HIMS Coding Auditor

RIVERSIDE HOSPITAL SERVICES; Newport News (VA); Remote; USD 40,000 - 55,000; Full time

Benefits offered by this job

Remote work eligibility

Job summary

Riverside Health System in Newport News, VA is seeking an experienced coding specialist responsible for maintaining data quality in inpatient and outpatient records. The role includes auditing accuracy, addressing denials, and mentoring staff in coding guidelines and compliance.

Ideal candidates hold CCS and AHIMA credentials, with 5–6 years IP/OP coding and 2 years auditing experience. Remote work eligibility is available for select states; benefits include CDI involvement and education support.

Qualifications

• 5-6 years Acute Care IP and OP coding experience.
• Auditing experience in IP and OP settings.
• Clinical Documentation Integrity (CDI) preferred.
• Strong knowledge of ICD-9/ICD-10 and CPT coding.

Responsibilities

• Ensures coding compliance with coding guidelines and regulations.
• Applies Coding Clinic standards in daily practice.
• Identifies training needs and educates team members.
• Performs focused audits and prepares leadership reports.
• Assists in addressing internal and external coding audits and denials.
• Coordinates DRG/CPT denial management and appeals where needed.
• Acts as a clinical coding liaison across departments.

Skills

Acute Care Coding

IP & OP Coding

Auditing

CDI Knowledge

Communication

Team Leadership

Education

CCS Certification

RHIA Certification

RHIT Certification

CDDS/CDIP Certification

CPC Certification

Job description

Newport News, VirginiaHiring Range$28.90 - $39.78/Hourly Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs.FOR APPLICATION REVIEW - PROVIDE YOUR AHIMA ID or CREDENTIAL NUMBER ON YOUR APPLICATION OR RESUMEThis position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA.OverviewResponsible for maintaining coded data quality through ongoing quality review and assessment of outpatient or inpatient records. Performs audits on accuracy of APC or MSDRGs as well as on quality of medical record documentation needed for accurate coding. Works with DRG and CPT denials from commercial payers and writes appeal letters as indicated.What you will doEnsures coding compliance. Applies all coding guidelines and principles as defined in the Coding Clinic and leading authorities. Complies with standardized coding standards, conventions and regulations, corporate compliance standards and reimbursement policies.Identifies training needs and provides education to team members. May teach or coordinate coding huddles. Coaches and mentors staff.Performs focused reviews and quality audits. Prepares audit reports for leadership.Assists coding leadership with reviewing and responding to internal and external coding audits. Works with coding leadership in settlement of audit findings as needed.Monitors and evaluates the coding functions to ensure effective and efficient coding operations and compliance with established standards, rules and regulations.Audits for documentation opportunities to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation if needed.Assists patient financial services and clinical documentation improvement team members with questions on coding and billing edits.Serves as a clinical coding liaison. Analyzes and evaluates documentation issues with consultation from the medical staff, clinical staff, CDI team and other departments as needed.Assists leadership with coordination of iCare initiatives related to the hospital coding department.Assists with DRG and certain CPT denials from payers as needed and writes appeals as indicated, documenting the denial/audit in denial management tool for tracking and reportsQualificationsEducationHigh School Diploma or GED, (Required)Associates Degree, Healthcare or Related (Preferred)Experience5-6 years Acute Care Inpatient (IP) and Outpatient (OP) Coding (Required)2 years Auditing - Acute Care IP and OP (Required)1 year Clinical Documentation Integrity (Preferred)Skills and AbilitiesMaintain current working knowledge of ICD-9, ICD-10 and CPT coding principles, government regulation, protocolsIntermediate proficiency with Excel, PowerPoint, WordSkill in completing assignments accurately and with attention to detailAbility to adapt to changes in the work environmentExcellent interpersonal skills and team orientedAbility to communicate effectively in both oral and written formLicenses and CertificationsCertified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) Upon Hire(Required)Registered Health Information Administrator (RHIA) - The American Health Information Management Association (AHIMA) Upon Hire(Preferred) orRegistered Health Information Technician (RHIT) - The American Health Information Management Association (AHIMA) Upon Hire(Preferred) orCertified Clinical Document Specialist (CD) - Association of Clinical Documentation Integrity Specialists (ACDIS) CCDS Certified Clinical Documentation Specialist or CDIP Clinical Documentation Improvement Professional Upon Hire(Preferred) orCertified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire(Preferred) orTo learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.