Coding Quality Auditor

Hackensack Meridian Health; Neptune Township (NJ); Remote; USD 87,000 - 107,000; Full time

Job summary

Hackensack Meridian Health seeks an experienced Coding Quality Auditor to monitor clinical documentation for accurate coding and reimbursement. The role focuses on DRG accuracy, ICU/PSI/HAC indicators, and CDI collaboration, with remote work from New Jersey and a 11:00 am–7:30 pm schedule.

Qualified candidates have 5+ years inpatient coding, CCS certification, and strong data analysis skills. Weekly weekend work is required, and there is ongoing education and process improvement involvement.

Qualifications

• Associate degree or higher in health information with 2–4 years coding experience.
• Minimum 5 years inpatient coding in a complex healthcare environment.
• Minimum 2 years of quality improvement audit experience.
• Strong knowledge of ICD-10 and DRG methodologies.
• Proficient in data reporting; skilled with Microsoft Office/Google Suite.
• Certified Coding Specialist (CCS) required.

Responsibilities

• Review DRG assignments for Medicare/Medicaid inpatients.
• Address edits including HAC, PSI and related indicators.
• Analyze physician documentation for coding accuracy and query physicians when needed.
• Provide guidance on coding changes and educate staff on guidelines.
• Enter data and DRG codes into the 3M system; support CDI reviews.
• Support DNFB goals and assist in audits and special projects.
• Create spreadsheets and summarize findings for leadership.
• Stay updated with CMS guidelines and reimbursement reporting requirements.

Skills

Inpatient coding

Quality improvement

ICD-10/DRG knowledge

Data analysis

Communication skills

Education

Associate degree or higher; CCS preferred

Tools

3M Coding System

Microsoft Office

Google Suite

Job description

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Coding Quality Auditor is responsible for monitoring compliance with applicable clinical documentation to support coding and billing regulations to insure appropriate reimbursement and to support public reporting and various initiatives as directed by Hackensack Meridian Health (HMH) Network.

This position is 100% remote, the hours are 11 am - 7:30 pm and it require a team member to work one weekend day each week, Saturday or Sunday.

Responsibilities

A day in the life of a Coding Quality Auditor at Hackensack Meridian Health includes:

• Reviews Diagnosis Related Group (DRG) assignment for selected Medicare/Medicaid inpatients, Hospital-acquired condition (HAC), Patient Safety Indicators (PSI) and Healthgrade target diagnoses, mortalities and dual diagnosis (dx) for principal diagnosis (Pdx) for the purpose of reimbursement, research and statistics in compliance with federal regulations according to ICD-10 coding classification systems.
• Addressing all edits, including but not limited to nosology, Exihauser, PSI, HAC, and others as needed based on quality indicator.
• Analyzes physician documentation in the medical record for clinical correlation for coding accuracy and queries physicians when code assignments are not straightforward or documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.
• Provides guidance on any changes made during their review to the Inpatient Coders by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines.
• Apply reason/tracking code and rationale (if needed) in 3M as needed for DRG mismatches on Clinical Documentation Improvement (CDI) reviewed cases.
• Provides guidance to the Clinical Documentation Specialists by furnishing input as necessary in addition to education regarding applicable coding clinics or coding guidelines.
• Performs data analysis and statistical gathering on a monthly basis with regards to DRG, Public Reporting, HAC compliance which is then presented to the Chief Compliance Officer.
• Makes recommendations on documentation improvement needs within the facility to improve patient care.
• Applies Present On Admission (POA) indicators on all inpatient charts.
• Brings identified concerns to the supervisor or department manager for resolution.
• Enters data such as diagnosis and procedure codes and charts abstracted information for DRG assignments into the 3M coding computer system.
• Assists and provides feedback to the Inpatient HIM Supervisor and Inpatient Coding Manager with education sessions for coding s.
• Assists in chart completion to ensure Discharged not final billed (DNFB) goals are met.
• Assists in special projects when applicable such as in-house audits or audits pertaining to contract coders.
• Creates spreadsheets and summary of findings.
• Attends monthly coding educator in-services provided by the Inpatient Coding Educator.
• Assists the coding staff when needed.
• Keeps abreast of coding guidelines and reimbursement reporting requirements, new technology and procedures as well as Centers for Medicare & Medicaid Services (CMS) approved clinical trials.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Associate's degree or higher or equivalent years of coding experience (2-4 years).
• Minimum of 5 years of inpatient coding experience in a complex healthcare environment.
• Minimum 2 years of quality improvement audit.
• Experience and thorough knowledge of ICD-10 and DRG methodologies.
• Knowledge of data reporting requirements and proficiency in computer skills.
• Extensive knowledge in data collection and clinical coding reviews.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.

Licenses and Certifications Required:

• Certified Coding Specialist.

Starting Minimum Rate

Minimum rate of $97,011.20 Annually

Job Posting Disclosure

HMH is committed to pay equity and transparency for our team members. The posted rate of pay