Acute Coding Quality Review Auditor (Remote)

Adventist Health; Roseville (CA); On-site; USD 50,847 - 69,734; Full time

Job summary

Adventist Health is seeking an experienced compliance auditor in Roseville, California. This role involves conducting quality reviews and audits to ensure adherence to various coding guidelines including DRG validation and ICD-10/PCS. The candidate will maintain high standards by preparing audit reports and providing educational support to the coding teams.

The position requires a High School diploma or GED, with preference given to those with an Associate's degree. Experience in acute care coding and relevant certifications are essential. This is a full-time position with a structured benefits program.

Qualifications

• Five years’ acute care inpatient and/or outpatient coding experience required.
• Three years’ coding auditing/monitoring experience preferred.
• Certified Coding Specialist credential through AHIMA required.
• Certified Coding Specialist (CCS) required.

Responsibilities

• Perform quality reviews and audits to ensure compliance with coding guidelines.
• Prepare detailed audit reports outlining findings and corrective actions.
• Assist in educational opportunities and maintain knowledge of coding guidelines.
• Communicate with manager and stakeholders regarding coding adherence.

Skills

Compliance knowledge

Interpersonal communication

Organizational skills

Facilitation skills

Problem-solving

Education

High School Education/GED

Associate’s/Technical Degree

Tools

Performance improvement tools

Job description

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus – a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well‑being and inspire your best work.

Job Summary

Performs quality reviews and audits to ensure compliance with DRG validation, ICD-10/PCS, and CPT coding guidelines. Coordinates with department leadership to ensure standards are met in accordance with department and organization policy. Contributes to improving the processes and infrastructure of the department. Demonstrates proficiency in facilitation and interpersonal communication, organizational skills, prioritization of tasks, professionalism, and education and training as required. Uses in depth understanding of the CQR quality workplan to promote compliance and awareness of the plan. Acts as subject matter expert (SME) in national coding guidelines for hospital inpatient and/or outpatient and will ensure compliance with those guidelines along with all company coding policies. Uses performance improvement analyses to improve the accuracy, integrity and quality of patient data, ensure minimal variation in coding practices and improve the quality of physician documentation within the body of the medical record to support code assignments which results in appropriate reimbursement and data integrity.

Job Requirements

• High School Education/GED or equivalent: Required
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
• Five years’ acute care inpatient and/or outpatient coding experience: Required
• Three years’ coding auditing/monitoring experience: Preferred

Licenses/Certifications

• Certified Coding Specialist credential through AHIMA: Required
• Certified Coding Specialist (CCS): Required

Essential Functions

• Performs regularly scheduled quality reviews and audits per departmental policies and procedures (routine, pre‑bill, policy driven, targeted, and post‑bill) for hospital inpatient and/or outpatient coding. Facilitates the coder audit appeal process, providing rationale and education to the coding team as required. Performs ad hoc quality reviews, such as targeted DRG reviews, and special projects as assigned by management.
• Prepares detailed audit reports outlining findings, recommendations, rationale, and corrective actions needed. Facilitates the coder appeal process. Assists team members with coding questions and provides resolution guidance.
• Assists in ensuring coding staff adherence with coding guidelines and policy, both internal and vendor teams. Demonstrates and applies expert level knowledge of medical coding practices and concepts. Communicates appropriately with manager and all stakeholders as required.
• Identifies and communicates educational opportunities to manager. Maintains working knowledge of workflows, systems, and tools used in the department. Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current.
• Maintains up‑to‑date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that affect the audit process. Assists in creation and maintenance of a positive working environment, including effective communication and setting an appropriate professional example.
• Performs other job‑related duties as assigned.

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E‑Verify. By applying, you acknowledge that you have accessed and read the E‑Verify Participation and Right to Work notices and understand the contents therein.

Job Information

Job Identification: 58643
Job Category: Associate
Posting Date: 2026-07-02T19:15:03+00:00
Locations: Roseville, CA, United States
Assignment Category: Full‑time regular
Pay Range: The estimated base pay for this position is $36.91 to $50.62 per hour. Additional individual compensation may be available through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions.
Hiring Department: RC Coding - Acute
Shift Length: 8 Hours