Coding Auditor

Corporate; United States; On-site; USD 80,000 - 120,000; Full time

Job summary

Corporate is seeking a Coding Auditor to conduct post-bill coding audits across inpatient and outpatient services, ensuring documentation alignment and reimbursement integrity. You will validate DRG assignments, modifiers, and APC reviews, apply ICD-10-CM/PCS and CPT/HCPCS knowledge, identify trends, and provide actionable education to improve coding accuracy and adherence to regulations.

This role requires collaboration with the education and onboarding teams and tracking audit outcomes and

Qualifications

• 5+ years of acute care inpatient or outpatient hospital coding.
• Associates degree or healthcare related discipline required.
• Strong knowledge of ICD-10-CM/PCS and CPT/HCPCS coding and modifier usage.

Responsibilities

• Conduct post-bill coding audits to assess coding accuracy, documentation alignment, and reimbursement integrity across inpatient and/or outpatient service lines.
• Perform coding validation activities, including DRG assignment, MCC/CC integrity review, modifier validation, and APC assignment review.
• Identify trends related to coding accuracy, documentation quality, service capture, and reimbursement outcomes.
• Provide detailed audit findings and feedback to support accuracy improvement and standardization of coding practices.
• Collaborate with education team to translate audit results into targeted education and training initiatives.
• Support onboarding audits and competency validation for new coders.
• Reinforce adherence to coding guidelines, regulatory requirements, and enterprise standards.
• Participate in development of coding education materials, guidance, and training content based on audit trends.
• Track and report on audit outcomes, accuracy rates, and quality trends and performance improvement trends.
• Proficient experience with EMR and CAC systems (Epic and Optum preferred).

Skills

5+ years acute care coding

ICD-10-CM/PCS CPT/HCPCS knowledge

CMS guidelines knowledge

Communication skills

Analytical skills

Education

High School diploma or equivalent

Associate degree in Healthcare or related field

Tools

Epic

Optum

Job description

Coding Auditor

Conducts post-bill coding audits to assess coding accuracy, documentation alignment, and reimbursement integrity across inpatient and/or outpatient service lines.

Performs coding validation activities, including DRG assignment, MCC/CC integrity review, modifier validation, and APC assignment review.

Applies knowledge of IPPS, OPPS, DRG, APC, ICD-10CM/PCS, CPT/HCPCS, modifier usage, and coding guidelines during audit reviews.

Identifies trends related to coding accuracy, documentation quality, service capture, and reimbursement outcomes.

Provides detailed audit findings and feedback to support accuracy improvement and standardization of coding practices.

Collaborate with the education team to translate audit results into targeted education and training initiatives.

Supports onboarding audits and competency validation for new coders.

Reinforces adherence to coding guidelines, regulatory requirements, and enterprise standards.

Participates in development of coding education materials, guidance, and training content based on audit trends.

Tracks and reports on audit outcomes, accuracy rates, and quality trends and performance improvement trends.

Performs other duties as assigned.

Proficient experience with EMR and CAC systems (Epic and Optum preferred).

Strong knowledge of ICD-10-CM/PCS, and/or CPT/HCPCS coding, modifier usage and reimbursement methodologies.

Understanding of DRG/IPPS and/or OPPS/APC reimbursement systems and coding requirements.

Ability to perform coding audits and identify accuracy, compliance, and reimbursement trends.

Ability to translate audit findings into clear, actionable feedback and education.

Knowledge of coding guidelines and CMS regulatory requirements.

Strong analytical and problem-solving skills.

Effective communication and collaboration skills.

Ability to manage time and meet deadlines.

High School Grad or Equiv.

Associates degree.

Healthcare related discipline.

5+ years of acute care inpatient or outpatient hospital coding.

Experience with high complexity cases.

Certified Coding Specialist (CCS) OR Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) OR Certified Professional Coder (CPC) OR Certified Interventional Radiology Cardiovascular Coder (CIRCC).