Senior Coding Compliance Auditor - Hybrid

DaMar Staffing; Riverside (CA); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Riverside University Health System (RUHS) seeks two Coding Compliance Auditors to support its Compliance Department. The role involves reviewing medical records for coding accuracy, performing DRG-related audits, and educating staff on regulatory changes.

Ideal candidates have 5+ years in acute care settings with MS-DRG reimbursement, 3–5 years in coding audit, and CCS/CPC/RHIT/C DIP/CPMA-style credentials. Hybrid schedule in Riverside, CA.

Qualifications

• Five+ years in an acute care hospital setting with inpatient MS-DRG reimbursement.
• 3–5 years of coding audit or compliance auditing experience.
• Strong knowledge of CMS IPPS/OPPS, OIG Work Plan priorities, and physician documentation rules.

Responsibilities

• Conduct comprehensive audits of inpatient and outpatient records for ICD-10-CM/PCS, CPT, and HCPCS coding.
• Evaluate DRG assignments, diagnoses, procedures, CC/MCC capture, and POA indicators.
• Monitor compliance with Medicare, Medicaid, and payer policies.
• Identify risks related to medical necessity, upcoding, undercoding, and unbundling.
• Prepare audit reports with findings, root cause, and corrective actions.

Skills

MS-DRG reimbursement

Auditing experience

Regulatory knowledge

Communication skills

Education

Bachelor's degree in accounting, business, or public administration, information services, finance, or related field

Tools

3M Encoder

Optum Encoder

EPIC

Job description

Riverside University Health System (RUHS) seeks two Coding Compliance Auditors to support its Compliance Department. The role involves reviewing medical records for coding accuracy, performing DRG-related audits, and educating staff on regulatory changes.

Ideal candidates have 5+ years in acute care settings with MS-DRG reimbursement, 3–5 years in coding audit, and CCS/CPC/RHIT/C DIP/CPMA-style credentials. Hybrid schedule in Riverside, CA.