Clinical Coding Auditor

Job Summary

To ensure coding accuracy and clinical chart validation for inpatient audits, the full-time Clinical Coding Auditor will analyze claims, utilize proprietary audit tools, and maintain productivity and quality standards while working remotely.

Key responsibilities

• Analyzes and audits inpatient claims using advanced ICD-10 coding expertise and clinical guidelines
• Effectively utilizes proprietary auditing systems to make determinations and generate audit documentation
• Meets or exceeds established standards for productivity, accuracy, and quality in auditing processes

Required qualifications

• Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT) or equivalent experience in claims auditing
• Active coding/CDI certification (e.g., RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS)
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG in claims auditing
• Expert knowledge of coding guidelines, medical necessity criteria, and payer reimbursement policies
• Proficiency in Microsoft Office applications and familiarity with industry-based standards