Responsible for validating the accuracy, completeness, and compliance of inpatient ICD-10-CM/PCS coding and MS-DRG/APR-DRG assignment through random and targeted audits of inpatient medical records.
This role supports regulatory compliance, reimbursement integrity, data quality, audit readiness, and institutional quality performance. It independently reviews complex clinical documentation and coding scenarios, resolves inpatient claim and coding edits, supports denial prevention and appeal activities, and collaborates with Revenue Cycle, CDI, Compliance, Internal Audit, and clinical stakeholders.
The analyst also performs pre-bill and post-bill reviews of high-risk, high-dollar, and regulatory-sensitive inpatient cases, documents audit findings and trends, and provides recommendations to improve coding accuracy, compliance, education, and workflows.
Additional responsibilities include pre-bill review of inpatient mortality cases and targeted audits for stroke, cardiac device cases, and selected core measures to support accurate mortality reporting and quality performance metrics.
Minimum qualifications
- Associate degree in Health Information Management, Health Information Technology, or a related field
- 3–5 years of recent inpatient hospital coding experience in an academic medical center or complex acute-care hospital setting
- Proficiency in ICD-10-CM and ICD-10-PCS coding, including principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS-DRG/APR-DRG assignment
- Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity
- Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and inpatient claim edit frameworks
- Experience with EHRs and HIM systems, including encoder, abstracting, and audit/reporting applications
- Ability to apply independent judgment to coding, documentation, compliance risk, and audit findings
- Strong written and verbal communication skills
Preferred qualifications
- Bachelor's degree in Health Information Administration, Health Information Management, or a related healthcare discipline
- Prior experience in inpatient coding quality review, auditing, denial management, or compliance-focused roles
- Experience supporting mortality case review, risk-adjusted outcomes, and quality reporting
- Experience in an academic medical center or multi-hospital health system environment
Certification requirements
- One of the following credentials is required: RHIA, RHIT, or CCS (AHIMA)
- Certification must be maintained in good standing
- Ongoing CEUs required per AHIMA standards
Location
Ohio, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
2 months ago