Responsible for auditing coded inpatient or outpatient medical records using ICD-10-CM/PCS and/or CPT-4 coding standards. Reviews APC, MSDRG, and APRDRG assignments and queries in accordance with official coding guidelines and regulatory requirements.
Conducts electronic medical record audits to verify coding and grouping accuracy, serves as an expert resource for coding staff, and works with coding managers to resolve claim denials and external audit findings. Also provides coding education, supports coder intern training, and helps maintain compliant physician query processes.
Maintains knowledge of ICD-10-CM/PCS, CPT, MSDRG, APRDRG, APC, and EAPG classification systems, while ensuring adherence to patient confidentiality and organizational standards.
Education and certification
- Accredited program in Health Information Management required
- One of the following required for hospital coding:
- CCS from AHIMA
- RHIA from AHIMA
- RHIT from the State of Florida
- For physician coding, one of the following may be accepted:
- CPC
- HCC
- CRC
- CPMA
Experience
- 3 years of inpatient coding experience for inpatient auditor roles
- 3 years of outpatient coding experience for outpatient auditor roles
Skills
- Strong knowledge of ICD-10-CM/PCS, CPT, APC, MSDRG, APRDRG, and query compliance standards
- Critical thinking and decisive judgment
- Effective written and verbal communication skills
- Time management and teamwork
- Ability to work with minimal supervision
- Proficiency with Microsoft Office, computerized encoders, and electronic medical record systems
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 week ago