HIMS Coding Auditor

101 Riverside Hospital, Inc.; United States; Remote; USD 3,981,000 - 5,480,000; Full time

Job summary

Riverside Health in Newport News, Virginia is seeking a Clinical Documentation Improvement Specialist with robust IP/OP coding and auditing experience. The role focuses on maintaining data quality, applying coding guidelines, and managing denials and appeals.

The ideal candidate has 5–6 years of Acute Care IP/OP coding experience, CCS certification, and strong Excel/Office skills; remote work eligibility offered for residents in specified states.

Qualifications

• 5–6 years Acute Care IP and OP Coding experience required.
• 2 years Auditing Acute Care IP and OP required.
• 1 year Clinical Documentation Integrity preferred.
• CCS certification required upon hire.

Responsibilities

• Ensure coding compliance and apply guidelines.
• Audit documentation for accuracy of APC/MSDRG coding.
• Handle DRG and CPT denials; write appeals.
• Identify training needs and educate team members.
• Mentor staff and coordinate coding huddles.
• Prepare audit reports for leadership and respond to audits.
• Collaborate with CDI, PFS, and other departments on documentation issues.

Skills

ICD-10/CPT knowledge

Excel proficiency

Attention to detail

Communication skills

Teamwork

Education

High school diploma or GED

Associate degree in healthcare or related

Tools

PowerPoint

Word

MS Office Suite

Job description

Newport News, Virginia

Hiring 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.

Remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA.

Overview

Responsible 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 do

• Ensures 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 reports.

Qualifications

• Education High School Diploma or GED, (Required) Associates Degree, Healthcare or Related (Preferred)
• Experience 5-6 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 Abilities

• Maintain current working knowledge of ICD-9, ICD-10 and CPT coding principles, government regulation, protocols
• Intermediate proficiency with Excel, PowerPoint, Word
• Skill in completing assignments accurately and with attention to detail
• Ability to adapt to changes in the work environment
• Excellent interpersonal skills and team oriented
• Ability to communicate effectively in both oral and written form

Licenses and Certifications

• Certified 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)
• Registered Health Information Technician (RHIT) - The American Health Information Management Association (AHIMA) Upon Hire (Preferred)
• Certified 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)
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire (Preferred)

Our mission is to care for others as we would care for those we love.

We extend that sense of caring to every patient, resident and customer, as well as to each member of our team.

We offer care at all stages of life, in hundreds of locations, giving you room to grow your career, along with great benefits and perks.

At Riverside Health, your trust and safety are our top priorities.