Coding Quality Auditor
About The Position
The Coding Quality Auditor provides internal coding quality reviews to ensure compliance with official coding guidelines for hospital coding. This role applies ethical coding principles (CMS, AMA, CPT, ICD-10-CM), HCC coding standards, and revenue cycle knowledge to assess coding accuracy and billing integrity. The auditor reviews and audits post-billed inpatient charts to ensure that the ICD-10 and ICD-10-PCS codes accurately reflect the documentation, patient acuity, and level of care provided for the specific admission. They recognize and review patterns with the CDIs for provider education, identify coding trends based on payer denials, rejections, and claim edits, and present audit findings bi-monthly to the team, educating them based on these findings. The auditor reviews work completed by the coder and, if the coder is in error, returns it with education to complete. They are responsible for obtaining required CEUs for current certification and completing required education. Additionally, the auditor identifies incorrect admit/discharge dates and patient types and sends them to the appropriate department for updates. They also cover open work queues (WQs) during end-of-month pushes or when requested by a supervisor or manager.
Requirements
- High school diploma/GED required
- RHIA – Cert – Reg Health Info Admin or RHIT – Cert – Reg Health Info Tech by American Health Information Management Association (AHIMA) required
- CPC – Certified Professional Coder by American Academy of Professional Coders (AAPC) required
- 5 years of DRG coding, professional billing or hospital billing experience required
Nice To Haves
- CPMA – Cert – Professional Medical Auditor by American Academy of Professional Coders (AAPC) preferred
- 1 year of auditing IP experience preferred
Responsibilities
- Provides internal coding quality reviews to ensure compliance with official coding guidelines for hospital coding
- Applies ethical coding principles (CMS, AMA, CPT, ICD-10-CM), HCC coding standards, and revenue cycle knowledge to assess coding accuracy and billing integrity
- Reviews and audits post-billed inpatient charts to ensure that the ICD-10 and ICD-10-PCS codes accurately reflect the documentation, patient acuity and level of care provided for the specific admission
- Recognizes and reviews patterns with the CDIs for provider education
- Identifies coding trends based on payer denials, rejections, and claim edits
- Presents audit findings bi-monthly to the team and educates the team based on findings
- Reviews work completed by the coder, and if the coder is in error, returns to the coder with education to complete
- Obtains required number of CEUs for current certification and completes required education
- Identifies incorrect admit/discharge dates and patient type and sends to the appropriate department to update
- Covers any open work queues (WQs) during end of month push or when a supervisor or manager requests
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
