Senior Medical Coding Auditor – DRG/ICD-10 Expert

AdventHealth Corporate; Orlando (FL); On-site; USD 67,000 - 124,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

PTO from Day One

403(b) Retirement Plan

Parental Leave

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth Corporate seeks an experienced CDI/audit professional to conduct pre-bill high-risk audits across inpatient and outpatient encounters, ensuring ICD-10-CM/PCS and CPT/HCPCS accuracy. You will validate DRG/IPPS/APC/OPPS methodologies and work with CDI and physicians to resolve complex coding scenarios before billing.

Required CCS/RHIA/RHIT/CPC/CIRCC certification and 6+ years in acute care coding or auditing, with strong regulatory knowledge and cross-functional collaboration skills.

Qualifications

• Proficient with EMR systems (Epic/Optum) and CAC.
• Advanced ICD-10-CM/PCS and CPT/HCPCS coding knowledge.
• Strong regulatory knowledge (CMS, OIG, NCCI, OPPS, IPPS).
• Excellent analytical and problem-solving abilities.
• Effective cross-functional communication and collaboration.
• Able to meet deadlines under pressure.
• Microsoft 365 proficiency.

Responsibilities

• Perform pre-bill high-risk audits across inpatient/outpatient encounters.
• Validate DRG/IPPS/APC/OPPS accuracy and coding alignment.
• Collaborate with CDI, physicians, and coding teams to resolve complex cases.
• Support RAC and post-payment audit rebuttals and denials.
• Track audit outcomes, risk exposure, and education needs.

Skills

ICD-10-CM/PCS

CPT/HCPCS

DRG/IPPS

APC/OPPS

Clinical documentation

Regulatory guidance

Analytical skills

Effective communication

Time management

Microsoft 365

Education

Associates degree

Bachelor's degree

Tools

Epic EMR

Optum CAC

Job description

AdventHealth Corporate seeks an experienced CDI/audit professional to conduct pre-bill high-risk audits across inpatient and outpatient encounters, ensuring ICD-10-CM/PCS and CPT/HCPCS accuracy. You will validate DRG/IPPS/APC/OPPS methodologies and work with CDI and physicians to resolve complex coding scenarios before billing.

Required CCS/RHIA/RHIT/CPC/CIRCC certification and 6+ years in acute care coding or auditing, with strong regulatory knowledge and cross-functional collaboration skills.