Hybrid Healthcare Coding Compliance Auditor

County of Riverside; California (MO); Hybrid; USD 110,000 - 150,000; Full time

Job summary

County of Riverside seeks two Coding Compliance Auditors (Administrative Services Manager I) to lead auditing of inpatient and outpatient records for accurate ICD-10-CM/PCS, CPT, and HCPCS coding. The role requires extensive CMS/IPPS knowledge and experience with external audits.

You will collaborate across CDI, HIM, and Revenue Cycle teams, deliver education to providers and staff, and support program development with risk-based audits and performance improvements.

Qualifications

• Bachelor's degree in accounting, business or public administration or closely related field.
• Minimum of three years in admin/staff role with at least two years supervising professional/technical staff.
• Experience with inpatient/outpatient auditing, CMS regulations, and external audits preferred.
• Certifications CCS, CPC, RHIT/RHIA, CDIP or CPMA required.
• Experience with encoder/audit software (3M, Optum, EPIC) is strongly preferred.

Responsibilities

• Conduct comprehensive audits of inpatient and outpatient records for ICD-10-CM/PCS, CPT, HCPCS according to guidelines.
• Evaluate DRG assignment accuracy and POA indicators.
• Monitor compliance with Medicare/Medicaid and payer policies.
• Assess documentation for medical necessity and risks like upcoding/undercoding.
• Perform focused audits based on risk assessments and audit priorities.
• Collaborate with CDI, HIM, Revenue Cycle, and Case Management to resolve discrepancies.
• Prepare detailed audit reports with findings, root cause and corrective actions.
• Educate providers and staff on regulatory updates and audit findings.
• Track audit metrics and perform re-audits for sustained improvements.
• Support external audits (RAC, MAC, OIG, payers) as needed.
• Maintain knowledge of CMS transmittals and coding guidance.

Skills

MS-DRG reimbursement

Auditing/compliance

CMS IPPS/OPPS

OIG Work Plan

NCCI edits

Medical necessity rules

Encoder/audit software

Education

Bachelor's degree in accounting, business, or public administration

CCS

CPC

RHIT/RHIA

CDIP

CPMA

Tools

3M

Optum

EPIC

Job description

County of Riverside seeks two Coding Compliance Auditors (Administrative Services Manager I) to lead auditing of inpatient and outpatient records for accurate ICD-10-CM/PCS, CPT, and HCPCS coding. The role requires extensive CMS/IPPS knowledge and experience with external audits.

You will collaborate across CDI, HIM, and Revenue Cycle teams, deliver education to providers and staff, and support program development with risk-based audits and performance improvements.