The Inpatient Coding Quality Analyst (Auditor) is responsible for validating the accuracy, completeness, and compliance of inpatient coding within The Ohio State University Health System.
This role conducts both random and targeted audits of inpatient medical records after coding, with a focus on ICD-10-CM/PCS coding accuracy, MS-DRG/APR-DRG assignment, reimbursement integrity, audit readiness, and regulatory compliance.
The position supports denial prevention, appeal activities, pre-bill review, trend analysis, and collaboration with Revenue Cycle, Central Business Office, CDI, Compliance, Internal Audit, and clinical stakeholders.
The analyst also serves as a coding quality resource, providing feedback, education, and recommendations to improve coding accuracy, workflow efficiency, and compliance outcomes.
Key responsibilities include:
- Pre-bill and post-bill audits of high-risk and high-dollar inpatient cases
- Validation of DRG assignment and code accuracy
- Review of claim and coding edits, including NCCI and payer-driven edits
- Support for denial mitigation and appeals
- Review of mortality cases and targeted audits for stroke, cardiac device, and core measure cases
- Documentation of audit findings, trends, and recommendations
- Collaboration with coding leadership and CDI partners to improve quality metrics and outcomes
Required 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
- Experience validating principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS-DRG/APR-DRG assignment
- Experience reviewing complex inpatient 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 using EHRs, encoder systems, abstracting tools, and audit/reporting applications
- Strong written and verbal communication skills
- Ability to apply independent judgment in evaluating coding and compliance risk
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 review, risk-adjusted outcomes, and quality reporting
- Experience in an academic medical center or multi-hospital health system
Certification Requirements
- One of the following credentials required: RHIA, RHIT, or CCS
- Certification must be maintained in good standing
Ongoing Requirements
- Maintain continuing education credits in accordance with AHIMA standards
- Participate in coding, quality, audit, and departmental meetings
- Complete required health system training and learning modules
- Maintain current knowledge of inpatient coding guidelines, regulatory updates, and compliance initiatives
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
2 months ago