Denial Management Coding Auditor

Baylor Scott & White Health; Boise (ID); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Immediate health benefits

401(k) with match

Tuition reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to review and resolve complex coding denials across Hospital and Professional Billing. You will work with a multi-disciplinary team of coders, Clinical Validation RNs, and Revenue Cycle staff to ensure accurate documentation and reimbursement.

The role requires advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG assignment, and payer policies. Collaboration and timely denial resolution are essential to succeed in this high-volume

Qualifications

• Education level required: HS diploma/GED; further degree preferred.
• Six+ years of experience in coding, audits, denial management, or revenue cycle.
• Professional certifications such as CPC/CCS/RHIT/RHIA or equivalent.
• Strong knowledge of inpatient and outpatient coding principles (ICD-10-CM/PCS, CPT, HCPCS).
• Experience reviewing and appealing denials for HB and PB claims.
• Ability to analyze documentation and provide persuasive appeal arguments.

Responsibilities

• Review and audit coding denials to determine resolution and appeal strategies.
• Investigate and appeal HB and PB denials, including DRG downgrades and MUE denials.
• Apply coding guidelines and payer policies to evaluate denied claims.
• Prepare and submit compliant appeal documentation with medical record evidence.
• Research and communicate denial trends and root causes to leadership.
• Support denial prevention initiatives through data analysis and collaboration.

Skills

Epic

Encoder software

Payer portals

Excel

Word

Education

HS Diploma/GED

Associate's or Bachelor's preferred

Tools

ICD-10-CM

ICD-10-PCS

CPT/HCPCS

DRG assignment

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to review and resolve complex coding denials across Hospital and Professional Billing. You will work with a multi-disciplinary team of coders, Clinical Validation RNs, and Revenue Cycle staff to ensure accurate documentation and reimbursement.

The role requires advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG assignment, and payer policies. Collaboration and timely denial resolution are essential to succeed in this high-volume