The Inpatient QA Coder Auditor is responsible for reviewing and auditing inpatient medical coding for accuracy, compliance, and adherence to regulatory and client-specific guidelines. This role ensures high-quality coding standards, identifies gaps, and provides actionable feedback to coders to drive continuous improvement and coding integrity.
Key Responsibilities
- Perform quality audits on inpatient coding (ICD-10-CM/PCS) to ensure accuracy and compliance with official coding guidelines
- Review medical records and validate appropriate assignment of diagnoses and procedures
- Identify coding errors, trends, and opportunities for process improvement
- Provide detailed feedback, coaching, and education to coders based on audit findings
- Ensure compliance with client requirements, regulatory standards (CMS, AHIMA, AAPC), and internal quality benchmarks
- Maintain audit reports, scorecards, and documentation of findings
- Participate in calibration sessions and client reviews as needed
- Support process improvement initiatives to enhance coding quality and productivity
Qualifications
- Bachelor's degree in Nursing
- Active coding certification (e.g., CCS, CPC, CIC) with valid credentials
- Minimum 5 years of inpatient medical coding experience
- At least 12 years of QA auditing experience in inpatient coding (preferred)
- Strong knowledge of ICD-10-CM/PCS coding guidelines and DRG assignment
- Experience with coding tools such as Epic, Cerner, 3M Encoder, Meditech
- Strong analytical skills with keen attention to detail
- Excellent communication and coaching skills
