Coding Auditor & Education Lead

Highmark Health; United States; Remote; USD 39,000 - 61,000; Full time

Job summary

Allegheny Health Network is seeking a Coding Auditor to perform internal, concurrent, prospective and retrospective coding audits. You will review medical records for data quality and coding accuracy across DRGs, APCs, CPT/HCPCS, and ICD codes, and communicate findings to affected areas to drive education and process improvements.

You will develop audit reports, train staff, and collaborate with management on external audits and compliance programs to enhance reimbursement accuracy and

Qualifications

• High school diploma / GED.
• AAPC or AHIMA certification (RHIT/CCS or CPC/COC/CPMA).
• 5 years with hospital or physician coding and/or auditing, or equivalent experience.
• In-depth knowledge of ICD-CM, ICD-PCS, CPT/HCPCS coding systems and DRG/APC structure.
• Strong analytical and communication skills.

Responsibilities

• Plans and conducts audits and reports on coding and documentation.
• Develops audit materials and conducts staff education.
• Validates coding systems and ensures regulatory compliance.
• Creates case mix reports and analyzes DRG/APC patterns.
• Interprets and applies coding guidelines and compliance standards.
• Mentors staff and supports coding manager responsibilities.

Skills

Strong analytical skills

Strong communication skills

Attention to detail

Education

RHIT

CCS

CPC

COC

CPMA

Associate’s Degree

Tools

Encoder

Grouper

Abstracting software

Job description

Allegheny Health Network is seeking a Coding Auditor to perform internal, concurrent, prospective and retrospective coding audits. You will review medical records for data quality and coding accuracy across DRGs, APCs, CPT/HCPCS, and ICD codes, and communicate findings to affected areas to drive education and process improvements.

You will develop audit reports, train staff, and collaborate with management on external audits and compliance programs to enhance reimbursement accuracy and