Inpatient Coding Auditor

Inpatient Coding Auditor

The Inpatient Coding Auditor is responsible for auditing inpatient coding and DRG assignment to ensure accurate ICD-10-CM/PCS coding, documentation support, and compliance with official guidelines and payer requirements. This role tracks audit outcomes, supports corrective actions, and provides education to improve coding quality and reduce audit risk.

Responsibilities include, but are not limited to:

• Review entire medical record to confirm correct assignment of ICD-10-CM/PCS coding, sequencing and POA to ensure proper assignment of MS-DRG/APR-DRG.
• Review clinical documentation for guideline compliance, clinical support, and accurate capture of CC/MCC and key secondary diagnoses and procedures.
• Identify trends, root causes, and compliance risks; recommend corrective actions and process improvements in collaboration with coding leadership and CDI.
• Work closely with leadership create and prepare detailed audit reports, including findings, financial impact considerations, and error-rate metrics; track follow-up actions and re-audit results.
• Provide education and feedback to inpatient coders and CDI partners; develop reference tools and training materials.
• Support external audits and payer requests (e.g., RAC/DRG audits) and assist with appeal support when needed.
• Stay current with CMS IPPS changes, Coding Clinic guidance, official coding guidelines, and payer policy updates.
• Ensure accurate abstraction of data elements impacting reimbursement and reporting (e.g., discharge disposition, admission source, procedure dates).
• Maintain audit tools, policies, and procedures; assist with continuous improvement initiatives.
• Maintain established productivity standards by PF Concepts or client
• Maintain HIPAA compliance and protect patient confidentiality in all work activities.

Compensation:

• $40.00–$44.00 per hour, depending on experience.

Schedule:

• Per diem / as needed; no guaranteed minimum hours.

Qualifications:

• Bachelor's Degree or Associate's Degree in Health Information Management or related field; bachelor's degree preferred
• Credentials from AHIMA or AAPC, AHIMA preferred, AAPC considered with facility coding experience.
• 5+ years of recent inpatient acute-care coding experience with auditing/DRG validation experience preferred.
• Expert knowledge of ICD-10-CM, ICD-10-PCS, MS-DRGs, POA, CC/MCC capture, and official coding guidelines/Coding Clinic.
• Strong analytical skills and ability to interpret clinical documentation and support audit conclusions.
• Ability to prepare detailed written reports and communicate findings effectively.
• Proficiency with EHR and encoder/coding tools and Microsoft Excel/Office.
• Effective communication and coaching skills to deliver coder education and corrective action follow-up.
• Active coding certification required (CCS or CIC); RHIT/RHIA and CDIP are a plus.
• Proficiency with multiple applications: Oracle, Epic, Meditech, Powerchart, Soarian Financials, Clintegrity, Solventum 360, etc