Lead IP Coding Quality Analyst

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

📋 Description

• Act as a senior subject matter expert and operational leader responsible for maintaining the integrity and defensibility of inpatient coding quality, audit implementation, and regulatory compliance.

• Provide daily leadership for coding quality review processes, ensuring that audit outcomes align with coding guidance, educational initiatives, and enterprise priorities.

• Assist in the development and execution of a comprehensive inpatient coding audit program, which includes audit tracking, reporting, corrective action planning, and follow-up validation of sustained improvements.

• Serve as a vital liaison among Coding, Clinical Documentation Integrity (CDI), Quality, Revenue Cycle, and Compliance to minimize regulatory risks, prevent DRG downgrades, and ensure accurate representation of patient severity, reimbursement, and publicly reported outcomes.

• Conduct advanced inpatient coding audits while offering functional leadership and oversight to coding quality analysts.

• Ensure uniformity in audit methodology, interpretation of coding guidelines, and adherence to regulatory requirements.

• Manage audit workflows, confirm audit accuracy through secondary reviews, and convert audit findings into actionable insights, educational strategies, and initiatives for performance improvement.

• Support enterprise audit governance through structured reporting, trend analysis, and participation in compliance and quality initiatives.

⛳️ Requirements

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

• A minimum of 4–8 years of recent inpatient hospital coding experience in an academic medical center or a complex acute-care hospital environment.

• Proven proficiency in ICD‑10‑CM and ICD‑10‑PCS coding, including validation of principal diagnoses, CCs/MCCs, procedures, POA indicators, and MS‑DRG/APR‑DRG assignments.

• 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 advanced inpatient claim edit frameworks.

• Experience with electronic health records (EHRs) and health information management systems, including encoders, abstracting, and audit/reporting applications.

• Capability to apply independent judgment in assessing coding, documentation, compliance risk, and audit findings.

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

• Prior experience in inpatient coding quality review, auditing, denial management, or compliance-oriented roles.

🏝️ Benefits

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

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

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