DRG Compliance Coding Auditor - Accuracy & Denials

HIM Central Services; United States; On-site; USD 70,000 - 110,000; Full time

Job summary

HIM Central Services in the United States is seeking a Compliance Coding Auditor to perform independent audits of coded medical records to evaluate accuracy, documentation integrity, and compliance with coding guidelines, regulatory requirements, and organizational policies. This role supports auditing activities, denial review, and appeal support to improve coding accuracy and readiness.

The position collaborates with coding, clinical, and revenue cycle stakeholders to promote consistent

Qualifications

• H.S. Diploma or GED required.
• Associate Degree in Health Information Management or related field preferred.
• 2-4 years in Health Information Management or related field required.
• 2-4 years of coding audit, denial management, or compliance review experience preferred.
• Experience with DRG validation, payer audits (e.g., RAC, commercial), and appeal processes preferred.

Responsibilities

• Performs retrospective and concurrent coding audits to assess accuracy, completeness, and compliance with ICD-10-CM/PCS, CPT/HCPCS, DRG, and applicable regulatory requirements.
• Reviews clinical documentation to ensure alignment with coded data, including evaluation of present on admission (POA), discharge disposition, and medical necessity.
• Conducts denial reviews and validates coding and documentation to support appeal processes and reimbursement outcomes.
• Develops and prepares audit findings, including detailed documentation and appeal rationale supported by clinical and coding guidelines.
• Identifies coding and documentation trends, risks, and opportunities for improvement, and communicates findings to appropriate stakeholders.
• Provides feedback and education to coding staff and leadership based on audit results to improve accuracy and compliance.
• Maintains audit tracking, reporting, and documentation of findings, trends, and resolution activities.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Skills

Coding audits

DRG methodologies

Regulatory requirements

Clinical documentation

Data analysis

Communication

Education

Associate Degree in Health Information Management

H.S. Diploma or GED

Job description

HIM Central Services in the United States is seeking a Compliance Coding Auditor to perform independent audits of coded medical records to evaluate accuracy, documentation integrity, and compliance with coding guidelines, regulatory requirements, and organizational policies. This role supports auditing activities, denial review, and appeal support to improve coding accuracy and readiness.

The position collaborates with coding, clinical, and revenue cycle stakeholders to promote consistent