Senior Compliance Coordinator - Inpatient Audit

University of Iowa; Iowa City (IA); Hybrid; USD 75,000 - 105,000; Full time

Job summary

The University of Iowa is seeking a Senior Compliance Coordinator to lead inpatient coding audits and ensure alignment with CMS regulations and payer requirements. You will review medical records, validate ICD-10-CM/PCS codes, POA indicators, and MS-DRG assignments while ensuring documentation supports coding decisions.

Responsibilities include preparing comprehensive audit reports, providing education on findings, and collaborating with HIM, Coding, CDI, and Revenue Integrity teams to mitigate

Qualifications

• Bachelor's degree in health information management or related field or equivalent combo of education and experience.
• Active coding credential through AHIMA/AAPC (RHIT/RHIA/CCS/CCS-P/CIC/CPC).
• 5 years of inpatient coding experience.
• Extensive knowledge of ICD-10-CM/PCS, MS-DRG, official coding guidelines, CMS inpatient billing rules, Medicare/Medicaid reimbursements, and clinical documentation requirements.
• Strong analytical, investigative, and problem-solving skills.
• Excellent written, verbal, and presentation abilities.
• Proficiency with EMR, encoder apps, DRG validation tools, and MS Office.
• Experience in a respectful workplace environment.

Responsibilities

• Conduct inpatient coding and documentation audits per policies and CMS/payor requirements.
• Review records to validate ICD-10-CM/PCS codes, diagnoses, POA indicators, and MS-DRG assignments.
• Evaluate compliance with Medicare, Medicaid, and commercial payor billing requirements.
• Research and interpret coding, billing, and regulatory guidance to support findings.
• Analyze audit results to identify trends, risks, and education opportunities.
• Prepare detailed audit reports with findings, financial implications, and corrective actions.
• Follow-up with stakeholders to ensure corrective actions are implemented.
• Assist with investigations involving inpatient coding, billing, and documentation concerns.
• Use RAT-STATS to determine samples and extrapolate overpayments.
• Collaborate with HIM, Coding, CDI, PFS, Revenue Integrity, and Compliance teams to address issues.
• Conduct audit meetings and education sessions with staff and leadership.
• Perform audits as needed per policy and guidelines.
• Monitor regulatory updates to coding guidelines and CMS rules.
• Maintain audit documentation and evidentiary support.
• Participate in developing audit methodologies and educational materials.

Skills

Inpatient coding expertise

Analytical and investigative skills

Excellent written and verbal comms

Presentation skills

EMR and coding tools proficiency

Cross-functional collaboration

Problem-solving skills

CMS inpatient billing knowledge

Education

Bachelor's degree in health information management or related field

Equivalent combination of education and experience

Active coding credential (RHIT, RHIA, CCS, CCS-P, CIC, or CPC)

Inpatient coder certification

Tools

Encoder applications

DRG validation tools

Microsoft Office

Electronic medical records systems

Job description

Key Responsibilities

• Conduct inpatient coding and documentation audits in accordance with organizational policies, CMS regulations, Official Coding Guidelines, and payor requirements.
• Review medical records to validate ICD-10-CM and ICD-10-PCS code assignment, principal diagnosis selection, procedure coding, Present on Admission (POA) indicators, and MS-DRG assignment by ensuring codes are fully supported by documented clinical indicators.
• Evaluate compliance with Medicare, Medicaid, and commercial payor billing requirements.
• Research and interpret coding, billing, and regulatory guidance to support audit findings and recommendations.
• Analyze audit results to identify trends, compliance risks, educational opportunities, and potential overpayment concerns.
• Prepare detailed written audit reports that clearly communicate findings, regulatory support, financial implications, and corrective action recommendations.
• Follow-up with key stakeholders to ensure completion and implementation of corrective actions.
• Assist with compliance investigations involving inpatient coding, billing, and documentation concerns.
• Utilize RAT-STATS to identify random samples and statistical values in extrapolating overpayments.
• Collaborate with Health Information Management (HIM), Coding, CDI, Patient Financial Services, Revenue Integrity, and Compliance teams to address identified issues.
• Conduct audit meetings and education sessions with coding professionals, CDI staff, providers, and leadership regarding audit findings and regulatory requirements.
• Perform professional coding and documentation audits on an as needed basis in accordance with organizational policies, CMS regulations, Official Coding Guidelines, and payor requirements.
• Monitor regulatory updates and changes to coding guidelines, CMS rules, and payor policies affecting inpatient reimbursement and compliance.
• Maintain audit documentation, workpapers, and supporting evidence in accordance with departmental standards.
• Participate in development and maintenance of audit methodologies, policies, procedures, and educational materials.

Required Qualifications

• A bachelor's degree in health information management or related field, or equivalent combination of education and experience is required.
• Active coding credential such as RHIT, RHIA, CCS, CCS-P, CIC, or CPC through a nationally recognized credentialing body such as AHIMA or AAPC.
• 5 years of inpatient coding experience.
• Extensive knowledge of
  • ICD-10-CM and ICD-10-PCS coding
  • MS-DRG methodology
  • Official Coding Guidelines
  • CMS inpatient billing regulations
  • Medicare and Medicaid reimbursement requirements
  • Clinical documentation requirements
• Strong analytical, investigative, and problem-solving skills.
• Excellent written, verbal, and presentation skills.
• Proficiency with electronic medical records, encoder applications, DRG validation tools, and Microsoft Office applications.
• Demonstrated experience working effectively in a welcoming and respectful workplace environment.

Desired Qualifications

• Prior inpatient coding audit or compliance audit experience.
• Inpatient coder certification.
• 1-3 years professional coding experience including CPT and HCPCS coding.
• Experience conducting provider or coder education.
• Experience in an academic medical center or teaching hospital environment.
• Knowledge of OIG Work Plan priorities, compliance program requirements, and overpayment investigation processes.
• Experience with statistical sampling methodologies and audit data analysis.
• Familiarity with CDI practices and documentation improvement initiatives.

  Additional Information

  • Classification Title: Senior Compliance Coordinator
  • Appointment Type: Professional and Scientific
  • Schedule: Full-time
  • Work Modality Options: Hybrid within Iowa

  Compensation

  • Pay Level: 4B

  Contact Information

  • Organization: Healthcare
  • Contact Name: Sharon Walther
  • Contact Email: [e-mail]

  This position is not eligible for University sponsorship for employment authorization now or in the future.

  This position is eligible for hybrid work within Iowa and will require a work arrangement form to be completed upon the start of your employment. Per policy, work arrangements will be reviewed annually, and must comply with the remote work program and related policies and employee travel policy when working at a remote location.