Senior Coding Auditor: DRG & ICD-10 Expert

AdventHealth; Florida; On-site; USD 67,000 - 124,000; Full time

Benefits offered by this job

Benefits from Day One

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave (4 weeks)

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Job summary

AdventHealth in Florida is seeking a dedicated coding auditor to execute pre-bill high-risk audits across inpatient and outpatient encounters, ensuring precise ICD-10-CM/PCS or CPT/HCPCS coding and robust DRG/IPPS/APC methodology application.

You will partner with CDI and physicians to resolve complex documentation issues, support retrospective reviews for improvement, and help drive enterprise risk mitigation with accurate reimbursements.

Qualifications

• Associates degree and 6+ years of related work experience, or equivalent.
• 6+ years of acute care inpatient or outpatient hospital coding experience.
• 4+ years of auditing experience.
• Bachelor's degree preferred.

Responsibilities

• Conduct pre-bill high-risk audits across inpatient and/or outpatient encounters targeting complex, high-acuity, and high impact cases.
• Performs advanced DRG validation, including MCC/CC integrity and clinical documentation alignment on inpatient audits.
• Reviews and validates ICD-10-CM/PCS or CPT/HCPCS and modifier usage, DRG/IPPS and/or OPPS/APC methodologies.
• Partners with CDI, physicians, and coding teams to resolve complex documentation and coding scenarios prior to billing.
• Collaborates with CDI on Retrospective reviews to identify documentation and coding opportunities and improve accuracy.
• Performs and supports CloudMed DRG validation reviews and/or charge capture reviews, ensuring accurate representation of patient acuity and appropriate reimbursement.

Skills

EMR/CAC systems

ICD/CPT coding

Clinical documentation

Regulatory guidance

Risk mitigation

Analytical skills

Audit feedback

Collaboration

Time management

MS Office

Education

Associates degree

Bachelors degree (preferred)

Tools

Epic

Optum

Job description

AdventHealth in Florida is seeking a dedicated coding auditor to execute pre-bill high-risk audits across inpatient and outpatient encounters, ensuring precise ICD-10-CM/PCS or CPT/HCPCS coding and robust DRG/IPPS/APC methodology application.

You will partner with CDI and physicians to resolve complex documentation issues, support retrospective reviews for improvement, and help drive enterprise risk mitigation with accurate reimbursements.