Inpatient Coding Quality Analyst (Auditor)

The Ohio State University Wexner Medical Center; United States; Remote; USD 85,000 - 110,000; Full time

Job summary

The Ohio State University Wexner Medical Center is seeking an Inpatient Coding Quality Analyst to drive coding quality, compliance, and audit readiness for inpatient records. The role focuses on validating ICD-10-CM/PCS coding and MS-DRG/APR-DRG assignments through targeted audits and education across CDI, Revenue Cycle, Compliance, and clinical teams.

Responsibilities include pre- and post-bill audits, DRG integrity validation, and providing expert guidance to coding staff.

Qualifications

• Associate degree in Health Information Management or related field.
• 3–5 years of inpatient hospital coding experience in academic medical center or complex acute-care setting.
• Proficiency in ICD-10-CM and ICD-10-PCS coding with MS-DRG/APR-DRG assignment validation.
• Experience reviewing complex inpatient records for coding accuracy and DRG integrity.
• Knowledge of CMS IPPS regulations, OIG expectations, payer audits, and DRG validation.
• Experience using EHRs and coder/abstracting/audit software; ability to communicate findings clearly.

Responsibilities

• Conduct pre-bill and post-bill audits to ensure accurate code assignment and DRG/APR-DRG outcomes.
• Provide education and guidance to inpatient coding staff; contribute to coding guidelines and SOPs.
• Collaborate with Revenue Cycle, CDI, Compliance, Internal Audit, and clinical stakeholders.
• Identify and mitigate mortality and high-risk DRG downgrade risks; support quality reporting.
• support denial mitigation and appeals; validate failed or rejected inpatient claims.

Skills

ICD-10-CM coding

ICD-10-PCS coding

DRG validation

CMS IPPS regulations

Auditing & chart review

EHR systems

Communications

Education

Associate degree in HIM / Health Information Technology

Bachelor's degree in HIM (preferred)

RHIA / RHIT / CCS certification (preferred)

Tools

Encoder software

Abstracting systems

Audit/reporting applications

Job description

Inpatient Coding Quality Analyst (Auditor)## Department:Health System Shared Services | MIM CDI and Coding**Remote Position**# Scope of PositionAfter inpatient medical records are coded within Medical Information Management (MIM), the Inpatient Coding Quality Analyst serves as a subject matter expert responsible for validating the accuracy, completeness, and compliance of ICD‐10‐CM/PCS coding and MS‐DRG/APR‐DRG assignment through both random and targeted audits of inpatient medical records.This position plays a critical role in supporting organizational goals related to regulatory compliance, reimbursement integrity, data quality, audit readiness, and institutional quality performance. The analyst independently evaluates complex clinical documentation and coding scenarios, resolves inpatient claim and coding edits, supports denial prevention and appeal activities, and collaborates with Revenue Cycle, Central Business Office (CBO), CDI, Compliance, Internal Audit, and clinical stakeholders.This role supports proactive identification and mitigation of DRG downgrade risk through targeted pre‐bill review, trend analysis, and feedback to coding leadership and CDI partners. The analyst provides actionable recommendations to improve coding accuracy, compliance, education strategy, and operational workflows.# Position SummaryThe Inpatient Coding Quality Analyst is responsible for driving inpatient coding quality improvement, compliance assurance, and claim integrity within a complex academic medical center environment. This role requires advanced knowledge of ICD‐10‐CM/PCS coding guidelines, Medicare Severity Diagnosis Related Groups (MS‐DRGs), APR‐DRGs, and payer‐specific inpatient billing and audit requirements.The analyst conducts pre‐bill and post‐bill audits of high‐risk, high‐dollar, and regulatory‐sensitive inpatient cases to ensure accurate code assignment and DRG/APR‐DRG outcomes that reflect the patient’s clinical severity, resource utilization, and services provided. Using IHIS and other abstracting, encoding, and reporting systems, the analyst documents audit results, trends, and recommendations to support continuous quality improvement and audit transparency.In addition to audit responsibilities, the analyst resolves complex inpatient claim and coding edits, including medical necessity, DRG validation, and National Correct Coding Initiative (NCCI) and other payer‐driven edit frameworks. The analyst supports denial mitigation and appeal efforts, validates failed or rejected inpatient claims, and collaborates with Revenue Cycle teams to ensure accurate and compliant billing.The analyst serves as a coding quality resource and educator, providing expert guidance to inpatient coding staff, participating in formal education sessions, and contributing to the development of coding guidelines, reference materials, and standard operating procedures.This role performs 100% pre‐bill review of inpatient mortality cases and targeted audits for stroke, cardiac device cases, and selected core measures. Audit activities support accurate mortality reporting, institutional quality metrics, and national benchmarking outcomes, including Vizient and U.S. News & World Report (USNWR) rankings.## **Minimum Qualifications – For Hire**### **Required*** Associate degree in **Health Information Management**, Health Information Technology, or a related field.* Minimum of **3–5 years of recent inpatient hospital coding experience** in an academic medical center or complex acute‐care hospital setting.* Demonstrated proficiency in **ICD‐10‐CM and ICD‐10‐PCS** coding, including validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS‐DRG/APR‐DRG assignment.* Experience reviewing complex inpatient medical records for **coding accuracy, compliance, and DRG integrity**, including high‐severity and high‐risk cases.* Working knowledge of **CMS IPPS regulations**, OIG compliance expectations, payer audits, DRG validation, and advanced inpatient claim edit frameworks.* Experience using **electronic health records (EHRs)** and health information management systems, including encoder, abstracting, and audit/reporting applications.* Ability to apply independent judgment in evaluating coding, documentation, compliance risk, and audit findings.* Strong written and verbal communication skills, including the ability to provide clear, educational feedback to coding staff and collaborate with CDI, Revenue Cycle, Quality, and Compliance partners.### **Preferred*** Bachelor’s degree in **Health Information Administration**, Health Information Management, or a related healthcare discipline.* Prior experience in **inpatient coding quality review, auditing, denial management, or compliance‐focused roles**.* Experience supporting **mortality case review, risk‐adjusted outcomes, and quality reporting** (e.g., SOI/ROM, Vizient, USNWR, PSI/HAC).* Experience in an **academic medical center** or multi‐hospital health system environment.### **Certification Requirements*** One of the following credentials required: + **Registered Health Information Administrator (RHIA)** + **Registered Health Information Technician (RHIT)** + **Certified Coding Specialist (CCS)** – AHIMA* Certification must be maintained in good standing.### **Ongoing Requirements*** Maintain required **continuing education credits (CEUs)** in accordance with AHIMA credential standards.* Participate in required coding, quality, audit, and departmental meetings.* Complete all mandatory health system training and hospital‐based learning modules (CBLs) in a timely manner.* Maintain current knowledge of inpatient coding guidelines, regulatory updates, and compliance initiatives.## Additional Information:## Location:Remote Location## Position Type:Regular## Scheduled Hours:40## **Shift:**First Shift***Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.***