 diagnosis and procedure codes
• Ensures accuracy, proper sequencing, and adherence to coding guidelines on all cases
• Reviews cases identified as OIG-focused DRGs, transfer DRGs, and other target areas as needed
• Verifies the accuracy and appropriateness of the selected DRG
• Communicates coding corrections to coders and explains the rationale for educational purposes
• Utilizes audit tracking tools to identify coding error types by coder
• Prepares written rebuttals for DRG reassignments or appeals, when requested
• Provides supporting documentation to third-party payers to ensure compliance and accurate reimbursement
• Utilizes audit tracking tools to identify coding error types by coder
• Prepares written rebuttals for DRG reassignments or appeals, when requested
• Provides supporting documentation to third-party payers to ensure compliance and accurate reimbursement
• Maintains accurate and complete documentation of all coding activities
• Monitors coding staff for potential violations and reports concerns to the Manager
• Continuously evaluates clinical documentation quality
• Identifies incomplete or inconsistent documentation impacting code selection, DRG grouping, and reimbursement
• Escalates documentation concerns as needed

Qualifications

• Bachelor’s degree in Health Information Management or a related field required
• RHIA or RHIT certification preferred
• CCS certification required
• If not CCS certified, must obtain CCS certification from AHIMA within 60 days of hire or within 60 days of the next available exam
• Minimum of 3 years of hospital inpatient coding experience
• Experience with ICD-9 and ICD-10 diagnosis and procedure coding
• Experience with DRG assignment
• Experience in a tertiary care or teaching hospital environment preferred
• Knowledge of complex services including surgical, transplant, trauma, neurosurgery, OB/GYN, and neonatology
• Knowledge of medical terminology, anatomy and physiology, and disease processes required
• Knowledge of Coding Clinic, POA, and query guidelines required
• Knowledge of CMS, Medicaid, and third-party payer coding, billing, and compliance regulations required
• Experience with encoder systems (e.g., Clintegrity 360) preferred
• Experience with Epic electronic health record preferred
• Ability to manage multiple and changing priorities
• Must be detail-oriented, accurate, and organized
• Strong verbal and written communication skills

What We Offer

• Medical & Prescription Drug Coverage
• Dental & Vision Insurance
• Health Savings Account (HSA) & Flexible Spending Account (FSA)
• Short- & Long-Term Disability Insurance
• Pension Plan
• Pet Insurance
• Employee Assistance Program (EAP)
• Professional Development

Compensation

The expected salary range for this position is in accordance with the New Jersey Pay Transparency Law; final compensation will be commensurate with experience and qualifications.