Senior Coding Auditor - Denials & Revenue Recovery

Baylor Scott & White Health; Salt Lake City (UT); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health benefits

401(k) matching up to 5%

Tuition Reimbursement

PTO accrual Day 1

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to join the Denial Resource Center. The role focuses on reviewing, auditing, and appealing moderate to high-complexity coding denials across Hospital Billing and Professional Billing.

You will leverage ICD-10-CM/PCS, CPT/HCPCS, DRG methodologies, and payer policies to improve revenue cycle performance. You will collaborate with Clinical Validation RNs and revenue cycle teams, identify denial trends, and develop persuasive appeal

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related field preferred.
• Certification in RHIA/RHIT/CCS/CCS-P/CPC or equivalent coding certification is common in this role.
• Six or more years of experience in coding, coding audits, denial management, appeals, revenue cycle operations, or health information management.

Responsibilities

• Review and audit coding-related denials to determine resolution and appeal strategies.
• Investigate and appeal complex HB/PB denials, including MUE denials and DRG downgrades.
• Comply with ICD-10-CM/PCS, CPT, HCPCS, DRG assignment, NCCI edits, and MUE guidelines when evaluating claims.
• Prepare and submit clear, concise appeal documentation.
• Perform root cause analysis to identify denial trends and improvement opportunities.
• Communicate findings and trend analysis to leadership to support denial prevention.

Skills

Analytical thinking

Written communication

Verbal communication

Epic

Encoder software

Payer portals

Excel

Word

Education

Associate's or Bachelor's degree in Health Information Management / related field

Tools

Epic

Encoder software

Payer portals

Excel

Word

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to join the Denial Resource Center. The role focuses on reviewing, auditing, and appealing moderate to high-complexity coding denials across Hospital Billing and Professional Billing.

You will leverage ICD-10-CM/PCS, CPT/HCPCS, DRG methodologies, and payer policies to improve revenue cycle performance. You will collaborate with Clinical Validation RNs and revenue cycle teams, identify denial trends, and develop persuasive appeal