Coding Quality Review Specialist - CQRS 25-34030

NavitasPartners • Nashville, TN

1d • $42 • Remote

About The Position

A healthcare services organization is seeking an experienced Coding Quality Review Specialist to support remote Health Information Management operations. This role is responsible for performing internal quality assessment reviews for inpatient and outpatient coding to ensure compliance with national coding standards, organizational policies, reimbursement accuracy, and data integrity. The ideal candidate will possess advanced coding audit expertise, strong MS-DRG auditing experience, and comprehensive knowledge across multiple medical specialties and body systems.

Requirements

• Undergraduate degree in HIM/HIT preferred (Associate’s or Bachelor’s degree)
• CCS, RHIA, or RHIT certification required
• IP Coding Auditor experience for MS-DRG required
• Minimum 3 years of hands-on MS-DRG auditing experience in a hospital setting required
• Extensive coding experience preferred, ideally 10+ years in inpatient coding and auditing
• Experience across all body systems required; specialty-only coding backgrounds will not be considered
• Physician coding experience alone will not qualify
• Mandatory 1-hour job shadow required during hiring process
• Strong understanding of inpatient coding guidelines and reimbursement methodologies
• Excellent analytical, auditing, and documentation review skills
• Ability to work independently in a remote environment
• Strong communication and collaboration skills
• High attention to detail and commitment to coding accuracy

Responsibilities

• Perform internal coding quality reviews for inpatient and outpatient medical records
• Ensure compliance with national coding guidelines and organizational coding policies
• Conduct routine, pre-bill, policy-driven, and incentive-driven coding reviews
• Evaluate coding accuracy, completeness, and reimbursement integrity
• Support coding staff adherence to coding standards and quality expectations
• Participate in special projects, audits, and process improvement initiatives
• Maintain productivity and accuracy standards of 95% or greater
• Provide feedback and education to coding professionals as needed
• Demonstrate expert-level knowledge of medical coding and MS-DRG auditing practices

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree