Inpatient/Outpatient Coding Auditor

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

📋 Description

• Conduct independent audits of both inpatient and outpatient facility coding to ensure accuracy, compliance, documentation support, and reimbursement implications.

• Analyze ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, evaluation and management, modifiers, bundling, present-on-admission, procedure, and DRG assignments.

• Examine inpatient hospitalizations along with outpatient clinic, urgent-care, radiology, laboratory, ancillary, observation, and ambulatory surgical encounters.

• Evaluate diagnoses and procedure coding, assess documentation adequacy, billability, and adherence to coding guidelines.

• Detect incorrect, missing, duplicate, unbundled, unsupported, upcoded, downcoded, or noncompliant codes, modifiers, and data elements.

• Review electronic health record documentation and utilize approved audit tools while adhering to established sampling protocols.

• Record findings with supporting authority, financial implications, associated risks, and suggested corrective actions.

• Maintain a minimum audit accuracy rate of 95 percent and engage in calibration processes.

• Aid in the development of audit work plans, collection tools, facility reports, consolidated reports, and progress updates.

• Discuss preliminary findings with HIMS leadership, the COR, management, and facility staff.

• Create or assist in the preparation of final reports addressing accuracy, documentation concerns, financial impacts, process enhancements, and educational requirements.

• Design and present facility-specific coding education, support exit conferences, and clarify findings using authoritative guidance.

• Safeguard VA information while adhering to audit timelines, reporting deadlines, training, credentialing, and access requirements.

⛳️ Requirements

• Must be a U.S. citizen and possess proficiency in the English language.

• Hold an active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.

• A minimum of two years of coding experience in the relevant coding field is required.

• At least three years of consulting experience reviewing records in large tertiary-care hospitals and outpatient organizations that provide primary care and subspecialty services.

• A minimum of three years of experience in education and training.

• Must demonstrate proficiency in ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, DRG, modifiers, bundling, reimbursement, documentation, and compliance requirements.

• Successful completion of the Low Risk NACI background process, along with required VA privacy, information-security, and mandatory training.

• Capability to work securely within the United States.

• Must maintain a minimum audit accuracy of 95 percent.

• Ability to meet reporting and turnaround time requirements.

• Submission of a current resume, signed Letter of Intent, completed candidate cover page, proof of active accepted AHIMA or AAPC credential, and two recent client references.

• Provide OIG exclusion search results and any requested background, security, identification, privacy, training, or onboarding documents.

🏝️ Benefits

• Competitive salaries and benefits packages.