Coding Quality Auditor

City of Hope; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

City of Hope in the United States seeks an Inpatient Coding Quality Auditor to independently evaluate coding accuracy, compliance, and reimbursement integrity across inpatient encounters. The role collaborates with Coding leadership, CDI, Quality, and Revenue Cycle teams to ensure adherence to Official Coding Guidelines and CMS rules.

The successful candidate will conduct pre-bill and retrospective audits, validate DRG assignments, monitor compliance risks, and provide education to coding staff

Qualifications

• Graduate of an accredited HIM/HIT/Healthcare program (associate degree or higher) or equivalent with anatomy and physiology coursework.
• Seven (7) years of acute care inpatient coding experience in a hospital or cancer center setting.
• Experience assigning ICD-10-CM/PCS codes for inpatient encounters and MS-DRGs/APR-DRGs.
• Experience conducting coding audits, validation reviews, and education activities.
• Knowledge of Official Coding Guidelines, Coding Clinic guidance, CMS regulations, and payer requirements.

Responsibilities

• Conduct routine, targeted, pre-bill and retrospective coding audits to evaluate accuracy and compliance.
• Review inpatient encounters to validate diagnoses, procedures, abstraction quality, and data integrity.
• Perform independent validation of complex coding, DRG/APR-DRG assignments and quality reporting elements.
• Monitor compliance risk areas, regulatory updates, and payer audit findings; provide recommendations.
• Prepare audit findings, scorecards, and staff coaching recommendations; drive continuous improvement.

Skills

ICD-10-CM/PCS coding

Auditing

MS-DRGs/APR-DRGs

Regulatory compliance

Communication skills

Education

HIM/HIT/Healthcare Admin degree

Anatomy & physiology coursework

Job description

Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

Position Summary

The Inpatient Coding Quality Auditor is an exempt professional role responsible for independently evaluating the accuracy, consistency, compliance, quality, and effectiveness of inpatient coding activities across City of Hope. The Inpatient Coding Quality Auditor serves as the organization's subject matter expert for coding quality assurance, coding validation, pre-bill and retrospective coding review, coding compliance, reimbursement integrity, and coding audit methodology. The role ensures consistent application of Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and organizational coding standards.

Through focused coding review, audit activities, compliance monitoring, performance analysis, and quality assessment, the Inpatient Coding Quality Auditor identifies opportunities to improve coding accuracy, coding consistency, reimbursement integrity, quality reporting, data quality, regulatory compliance, and program effectiveness. The role collaborates closely with Coding leadership, Inpatient Coders, CDI, Quality, Revenue Cycle, Compliance, and Physician Advisor teams to support accurate clinical representation and coding integrity.

The Inpatient Coding Quality Auditor functions independently from routine production coding activities and maintains primary responsibility for coding quality assurance, coding validation, competency assessment, coding education, regulatory compliance monitoring, audit reporting, and continuous program improvement.

As a successful candidate, you will:

Coding Quality Assurance, Pre-Bill & Retrospective Audit Review

Conduct routine, targeted, pre-bill, and retrospective coding audits to evaluate coding accuracy, DRG assignment accuracy, abstraction quality, coding compliance, reimbursement integrity, and adherence to Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and City of Hope coding standards. Review selected inpatient encounters to validate diagnosis assignment, procedure assignment, abstracting accuracy, reimbursement classifications, and data integrity. Evaluate adherence to coding policies, query practices, and regulatory requirements while identifying coding opportunities, coding risks, and compliance concerns.

Coding Validation, Compliance Oversight & Revenue Cycle Support

Perform independent validation reviews of complex diagnosis coding, procedure coding, MS-DRG assignment, APR-DRG assignment, quality reporting elements, reimbursement classifications, and abstracted data. Monitor coding compliance risk areas, Coding Clinic updates, CMS guidance, payer audit findings, OIG Work Plan priorities, RAC-targeted services, denial trends, and emerging regulatory requirements that may impact coding quality, reimbursement integrity, or organizational compliance. Provide recommendations to support regulatory readiness and coding excellence. Complete assigned work within established productivity and turnaround time expectations to support candidate-for-bill (CFB), DNFB, revenue cycle, and organizational performance goals.

Quality Assurance, Staff Auditing & Competency Assessment

Conduct routine and focused audits of coding staff activities to evaluate coding accuracy, coding consistency, abstraction quality, coding compliance, and productivity-to-quality balance. Prepare audit findings, coding quality reports, scorecards, and recommendations to support continuous improvement and coding consistency. Monitor and trend coder-specific quality findings to identify opportunities for coaching, competency development, coding education, remediation efforts, and performance improvement.

Your qualifications should include:

• Graduate of an accredited Health Information Management (HIM), Health Information Technology (HIT), Healthcare Administration, Nursing, or related healthcare program (Associate's degree or higher); or
  High School diploma, GED, or equivalent, AND completion of anatomy and physiology coursework.
• Seven (7) years of acute care inpatient coding experience within a hospital, academic medical center, cancer center, or integrated healthcare system environment
• Demonstrated experience independently assigning ICD-10-CM and ICD-10-PCS codes for inpatient encounters
• Demonstrated experience assigning MS-DRGs, APR-DRGs, and other applicable reimbursement classifications
• Experience conducting coding audits, coding validation reviews, coding quality reviews, coding compliance reviews, or coding education activities
• Experience evaluating coding accuracy, DRG assignment accuracy, coding compliance, abstracting quality, reimbursement integrity, and coding consistency
• Experience applying Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and organizational coding standards
• Experience identifying coding trends, coding risks, compliance concerns, denial opportunities, or reimbursement issues through coding review activities
• Experience providing feedback, education, coaching, or competency support related to coding quality and coding compliance

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

To learn more about our Comprehensive Benefits, please CLICK HERE.