Senior Coding Auditor: Drive Medical Coding Excellence

Highmark Health; Philadelphia (Philadelphia County); On-site; USD 39,000 - 61,000; Full time

Job summary

Allegheny Health Network in Philadelphia is seeking a Coding Auditor to perform internal and external coding audits, ensuring data accuracy for DRGs, APCs, CPT/HCPCS and ICD coding. You will generate actionable findings and educate teams to optimize reimbursement in line with regulations.

Responsibilities include developing audit reports, training staff, validating code sets, and maintaining compliance with HIPAA and coding guidelines while collaborating with management and external auditors.

Qualifications

• Minimum 5 years with hospital or physician coding and/or auditing; internal transfer candidates may have 3 years.
• In-depth knowledge of ICD-CM, ICD-PCS, CPT/HCPCS; DRG/APC structure; National Correct Coding Initiatives.
• Proficiency with encoder, grouper, and abstracting software; strong analytical and communication skills.

Responsibilities

• Plan and conduct audits of documentation, coding and billing for AHN entities.
• Develop audit materials and deliver training to address deficiencies.
• Validate ICD-CM/ICD-PCS, CPT and HCPCS codes and DRG/APC structure.
• Create inpatient case mix reports and monitor top DRGs/APCs.
• Ensure compliance with coding guidelines and regulatory requirements.
• Mentor new staff and support coding manager.
• Provide facility education on coding guidelines and documentation techniques.
• Collaborate with external audits and respond to findings.

Skills

Analytical skills

Communication skills

Coding/auditing experience

Education techniques

Education

AAPC CPC/COC/CPMA

RHIT/CCS

Associate's Degree

Tools

Encoder software

Grouper

Abstracting software

Coding guidelines

Job description

Allegheny Health Network in Philadelphia is seeking a Coding Auditor to perform internal and external coding audits, ensuring data accuracy for DRGs, APCs, CPT/HCPCS and ICD coding. You will generate actionable findings and educate teams to optimize reimbursement in line with regulations.

Responsibilities include developing audit reports, training staff, validating code sets, and maintaining compliance with HIPAA and coding guidelines while collaborating with management and external auditors.