Inpatient Coding QA Specialist - Audit & Compliance

Nexus Recruitment Group; Pasig; On-site; PHP 400,000 - 700,000; Full time

Job summary

Nexus Recruitment Group is seeking an experienced In-Patient Coding Quality Assurance Specialist to ensure the accuracy, consistency, and regulatory compliance of inpatient coding. This role emphasizes meticulous audits, education for coding teams, and adherence to CMS, OIG, and payer requirements.

You will collaborate with clinical and IT teams to refine workflows, maintain audit logs, and stay current with coding updates. A strong background in HIM and relevant certifications is essential.

Qualifications

• Associates or Bachelors degree in Health Information Management, Nursing, or a related field preferred.
• Active CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification required.
• Minimum 3-5 years of inpatient coding experience, with at least 1-2 years in a QA or auditing role.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG/APR-DRG assignment, and official coding guidelines.
• Experience using EMR systems and coding tools (e.g., 3M, Optum).
• Familiarity with HIPAA and quality management standards in healthcare documentation.

Responsibilities

• Perform retrospective and concurrent audits of inpatient coded records to validate accuracy, completeness, and adherence to official coding guidelines.
• Provide detailed feedback and education to coding teams based on audit findings.
• Identify trends or recurring issues in coding accuracy and recommend corrective actions or training.
• Collaborate with internal teams to refine coding workflows and ensure documentation supports code assignments.
• Maintain audit logs, scorecards, and reporting metrics as required by internal and client guidelines.
• Stay current on inpatient coding updates, payer requirements, and regulatory changes (e.g., CMS, OIG).
• Assist with new coder onboarding QA reviews and periodic competency assessments.

Skills

Inpatient coding

Auditing

Quality assurance

EMR systems

HIPAA knowledge

Education

Health Information Management (HIM) degree

CCS or CIC certification

Tools

3M

Optum

Job description

Nexus Recruitment Group is seeking an experienced In-Patient Coding Quality Assurance Specialist to ensure the accuracy, consistency, and regulatory compliance of inpatient coding. This role emphasizes meticulous audits, education for coding teams, and adherence to CMS, OIG, and payer requirements.

You will collaborate with clinical and IT teams to refine workflows, maintain audit logs, and stay current with coding updates. A strong background in HIM and relevant certifications is essential.