Senior Coding Auditor – Denials & Revenue Recovery

Baylor Scott & White Health; Salem (OR); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

PTO from Day 1

401(k) with match

Tuition Reimbursement

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to join the Denial Resource Center. The role reviews and appeals complex coding denials, using ICD-10-CM/PCS, CPT, DRG methods, and payer policies to secure appropriate reimbursements.

You will collaborate with Clinical Validation RNs and revenue cycle teams to strengthen documentation, coding accuracy, and trend analysis, driving lower denial rates and better financial performance.

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related field preferred.
• Six (6) or more years of experience in coding, coding audits, denial management, appeals, revenue cycle operations, or health information management.
• Certified Professional Coder (CPC), CCS, CCS-P, RHIT, RHIA, or equivalent coding certification required or preferred.
• Advanced knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG assignment, NCCI edits, and MUE guidelines.
• Strong understanding of CMS regulations, Medicare and Medicaid billing requirements, reimbursement methodologies, and commercial payer coding policies.

Responsibilities

• Review and audit coding-related denials to determine appropriate resolution and appeal strategies based on coding guidelines and payer rationale.
• Investigate and appeal complex HB/PB denials, including MUE denials, DRG downgrades, modifier denials, and other related reductions.
• Apply advanced coding knowledge to evaluate denied claims and determine appeal viability.
• Prepare and submit clear, compliant appeal documentation with supporting evidence.
• Identify denial trends and collaborate with teams to improve coding accuracy and reduce denials.

Skills

Coding audits

Denial management

CMS regulations

Education

Associate's or Bachelor's degree in Health Information Management

Tools

Epic

encoder software

payer portals

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to join the Denial Resource Center. The role reviews and appeals complex coding denials, using ICD-10-CM/PCS, CPT, DRG methods, and payer policies to secure appropriate reimbursements.

You will collaborate with Clinical Validation RNs and revenue cycle teams to strengthen documentation, coding accuracy, and trend analysis, driving lower denial rates and better financial performance.