Inpatient Coding Compliance Auditor

At Memorial Healthcare System, the Inpatient Coding Compliance Auditor is responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. The role involves reviewing Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG), and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries, following official coding guidelines and regulatory requirements. The auditor provides training and education based on audit results and regulatory changes affecting Federal, State, and AHIMA guidelines.

Key responsibilities include maintaining thorough knowledge of ICD-10 CM/PCS and CPT coding principles and guidelines, conducting and reporting on electronic medical record audits to verify coding and grouping accuracy, supporting coding staff as an expert resource, analyzing and resolving claim denials, coordinating coder intern education and training aligned with AHIMA standards, holding educational sessions, and ensuring adherence to patient confidentiality and compliance standards.

Candidates must have a background in Health Information Management through an accredited program and hold certifications such as Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT). Experience of three years in inpatient or outpatient coding audit is required.

The role is primarily office-based with responsibilities encompassing training, auditing, and collaboration with coding and revenue cycle departments. It demands critical thinking, attention to detail, excellent communication skills, and the ability to work independently and under pressure. Basic computer proficiency and familiarity with electronic medical records and coding software are essential.