Inpatient Coding Quality Lead

City of Hope; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

City of Hope in the United States seeks an Inpatient Coding Quality Auditor to independently evaluate coding accuracy, compliance, and reimbursement integrity across inpatient encounters. The role collaborates with Coding leadership, CDI, Quality, and Revenue Cycle teams to ensure adherence to Official Coding Guidelines and CMS rules.

The successful candidate will conduct pre-bill and retrospective audits, validate DRG assignments, monitor compliance risks, and provide education to coding staff

Qualifications

• Graduate of an accredited HIM/HIT/Healthcare program (associate degree or higher) or equivalent with anatomy and physiology coursework.
• Seven (7) years of acute care inpatient coding experience in a hospital or cancer center setting.
• Experience assigning ICD-10-CM/PCS codes for inpatient encounters and MS-DRGs/APR-DRGs.
• Experience conducting coding audits, validation reviews, and education activities.
• Knowledge of Official Coding Guidelines, Coding Clinic guidance, CMS regulations, and payer requirements.

Responsibilities

• Conduct routine, targeted, pre-bill and retrospective coding audits to evaluate accuracy and compliance.
• Review inpatient encounters to validate diagnoses, procedures, abstraction quality, and data integrity.
• Perform independent validation of complex coding, DRG/APR-DRG assignments and quality reporting elements.
• Monitor compliance risk areas, regulatory updates, and payer audit findings; provide recommendations.
• Prepare audit findings, scorecards, and staff coaching recommendations; drive continuous improvement.

Skills

ICD-10-CM/PCS coding

Auditing

MS-DRGs/APR-DRGs

Regulatory compliance

Communication skills

Education

HIM/HIT/Healthcare Admin degree

Anatomy & physiology coursework

Job description

City of Hope in the United States seeks an Inpatient Coding Quality Auditor to independently evaluate coding accuracy, compliance, and reimbursement integrity across inpatient encounters. The role collaborates with Coding leadership, CDI, Quality, and Revenue Cycle teams to ensure adherence to Official Coding Guidelines and CMS rules.

The successful candidate will conduct pre-bill and retrospective audits, validate DRG assignments, monitor compliance risks, and provide education to coding staff