Inpatient/Outpatient Coding Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Inpatient/Outpatient Coding Auditor based in the United States. This fully remote role supports healthcare coding quality across multiple medical facilities within a large regional health network. You will independently audit inpatient and outpatient records for coding accuracy, documentation support, compliance, and reimbursement impact. The position combines detailed record review with reporting, quality improvement, and facility-specific education. You will evaluate complex coding across diagnoses, procedures, modifiers, DRGs, bundling rules, and reimbursement requirements. The role offers an opportunity to apply advanced coding expertise in a structured, regulated healthcare environment. You will collaborate with health information management leadership and facility stakeholders while maintaining high standards for accuracy and confidentiality. The assignment is remote within the United States and is contingent upon contract award. Accountabilities - Independently audit inpatient and outpatient facility coding for accuracy, documentation support, regulatory compliance, and reimbursement impact. - Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, evaluation and management, modifier, bundling, present-on-admission, procedure, and DRG assignments. - Assess inpatient hospitalizations and outpatient encounters across clinics, urgent care, radiology, laboratory, ancillary services, observation, and ambulatory surgery. - Evaluate principal and secondary diagnoses, procedures, documentation sufficiency, billability, and adherence to applicable coding guidance. - Identify incorrect, missing, duplicate, unbundled, unsupported, upcoded, downcoded, or otherwise noncompliant codes and data elements. - Review electronic health record documentation and approved audit tools according to established sampling and audit requirements.

- Document audit findings with supporting authority, financial impact, risk assessment, and recommended corrective actions. - Maintain a minimum audit accuracy of 95% and participate in calibration activities to support consistency across reviewers. - Contribute to audit work plans, data collection tools, facility-level reports, consolidated reporting, and progress updates. - Present preliminary and final findings to health information management leadership, management, designated facility personnel, and other stakeholders. - Develop and deliver facility-specific coding education, support exit conferences, and explain findings using authoritative coding guidance. - Protect confidential healthcare information and comply with applicable privacy, security, training, credentialing, reporting, and access requirements. - Maintain required credentials and meet all established audit schedules, turnaround times, and quality standards. Requirements - Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential from an accepted professional organization. - At least two years of experience in the applicable inpatient and/or outpatient coding specialty. - At least three years of consultant experience reviewing medical records in large tertiary-care hospitals and outpatient organizations with primary care and subspecialty services. - At least three years of education and training experience, including the ability to present audit findings and provide facility-specific coding education. - Strong working knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, DRGs, modifiers, bundling rules, reimbursement methodologies, documentation requirements, and coding compliance. - Demonstrated ability to identify coding discrepancies, assess documentation sufficiency, determine financial impact, and support findings with authoritative guidance. - Ability to maintain at least 95% audit accuracy while meeting reporting and turnaround requirements.