Senior Medical Coding Auditor & Educator

Highmark Health; Northern (KY); Hybrid; USD 47,000 - 75,000; Full time

Job summary

Allegheny Health Network is seeking a Senior Coding Auditor to evaluate medical records for DRG, OPPS and outpatient claim accuracy. You will report findings verbally and in writing, and guide education, process changes and risk reduction across the system.

The role involves mentoring staff, keeping current with CMS and ICD coding rules, and presenting clear recommendations to management and external regulators. Strong communication and MS Office skills are essential.

Qualifications

• Bachelor’s Degree and RHIA certification or 10 years in medical records with one related certification
• AAPC/AHIMA credentials listed in the job description
• Minimum 7 years’ hospital coding and auditing experience
• Proficiency in DRGs, NCCI, ICD-10 guidelines, OPPS and CMS rules
• Strong analytical and communication skills; proficient report writing and training material creation
• Ability to explain findings to staff, management and regulatory bodies
• Proficient in Word, Excel and PowerPoint

Responsibilities

• Audits and reports on documentation, coding and billing across System entities
• Develops and delivers training to address audit deficiencies
• Consults with management and drafts written guidance
• Keeps coding knowledge current with DRGs, CPT, ICD CMS changes
• Mentors staff as SME and supports new programs
• Performs other duties as assigned or required

Skills

Auditing

Healthcare coding

Regulatory knowledge

Communication

Microsoft Office

Education

Bachelor’s Degree / RHIA eligible

RHIA or RHIT certification

Master’s Degree

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Allegheny Health Network is seeking a Senior Coding Auditor to evaluate medical records for DRG, OPPS and outpatient claim accuracy. You will report findings verbally and in writing, and guide education, process changes and risk reduction across the system.

The role involves mentoring staff, keeping current with CMS and ICD coding rules, and presenting clear recommendations to management and external regulators. Strong communication and MS Office skills are essential.