DRC Coding Auditor: Denials & Appeals Expert

Baylor Scott & White Health; Jackson (MS); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

401(k) match up to 5%

Tuition Reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to audit, review, and appeal denials across Hospital Billing and Professional Billing claims. You will apply ICD-10-CM/PCS, CPT, HCPCS knowledge and payer policies to recover revenue and improve coding accuracy.

You will collaborate with Clinical Validation RNs and Revenue Cycle teams, research denials, identify trends, and support denial prevention initiatives while ensuring compliance in a high-volume environment.

Qualifications

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - 6+ years in coding audits, denial management, revenue cycle operations
• CERTIFICATION/LICENSE/REGISTRATION - CPC/CCS/RHIA/RHIT or equivalent coding certification

Responsibilities

• Review and audit coding-related denials to determine resolution and appeal strategies.
• Investigate and appeal complex HB/PB denials, including MUE denials and DRG downgrades.
• Apply knowledge of ICD-10-CM/PCS, CPT/HCPCS, DRG, NCCI edits and payer requirements.
• Prepare and submit clear, compliant appeal documentation with references.
• Research and validate coding and reimbursement positions with stakeholders.

Skills

Analytical skills

Written communication

Verbal communication

Collaboration

Education

Associate's or Bachelor's in Health Information Management

High School Diploma or GED

Tools

Epic

Encoder software

Payer portals

Excel

Word

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to audit, review, and appeal denials across Hospital Billing and Professional Billing claims. You will apply ICD-10-CM/PCS, CPT, HCPCS knowledge and payer policies to recover revenue and improve coding accuracy.

You will collaborate with Clinical Validation RNs and Revenue Cycle teams, research denials, identify trends, and support denial prevention initiatives while ensuring compliance in a high-volume environment.