Description

The Inpatient and Outpatient Coding Auditor is responsible for conducting comprehensive audits of inpatient and outpatient medical coding to ensure compliance with federal and state regulations, payer requirements, coding guidelines, and organizational policies. This position evaluates coding accuracy, documentation integrity, reimbursement optimization, and compliance with ICD-10-CM/PCS, CPT®, HCPCS, and official coding guidelines. The auditor provides education, feedback, and recommendations to coding professionals, providers, and leadership to improve coding quality, reduce compliance risk, and enhance revenue cycle performance.

Requirements

Perform comprehensive coding audits for inpatient and outpatient records to ensure compliance with ICD-10-CM, ICD-10-PCS, and CPT/HCPCS guidelines.

Evaluate coding accuracy, documentation quality, and adherence to regulatory and payer requirements.

Develop and deliver educational programs, training sessions, and feedback based on audit findings.

Provide one-on-one coaching to coders to improve performance and resolve coding discrepancies.

Monitor and report coding trends, audit results, and compliance risks to leadership.

Stay current with coding updates, regulations, and industry best practices.

Collaborate with providers and clinical staff to improve clinical documentation integrity (CDI).Assist in developing and maintaining coding policies, procedures, and training materials.

Support internal and external audits and regulatory reviews.