Senior Coding Auditor — Denials & Appeals

Baylor Scott & White Health; Augusta (ME); On-site; USD 65,000 - 90,000; Full time

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with a multidisciplinary team to resolve complex coding-related denials for Hospital and Professional Billing. The role requires advanced knowledge of inpatient and outpatient coding, CMS rules, payer policies, and documentation support to drive successful appeals.

You will work with Clinical Validation RNs and other revenueCycle teams to improve coding accuracy, reduce denials, and enhance overall revenue cycle performance,

Qualifications

• Education as above and six+ years of coding, auditing, denial management or revenue cycle experience.
• Experience with inpatient/outpatient coding, ICD-10-CM/PCS, CPT/HCPCS and DRG rules.

Responsibilities

• Review and audit coding-related denials to determine resolution and appeal strategy.
• Investigate and appeal HB and PB denials including MUE denials and DRG downgrades.
• Apply knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG assignment, NCCI edits and MUE guidelines.
• Prepare and submit compliant appeal documentation with supporting references.
• Research and validate coding and reimbursement positions; communicate recommendations.
• Perform root cause analysis to identify denial trends and improvement opportunities.
• Communicate findings and trends to leadership and stakeholders to support prevention initiatives.

Skills

Analytical thinking

Written communication

Verbal communication

Attention to detail

Regulatory knowledge

Education

High school diploma or GED

Health Information Management or related degree preferred

Tools

Epic

Encoder software

Payer portals

Excel

Word

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with a multidisciplinary team to resolve complex coding-related denials for Hospital and Professional Billing. The role requires advanced knowledge of inpatient and outpatient coding, CMS rules, payer policies, and documentation support to drive successful appeals.

You will work with Clinical Validation RNs and other revenueCycle teams to improve coding accuracy, reduce denials, and enhance overall revenue cycle performance,