Inpatient Coding Compliance Auditor

The University of Iowa; Iowa City (IA); Hybrid; USD 85,000 - 105,000; Full time

Job summary

The University of Iowa is seeking a Senior Compliance Inpatient Auditor to perform comprehensive inpatient coding and documentation audits, ensuring adherence to CMS, Medicare/Medicaid, and payor requirements. You will review ICD-10-CM/PCS coding, MS-DRG assignments, and POA indicators to identify education and risk mitigation opportunities.

You will prepare detailed audit reports, collaborate with HIM, Coding, CDI, and Revenue Integrity teams, and participate in education sessions to improve

Qualifications

• Bachelor’s degree in health information management or related field or equivalent.
• Active coding credential such as RHIT, RHIA, CCS, CCS-P, CIC, or CPC.
• 5 years of inpatient coding experience.
• Extensive knowledge of ICD-10-CM and ICD-10-PCS coding.
• MS-DRG methodology and CMS inpatient billing regulations.
• Medicare/Medicaid reimbursement requirements and regulatory guidance.
• Clinical documentation requirements.
• Strong analytical, investigative and problem-solving skills.
• Excellent written, verbal and presentation skills.
• Proficiency with EMR, encoder apps, DRG validation tools and MS Office.

Responsibilities

• Conduct inpatient coding and documentation audits per policies and CMS/payor requirements.
• Review medical records to validate ICD-10-CM/PCS codes and MS-DRG assignments with proper supporting clinical indicators.
• Evaluate compliance with Medicare, Medicaid, and commercial payor billing requirements.
• Prepare detailed audit reports with findings, financial implications, and corrective actions.
• Follow up with stakeholders to ensure corrective actions are implemented.
• Assist with investigations related to inpatient coding, billing, and documentation concerns.
• Use RAT-STATS for sampling and extrapolation of overpayments.
• Collaborate with HIM, Coding, CDI, and Revenue Integrity to address issues.
• Conduct audit meetings and education sessions for staff and leadership.

Skills

Analytical

Investigative

Problem-solving

Written communication

Verbal communication

Education

Bachelor’s degree in health information management or related field

Active coding credential (RHIT, RHIA, CCS, CCS-P, CIC, CPC)

Tools

Electronic medical records

Encoder applications

DRG validation tools

Microsoft Office

Job description

The University of Iowa is seeking a Senior Compliance Inpatient Auditor to perform comprehensive inpatient coding and documentation audits, ensuring adherence to CMS, Medicare/Medicaid, and payor requirements. You will review ICD-10-CM/PCS coding, MS-DRG assignments, and POA indicators to identify education and risk mitigation opportunities.

You will prepare detailed audit reports, collaborate with HIM, Coding, CDI, and Revenue Integrity teams, and participate in education sessions to improve