Senior Inpatient Coding Compliance Auditor

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

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