Senior DRC Coding Auditor - Denial Resolution

Baylor Scott & White Health; Topeka (KS); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health benefits

401(k) match up to 5%

Tuition reimbursement

PTO accrual Day 1

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with a multi-disciplinary team to resolve complex coding denials for Hospital and Professional Billing. You will audit, appeal, and report on denials, DRG downgrades, and clinical validation disputes, ensuring documentation supports billed services.

The role requires deep knowledge of ICD-10, CPT, HCPCS, and payer policies, plus collaboration with Clinical Validation RNs to improve revenue cycle performance and reduce denials

Qualifications

• High school diploma or GED required; associate's or bachelor's preferred in relevant field.
• Advanced knowledge of inpatient and outpatient coding principles and CMS guidelines.

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.
• Apply codings guidelines and payer policies when evaluating denied claims.
• Prepare and submit compliant appeal documentation with medical record support.
• Perform root cause analysis to identify denial trends and opportunities for improvement.
• Communicate denial findings and trends to leadership to support denial prevention initiatives.
• Maintain accurate documentation and ensure audit readiness within systems.

Skills

Analytical skills

Written communication

Verbal communication

Team collaboration

Attention to detail

Education

H.S. Diploma / GED

Associate or Bachelor in Health Information Management or related

Healthcare certifications (CPC / CCS / RHIT / RHIA)

Tools

Epic

Encoder software

Payer portals

Excel

Word

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with a multi-disciplinary team to resolve complex coding denials for Hospital and Professional Billing. You will audit, appeal, and report on denials, DRG downgrades, and clinical validation disputes, ensuring documentation supports billed services.

The role requires deep knowledge of ICD-10, CPT, HCPCS, and payer policies, plus collaboration with Clinical Validation RNs to improve revenue cycle performance and reduce denials