Auditor Jobs

About The Position

Requirements

• Graduate of an accredited Health Information Management (HIM), Health Information Technology (HIT), Healthcare Administration, Nursing, or related healthcare program, with an associate's degree or higher; or a high school diploma, GED, or equivalent and completion of anatomy and physiology coursework.
• Seven years of acute care inpatient coding experience within a hospital, academic medical center, cancer center, or integrated healthcare system environment.
• Demonstrated experience independently assigning ICD-10-CM and ICD-10-PCS codes for inpatient encounters.
• Demonstrated experience assigning MS-DRGs, APR-DRGs, and other applicable reimbursement classifications.
• Experience conducting coding audits, coding validation reviews, coding quality reviews, coding compliance reviews, or coding education activities.
• Experience evaluating coding accuracy, DRG assignment accuracy, coding compliance, abstracting quality, reimbursement integrity, and coding consistency.
• Experience applying Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and organizational coding standards.
• Experience identifying coding trends, coding risks, compliance concerns, denial opportunities, or reimbursement issues through coding review activities.
• Experience providing feedback, education, coaching, or competency support related to coding quality and coding compliance.

Responsibilities

• Conduct routine, targeted, pre-bill, and retrospective coding audits to evaluate coding accuracy, DRG assignment accuracy, abstraction quality, compliance, reimbursement integrity, and adherence to applicable guidelines, regulations, payer requirements, and organizational standards.
• Review inpatient encounters to validate diagnosis and procedure assignments, abstracting accuracy, reimbursement classifications, and data integrity.
• Evaluate adherence to coding policies, query practices, and regulatory requirements; identify coding opportunities, risks, and compliance concerns.
• Independently validate complex diagnosis and procedure coding, MS-DRG and APR-DRG assignments, quality reporting elements, reimbursement classifications, and abstracted data.
• Monitor coding compliance risk areas, Coding Clinic updates, CMS guidance, payer audit findings, OIG Work Plan priorities, RAC-targeted services, denial trends, and emerging regulatory requirements that may affect coding quality, reimbursement integrity, or compliance.
• Provide recommendations to support regulatory readiness and coding excellence.
• Complete assigned work within established productivity and turnaround time expectations to support candidate-for-bill (CFB), DNFB, revenue cycle, and organizational performance goals.
• Conduct routine and focused audits of coding staff activities to evaluate coding accuracy, consistency, abstraction quality, compliance, and productivity-to-quality balance.
• Prepare audit findings, coding quality reports, scorecards, and recommendations to support continuous improvement and coding consistency.
• Monitor and trend coder-specific quality findings to identify opportunities for coaching, competency development, education, remediation, and performance improvement.

Benefits

• Comprehensive Benefits