Denials Auditor II: Coding & Reimbursement Expert

Baylor Scott & White Health; Columbus (OH); On-site; USD 70,000 - 90,000; Full time

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with multidisciplinary teams and resolve complex coding denials. You will review, audit, and appeal denials across Hospital and Professional Billing, applying ICD-10-CM/PCS, CPT, and DRG knowledge to support payment accuracy and compliance.

Lead root-cause analysis, collaborate with Clinical Validation RNs, and contribute to revenue cycle improvements in a high-volume environment.

Qualifications

• Education: HS diploma or GED; health information degree preferred.
• Certification in CPC/CCS/RHIT/RHIA or equivalent preferred or required.
• 6+ years in coding, audits, denial management, or revenue cycle.
• Strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG and payer policies.
• Ability to research, document, and advocate appeal positions with evidence.

Responsibilities

• Review and audit coding denials for HB and PB claims to determine resolution.
• Investigate and appeal complex denials (MUE, DRG downgrades, modifiers).
• Apply coding guidelines and payer policies to denials with documentation.
• Perform root cause analysis to identify denial trends and improvements.
• Communicate findings and outcomes to leadership and stakeholders.
• Maintain audit-ready documentation and track appeal deadlines.

Skills

ICD-10-CM

ICD-10-PCS

CPT

HCPCS

DRG assignment

NCCI edits

MUE guidelines

Epic

Encoder software

Payer portals

Microsoft Office (Excel/Word)

Education

Associate's or Bachelor's degree in Health Information Management

High School Diploma/GED

RHIA

RHIT

CCS

CCS-P

CPC

COC

CIC

Tools

Epic

Encoder software

Payer portals

Microsoft Office

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with multidisciplinary teams and resolve complex coding denials. You will review, audit, and appeal denials across Hospital and Professional Billing, applying ICD-10-CM/PCS, CPT, and DRG knowledge to support payment accuracy and compliance.

Lead root-cause analysis, collaborate with Clinical Validation RNs, and contribute to revenue cycle improvements in a high-volume environment.