Inpatient Coding Quality Analyst (Auditor)
Core
Validates accuracy, completeness, and compliance of inpatient ICD-10-CM/PCS coding and MS-DRG/APR-DRG assignment through random and targeted audits of complex medical records.
Role type
Inpatient Coding Quality Analyst (Auditor)
Builds
Audit reports, trend analyses, and educational feedback to improve coding accuracy and compliance.
Domain
Healthcare / Health Information Management / Revenue Cycle
Required skills
ICD-10-CM/PCS coding, MS-DRG/APR-DRG assignment, pre-bill and post-bill auditing, EHR and HIM systems, CMS IPPS regulations, NCCI edits, denial mitigation, clinical documentation review
Preferred skills
RHIA/RHIT/CCS certification, mortality case review, risk-adjusted outcomes reporting, academic medical center experience
Technologies
IHIS, EHRs, encoder applications, abstracting systems, audit/reporting applications
Responsibilities
Conduct pre-bill and post-bill audits of high-risk inpatient cases; resolve complex claim and coding edits; support denial prevention and appeal activities; provide coding quality education and guidance to staff; analyze trends to mitigate DRG downgrade risk; document audit results and recommendations.
Seniority
Mid-level, hands-on IC