Certified Inpatient Coding Auditor

Job Summary

To support a culture of continuous improvement, the full-time remote Certified Inpatient Coding Auditor will perform clinical reviews of medical records, ensuring claims coding accuracy and compliance with regulatory guidelines.

Key responsibilities:

• Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles
• Ensures claims analysis complies with ethical coding standards and validates issues of medical necessity
• Researches reimbursement regulations and assists in developing claims audit process documentation

Required qualifications:

• Registered Nurse with 2+ years of experience in inpatient claims, preferably NICU and maternity
• Inpatient Coding Certification (CCS or CIC) required, or must obtain within 6 months of hire
• Strong understanding of MS-DRG, AP-DRG, and APR-DRG payment systems
• Expert knowledge of DRG, ICD-10, CPT, and HCPCS codes
• Experience with appeals and familiarity with medical claims billing/payment systems