Coding Auditor

AdventHealth•Orlando, FL

2d•Onsite

About The Position

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. Performs other duties as assigned.

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.
High School Grad or Equiv.
5+ years of acute care inpatient or outpatient hospital coding.
Experience with high complexity cases.
Certified Coding Specialist (CCS) OR Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) OR Certified Professional Coder (CPC) OR Certified Interventional Radiology Cardiovascular Coder (CIRCC).

Nice To Haves

Associates degree.
Experience in coding audits or quality review.

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.
Performs other duties as assigned.