Coding Audit Specialist

Northwestern-Medical-Center; Town of Vermont (WI); On-site; USD 33,000 - 47,000; Full time

Job summary

Northwestern Medical Center is hiring a Coding Audit Specialist to join our revenue cycle team. The full-time role (80 hours bi-weekly) focuses on auditing inpatient, outpatient, and professional medical records to ensure accurate coding per ICD-10-CM, ICD-10-PCS, CPT, and HCPCS guidelines.

The position requires a minimum of 4 years in coding or health information management, knowledge of HIPAA, and CPC certification; bachelor’s in a related field preferred.

Qualifications

• Minimum of 4 years of coding, auditing, or health information management experience.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and reimbursement methodologies.
• HIPAA regulations and compliance standards knowledge.
• Experience in acute care hospital coding audits and education/training experience.
• Knowledge of coding guidelines and ability to communicate regulations.

Responsibilities

• Perform retrospective coding and audits to evaluate accuracy and compliance.
• Review records to verify ICD, CPT, and HCPCS code assignments.
• Document audit findings with references to coding guidelines.
• Calculate and report coding accuracy rates and compliance metrics.
• Provide education and feedback to staff on coding requirements.
• Monitor regulatory changes and maintain coding expertise.
• Develop recommendations to improve coding quality and reimbursement.
• Prepare audit reports and present findings to leadership.

Skills

Analytical skills

Problem solving

Communication

Detail oriented

Education

High school diploma or equivalent

Bachelor's degree in health information management or related field preferred

Tools

EHR systems

Audit software

Job description

• Pay or shift range: $24.28 USD to $33.92 USD The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and other job-related reasons.

Description

NMC is currently recruiting a Coding Audit Specialist. The position is full-time (80 hours bi-weekly), generally Monday - Friday 7 am - 3:30 pm. Northwestern Medical Center’s mission is to provide exceptional health care to our community. Join our high reliability team! With "people" as one of our core values, valuing our employees is a top priority for Northwestern. We care about our employees, their families, and their overall health & well-being. We are proud to offer a generous benefits package, with recognized national carriers, designed to help our people stay healthy, balance work & life responsibilities, protect your assets & plan for a secure financial future.

Hiring Range: $24.28 - $33.92

Coding Audit Specialist

JOB SUMMARY: The Coding Audit Specialist is responsible for auditing inpatient, outpatient, and professional medical records to ensure accurate assignment of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes in accordance with regulatory requirements, payer guidelines, and organizational policies. This role identifies coding compliance risks, provides education and feedback to coding staff, and supports revenue cycle integrity through ongoing monitoring and audit activities

PRE-REQUISITES:

Education: High school diploma or equivalent required, bachelor’s degree in health information management, Healthcare Administration, or related field preferred.

Experience:

• Minimum of 4 years of coding, auditing, or health information management experience.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and reimbursement methodologies.
• Knowledge of HIPAA regulations and compliance standards.
• Experience in acute care hospital coding audits.
• Prior coding education or training experience.
• Medical record auditing and compliance monitoring.
• Advanced ICD, PCS and CPT coding expertise.
• Strong analytical and problem-solving skills.
• Ability to interpret and communicate coding regulations and documentation requirements

Other Skills:

Experience with electronic health record (EHR) systems

Proficiency with audit tools, EHR systems, and reporting software

Certifications:

Certified Professional Coder (CPC) credential required, Certified Coding Specialist (CCS) preferred.

RELATIONSHIPS:

Reports To: HIM Supervisor

Other Contacts: HIM Supervisor, RCG Director, Leadership team, managers, supervisors, Clinical resource nurses, all employees, medical staff, outsourced coding company and general public.

SCOPE:

Machinery or Equipment Used: Solventum Encoder, Optum encoder Pro, computer, scanner, fax, copier

Physical Demands: Mostly sedentary work. Manual dexterity and mobility. Occasional reaching, stooping, bending, kneeling, crouching, lifting.

Working Conditions: Office environment, occasional pressure due to multiple calls and inquiries, subject to many interruptions.

Required Protective Equipment: As the situation dictates

ESSENTIAL FUNCTIONS:

• Perform retrospective coding and audits to evaluate coding accuracy, documentation quality, and compliance with applicable guidelines.
• Review medical records to verify the appropriate assignment of ICD, CPT, and HCPCS codes.
• Document audit findings, including coding errors, trends, root causes, and references to official coding guidelines.
• Calculate and report coding accuracy rates and compliance metrics.
• Analyze denial and payer audit data to identify opportunities for coding and documentation improvement.
• Provide education, coaching, and feedback to coding professionals, clinical staff, and providers regarding coding and documentation requirements.
• Monitor regulatory changes and maintain expertise in coding standards, payer requirements, and compliance regulations.
• Assist with RAC reviews and external audit responses.
• Develop recommendations to improve coding quality, reimbursement accuracy, and documentation integrity.
• Prepare audit reports and present findings to leadership and operational stakeholders.
• Support organizational initiatives related to revenue cycle optimization and compliance monitoring

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.