Senior Coding Auditor - Denials & Reimbursement

Baylor Scott & White Health; Little Rock (AR); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Tuition Reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with a multidisciplinary team to resolve complex coding denials for Hospital and Professional Billing. You will review, audit, and appeal challenging denials using ICD-10-CM/PCS, CPT, and payer policies, while collaborating with Clinical Validation RNs to ensure documentation supports billed services.

You will analyze denial trends, perform root cause analysis, and help improve revenue cycle performance by reducing

Qualifications

• Bachelor's degree in HIM or related field.
• Coding certification (CPC/CCS/RHIA/RHIT) preferred or required.
• 6+ years in coding, audits, denial management, appeals, or revenue cycle.

Responsibilities

• Review and audit denials to determine resolution and appeal strategies.
• Investigate and appeal HB/PB denials including MUE, DRG downgrades, and modifier denials.
• Apply ICD-10-CM/PCS, CPT, HCPCS, DRG methodologies and payer guidelines.
• Prepare and submit compliant appeal documentation with supporting references.
• Collaborate with RNs and revenue cycle teams to resolve denial issues.
• Perform root cause analysis to identify denial trends and process improvements.
• Communicate findings and outcomes to leadership for denial prevention.
• Maintain accurate documentation and system activity for audits.

Skills

ICD-10-CM

ICD-10-PCS

CPT coding

CMS regulations

Communication

Education

Health Information Management degree

Coding certification (CPC/CCS/RHIA/RHIT)

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 denials for Hospital and Professional Billing. You will review, audit, and appeal challenging denials using ICD-10-CM/PCS, CPT, and payer policies, while collaborating with Clinical Validation RNs to ensure documentation supports billed services.

You will analyze denial trends, perform root cause analysis, and help improve revenue cycle performance by reducing