Head of Coding Quality & Audit

Healthrise; Farmington Hills (MI); On-site; USD 150,000 - 210,000; Full time

Job summary

Healthrise seeks an experienced Director of Quality Audit Coding to lead coding audit and quality assurance across hospital and professional services engagements. You will serve as a subject matter expert in coding quality, owning the audit methodology, accuracy standards, and remediation programs grounded in ICD-10-CM/PCS guidelines and AHIMA standards.

The Director will partner with client stakeholders to evaluate current-state coding quality, translate findings into education and workflow

Qualifications

• Active coding credential such as CCS, CPC, RHIA or RHIT (AHIMA or AAPC) required.
• Minimum seven years of progressive coding experience, including at least three years leading coding audit or quality assurance teams.
• Experience building coding quality assurance and compliance programs with statistically valid sampling and accuracy scoring.
• Expert knowledge of ICD-10-CM/PCS guidelines, AHA Coding Clinic, CPT, HCPCS, CMS and OIG requirements.
• Willingness and ability to travel to client sites on a quarterly basis.

Responsibilities

• Design and lead coding quality audit programs across hospital and professional services using industry-standard methodology.
• Establish coding accuracy standards with defined error categories and IRR testing.
• Own independent audit methodology, sampling plans, scoring criteria, and re-audit protocols.
• Perform and oversee detailed coding quality audits to identify compliance risks and revenue leakage.
• Validate inpatient coding accuracy including MS-DRG/APR-DRG assignments and POA indicators.
• Audit outpatient and professional coding for CPT/HCPCS/ICD-10 compliance and payer requirements.
• Translate audit findings into structured recommendations and education programs.
• Lead onshore coding quality audit team and coordinate with global delivery partners.
• Ensure audit practices adhere to AHIMA Standards of Ethical Coding.

Skills

Coding quality leadership

Auditing

Regulatory compliance

Stakeholder collaboration

Project management

Job description

Healthrise seeks an experienced Director of Quality Audit Coding to lead coding audit and quality assurance across hospital and professional services engagements. You will serve as a subject matter expert in coding quality, owning the audit methodology, accuracy standards, and remediation programs grounded in ICD-10-CM/PCS guidelines and AHIMA standards.

The Director will partner with client stakeholders to evaluate current-state coding quality, translate findings into education and workflow