Inpatient Coding Quality Analyst (Auditor)

Position Summary The Inpatient Coding Quality Analyst (Auditor) serves as an expert validating the accuracy, completeness, and compliance of ICD‑10‑CM/PCS coding, MS‑DRG/APR‑DRG assignment, and inpatient claim quality. This role supports regulatory compliance, reimbursement integrity, audit readiness, and institutional quality performance at a large academic medical center. Key Responsibilities Conduct random and targeted audits of inpatient medical records to verify ICD‑10‑CM/PCS coding and DRG/APR‑DRG assignment. Resolve inpatient claim and coding edits, including medical necessity, DRG validation, and payer‑driven edit frameworks such as NCCI. Support denial mitigation and appeal efforts by validating failed or rejected claims and collaborating with Revenue Cycle teams. Provide actionable recommendations to improve coding accuracy, compliance, and operational workflows. Perform 100% pre‑bill review of inpatient mortality cases and targeted audits for stroke, cardiac device cases, and core measures. Collaborate with CDI, Revenue Cycle, CBO, Compliance, Internal Audit, and clinical stakeholders to reduce DRG downgrade risk and enhance data quality. Educate coding staff through formal sessions, guideline development, and reference materials. Minimum Qualifications Associate degree in Health Information Management, Health Information Technology, or related field. 3–5 years of recent inpatient hospital coding experience in an academic or complex acute‑care setting. Proficiency in ICD‑10‑CM/PCS coding, including principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS‑DRG/APR‑DRG assignment. Experience reviewing complex inpatient records for coding accuracy, compliance, and DRG integrity. Working knowledge of CMS IPPS regulations, OIG compliance, payer audits, and advanced inpatient claim edit frameworks. Experience with EHR and HIM systems for encoding, abstracting, and audit reporting. Strong written and verbal communication skills and ability to provide educational feedback to staff. Preferred Qualifications Bachelor’s degree in Health Information Administration, Health Information Management, or related discipline. Prior experience in inpatient coding quality review, auditing, denial management, or compliance‑focused roles. Experience supporting mortality case review, risk‑adjusted outcome reporting, and quality metrics such as Vizient, USNWR, PSI/HAC. Experience in an academic medical center or multi‑hospital health system. Certification Requirements Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) Certified Coding Specialist (CCS) – AHIMA, maintained in good standing Additional Information Remote location; Regular full‑time position with 40 scheduled hours per week, first shift. Final candidates are subject to successful background check and may require drug screen or physical during the post‑offer process. The university is an equal‑opportunity employer, including veterans and disability. #J-18808-Ljbffr Ohio State University