Healthcare Coding Quality & DRG Auditor

Pena4; United States; On-site; USD 65,000 - 100,000; Part time

Job summary

Pena4 seeks a Quality Reviewer to ensure accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters across payer sources. This role demands critical thinking and a skill set above a standard coder, with strict adherence to applicable regulations and client guidelines.

The Quality Reviewer will manage SMART queues, review EPIC SMART WQ’s, and direct coders with precise recommendations.

Qualifications

• Bachelor’s degree or equivalent in experience.
• 4+ years acute care coding and/or auditing experience with a Bachelor’s degree.
• 7+ years acute coding and/or auditing experience without a Bachelor’s degree.
• CCS, ICD-10-CM/PCS proficiency required; CPC-H, RHIT, RHIA and/or RN encouraged.
• Extensive knowledge of ICD-10-CM/PCS and CPT coding; medical terminology and anatomy.

Responsibilities

• Ensure accuracy of ICD-10-CM/PCS coding and DRG assignment.
• Critically analyze inpatient records for coding, DRG judgments, SOI, ROM and POA.
• Manage SMART queues for all acute care facilities.
• Direct coders with case-specific recommendations and provide education.
• Coach coders on coding principles, assignments and sequencing with clear documentation.
• Maintain records of review activity and communicate recommendations to Coding team.
• May perform other related duties.

Skills

Critical thinking

Communication

Time management

Independence

Coaching/education

Team collaboration

Education

Bachelor’s degree or equivalent

CCS

CPC-H

RHIT

RHIA

RN

Tools

3M Coding & Reimbursement

Citrix

EPIC

SMART Software

Job description

Pena4 seeks a Quality Reviewer to ensure accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters across payer sources. This role demands critical thinking and a skill set above a standard coder, with strict adherence to applicable regulations and client guidelines.

The Quality Reviewer will manage SMART queues, review EPIC SMART WQ’s, and direct coders with precise recommendations.