Coding Quality Auditor

Accountabilities: Review Diagnosis Related Group (DRG) assignments for selected Medicare and Medicaid inpatient cases, including Hospital-Acquired Conditions (HACs), Patient Safety Indicators (PSIs), target diagnoses, mortality cases, and dual diagnoses, to support accurate reimbursement, research, statistics, and regulatory compliance. Review and resolve coding-related edits, including nosology, Exihauser, PSI, HAC, and other quality indicator requirements. Analyze physician documentation in medical records to establish clinical correlation and coding accuracy, and query physicians when documentation is inadequate, ambiguous, unclear, or does not support straightforward code assignment. Provide guidance and education to inpatient coders regarding review findings, coding changes, applicable coding clinics, and official coding guidelines. Apply appropriate reason, tracking codes, and rationale in the 3M coding system when required for DRG mismatches identified in Clinical Documentation Improvement-reviewed cases. Provide guidance and educational input to Clinical Documentation Specialists regarding coding guidelines, documentation requirements, and applicable coding clinics. Perform monthly data analysis and statistical reporting related to DRGs, public reporting, and HAC compliance, and present findings to appropriate compliance leadership. Identify documentation improvement opportunities that can support better patient care, coding accuracy, reimbursement, and quality outcomes. Apply Present on Admission (POA) indicators to inpatient charts and escalate identified concerns to the appropriate supervisor or department manager. Enter diagnosis and procedure codes and abstract relevant chart information into the 3M coding system to support accurate DRG assignments. Support education sessions for coding staff and provide feedback to inpatient HIM leadership and coding management. Assist with chart completion activities to help meet Discharged Not Final Billed (DNFB) goals. Participate in special projects, including internal audits and reviews of contract coding activities, as needed. Create spreadsheets, summaries, and reports documenting audit findings and quality trends. Participate in coding education and professional development sessions to remain current with evolving standards. Assist coding staff with complex cases or other operational needs when required. Stay current with coding guidelines, reimbursement reporting requirements, emerging technologies, procedures, and applicable CMS-approved clinical trials. Follow official coding guidelines and the Standards of Ethical Coding established by the American Health Information Management Association. Perform additional duties and projects as assigned while maintaining applicable organizational standards and professional expectations. Requirements: Hold an associate's degree or higher, or have equivalent coding experience of approximately 2–4 years. Bring at least 5 years of inpatient coding experience within a complex healthcare environment. Have a minimum of 2 years of experience performing quality improvement audits. Demonstrate thorough knowledge of ICD-10 coding and DRG methodologies. Possess strong knowledge of clinical coding review processes and data collection requirements. Have experience analyzing coding data and supporting quality, reimbursement, and regulatory reporting initiatives. Demonstrate strong computer skills, including proficiency with Microsoft Office and Google Workspace or comparable productivity platforms. Possess excellent written, verbal, interpersonal, and communication skills. Be highly detail-oriented and capable of analyzing complex clinical documentation and coding discrepancies accurately. Demonstrate the ability to work independently while collaborating effectively with physicians, coders, clinical documentation specialists, compliance teams, and leadership. Hold a Certified Coding Specialist (CCS) certification. Be comfortable working a fully remote evening schedule from 11:00 a.m. to 7:30 p.m. Be available to work one weekend day every week, either Saturday or Sunday. Benefits: Starting minimum annual salary of $97,011.20 USD. Full-time position with benefits. 100% remote work arrangement. Evening schedule from 11:00 a.m. to 7:30 p.m. One weekend day required each week, with no on-call requirement. No holiday work required. Health, dental, and vision benefits. Paid leave. Tuition reimbursement. Retirement benefits. Potential eligibility for performance-based incentives, bonuses, or shift differentials where applicable. Opportunity to contribute to inpatient coding quality, documentation improvement, reimbursement accuracy, and healthcare compliance. Ongoing exposure to clinical coding standards, quality auditing, data analysis, and evolving healthcare reimbursement requirements.