Quality Auditor

JD –Code Auditor

Job Title – Certified Auditor

Position Summary:

The Coding Auditor is responsible for performing thorough reviews of coded medical records to ensure coding accuracy, documentation integrity, and compliance with ICD-10-CM, ICD-10-PCS, and MS-DRG assignment rules. This role serves as a key resource for ensuring accurate clinical coding and billing in line with federal guidelines, payer regulations, and hospital policies.

Key Responsibilities:

Auditing & Coding Accuracy

• Ensure coding accuracy in line with CMS, UHDDS guidelines, AHA Coding Clinic, and SRMC policies.
• Verify appropriate sequencing of codes and adherence to coding conventions and regulatory updates.

Compliance Monitoring

• Ensure compliance with applicable regulations including CMS, OIG, HIPAA, and payer-specific billing rules.

Reporting & Education

• Generate detailed audit reports outlining findings, trends, and improvement opportunities.
• Provide constructive feedback and coding education to coding staff based on audit results.
• Recommend coding training plans for identified areas of concern or underperformance.

Continuous Improvement

• Track and analyze audit trends to identify systemic issues or gaps in documentation.
• Participate in policy development for coding compliance, audit escalation, and documentation improvement.
• Collaborate with HIM leadership, CDI, and coding supervisors on corrective actions and workflow improvements.

Qualifications:

• Required Certifications:
• CCS (Certified Coding Specialist) (Inpatient Coder)
• RHIA or RHIT (preferred) (Inpatient Coder)
• CPC, CCS (AHIMA or AAPC credential required) (Outpatient Coder)
• Experience:
• 1-3 years of coding audit experience preferred
• 3+ years of coding experience
• Familiarity with audit tools and EHR/encoder systems (e.g., 3M 360, TruCode, Epic)
• Excellent analytical skills and attention to detail
• Strong written and verbal communication skills

Performance Expectations:

• Coding accuracy threshold: ≥95%
• Timely completion of audits and feedback cycles
• Contribution to coder education sessions, quarterly reporting, and risk mitigation

Preferred Attributes:

• Experience working in rural or territory-based U.S. hospitals (e.g., U.S. Virgin Islands, Puerto Rico)
• Exposure to payer audits (e.g., RAC, MAC, OIG)
• Experience with DRG validation tools or risk adjustment models

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.