Coding Quality Auditor

Texas Children's Hospital•Bellaire, TX

About The Position

This role is responsible for conducting internal coding quality reviews to ensure compliance with official coding guidelines for hospital coding. The auditor will apply ethical coding principles (CMS, AMA, CPT, ICD-10-CM), HCC coding standards, and revenue cycle knowledge to assess coding accuracy and billing integrity. A key responsibility includes reviewing and auditing post-billed inpatient charts to ensure accurate ICD-10 and ICD-10-PCS coding that reflects documentation, patient acuity, and the level of care provided. The position also involves recognizing and reviewing patterns with Clinical Documentation Improvement Specialists (CDIs) for provider education, identifying coding trends based on payer denials, rejections, and claim edits, and presenting audit findings bi-monthly to the team with educational components. The auditor will also review work completed by coders, returning it with education if errors are found, and ensure completion of required continuing education units (CEUs) for current certification. Additionally, the role includes identifying and reporting incorrect admit/discharge dates and patient types to the appropriate departments, and covering open work queues as needed, especially during end-of-month pushes or at the request of supervisors or managers.

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