Inpatient Coding Quality Analyst, Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• The Inpatient Coding Quality Analyst acts as a subject matter expert tasked with ensuring the accuracy, completeness, and compliance of ICD‑10‑CM/PCS coding and MS‑DRG/APR‑DRG assignment through both random and targeted audits of inpatient medical records.

• Assesses intricate clinical documentation and coding situations, resolves inpatient claim and coding edits, aids in denial prevention and appeal processes, and partners with Revenue Cycle, Central Business Office (CBO), CDI, Compliance, Internal Audit, and clinical stakeholders.

• Delivers actionable insights to enhance coding accuracy, compliance, educational strategies, and operational workflows.

• Performs pre-bill and post-bill audits on high-risk, high-dollar, and regulatory-sensitive inpatient cases to confirm accurate code assignment.

• Assists in denial mitigation and appeal initiatives, verifies failed or rejected inpatient claims, and collaborates with Revenue Cycle teams to guarantee accurate and compliant billing.

• Functions as a coding quality resource and educator, offering expert guidance to inpatient coding staff and engaging in formal educational sessions.

⛳️ Requirements

• Associate degree in Health Information Management, Health Information Technology, or a related discipline.

• A minimum of 3–5 years of recent inpatient hospital coding experience within an academic medical center or a complex acute-care hospital environment.

• Proven expertise in ICD‑10‑CM and ICD‑10‑PCS coding, including the validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS‑DRG/APR‑DRG assignment.

• Experience in reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity, including high-severity and high-risk cases.

• Familiarity with CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and sophisticated inpatient claim edit frameworks.

• Proficient in using electronic health records (EHRs) and health information management systems, encompassing encoder, abstracting, and audit/reporting applications.

• Capability to exercise independent judgment in assessing coding, documentation, compliance risk, and audit results.

• Excellent written and verbal communication skills, including the ability to provide clear, educational feedback to coding staff and work collaboratively with CDI, Revenue Cycle, Quality, and Compliance partners.

🏝️ Benefits

• Medical, dental, and vision coverage, with Ohio State covering a significant portion of the expenses.

• Paid time off, which includes sick leave, vacation time, and 11 holidays.

• State retirement plan or an alternative retirement plan, both featuring generous employer contributions.