Coding Compliance Auditor

This remote position involves auditing hospital inpatient, outpatient, and surgical encounter visits for accurate reimbursement, research, and compliance with coding standards. The role requires expertise in ICD-10-CM/PCS and CPT-4 coding systems, with responsibilities including auditing, consulting, training, and ensuring coding accuracy.

Location: Remote (EST or CST hours)

Responsibilities

• Audit ICD-10 diagnostic codes and CPT-4 procedure codes for outpatient, ambulatory surgery, and observation visits.
• Audit complex inpatient cases such as trauma, rehab, neurology, critical care, etc., ensuring accurate coding and assignment.
• Serve as a clinical coding subject matter expert, analyze documentation issues, and consult with medical staff.
• Provide training and guidance to coding specialists, monitor coding quality and productivity, and conduct specialized audits.
• Communicate with hospital departments regarding coding accuracy, assist in writing coding queries, and collaborate with Clinical Documentation Improvement (CDI) teams.
• Ensure compliance with AHIMA standards and coding guidelines, support the client’s mission and policies, and perform additional duties as assigned.

Requirements

• High School graduate or equivalent with formal ICD-10-CM, ICD-10-PCS, CPT-4 training.
• Associates or Bachelor’s degree; education may substitute for experience.
• Minimum of two years ICD-10-CM/ICD-10-PCS coding and abstracting experience at a Level 1 Trauma hospital or four years of inpatient hospital coding experience.
• 2-3 years of ambulatory coding experience.
• Inpatient auditing experience.