Senior Medical Coding Auditor: DRG, CPT & CMS Expert

Highmark Health; Pennsylvania; Hybrid; USD 47,000 - 75,000; Full time

Job summary

Highmark Health is seeking a senior coding auditor to evaluate medical records for accuracy of DRG, OPPS and outpatient billing. You will generate findings, train staff, and guide improvements across system entities.

You will interact with external auditors and consultants, ensuring compliance with HIPAA and CMS guidelines. The role requires deep knowledge of DRGs, CPT and ICD coding, plus strong analytical and communication skills.

Qualifications

• Bachelor’s Degree and RHIA certification or 10+ years in medical records.
• AHIMA or AAPC credentials listed for inpatient/outpatient.
• 7+ years hospital coding and auditing experience.
• Proficient with DRGs, ICD-10, and CMS coding guidelines.
• Strong written and verbal communication; ability to train staff.

Responsibilities

• Audit documentation, coding and billing across system entities.
• Develop and deliver training materials addressing audit deficiencies.
• Consult with management; provide written guidance on external audit findings.
• Attend meetings to advise on new programs and resolve issues.
• Maintain knowledge of DRGs, CPT, ICD coding and CMS changes.
• Mentor staff and act as subject matter expert.

Skills

Documentation and reporting

Communication

Microsoft Word

Excel

PowerPoint

Education

Bachelor’s Degree

RHIA/ RHIT / CCS / CPC-H / CPC / COC / CPMA

Tools

CMS guidelines

DRGs

ICD coding

Job description

Highmark Health is seeking a senior coding auditor to evaluate medical records for accuracy of DRG, OPPS and outpatient billing. You will generate findings, train staff, and guide improvements across system entities.

You will interact with external auditors and consultants, ensuring compliance with HIPAA and CMS guidelines. The role requires deep knowledge of DRGs, CPT and ICD coding, plus strong analytical and communication skills.