JOB SUMMARY:
We are seeking a highly skilled Coding Compliance Auditor to ensure the accuracy, compliance, and integrity of inpatient and outpatient coding practices. This role serves as a subject matter expert in ICD 10 CM, ICD 10 PCS, and CPT 4 coding, supporting reimbursement accuracy, regulatory compliance, and overall coding quality across the organization.
RESPONSIBILITIES:
- Perform comprehensive audits of inpatient, outpatient, ambulatory surgery, and observation encounters to ensure coding accuracy and compliance
- Validate ICD 10 CM, ICD 10 PCS, and CPT 4 code assignment for appropriate reimbursement, regulatory compliance, and data integrity
- Audit complex inpatient cases including trauma, critical care, neurology, and rehabilitation to ensure accurate APR DRG, SOI, ROM, and POA assignment
- Serve as a subject matter expert by analyzing clinical documentation and resolving coding discrepancies in collaboration with providers, CDI specialists, and coding staff
- Research and stay current on coding guidelines, regulatory updates, new procedures, and emerging technologies
- Provide education, training, and ongoing feedback to coding staff to improve accuracy and performance
- Monitor and report coder quality, accuracy rates, and productivity metrics
- Conduct focused and specialty audits to support quality improvement initiatives
- Assist coding staff with development of compliant and appropriate physician queries
- Communicate audit findings, trends, and coding concerns clearly to internal stakeholders and leadership
- Collaborate with CDI, clinical, and operational teams to improve documentation and coding outcomes
- Ensure adherence to AHIMA ethical coding standards and organizational compliance requirements
- Maintain knowledge of quality indicators such as PPCs, MHACs, and PQIs and their impact on reimbursement and performance
- Complete coding corrections, participate in special projects, and perform additional duties as assigned in support of organizational goals
Hours: Operating hours are 6AM to 6PM EST
40 hours per week within the operating timeframe
- High School diploma or equivalent required
- Formal training in ICD 10 CM, ICD 10 PCS, and CPT 4 coding required
- Associate or Bachelor degree in Health Information Management or related field preferred
- Relevant education may be considered in lieu of experience
- Minimum 2 years ICD 10 CM and ICD 10 PCS inpatient coding and abstracting experience in a Level 1 Trauma hospital
OR 4 years inpatient hospital coding experience
- Minimum 2 to 3 years ambulatory coding experience
- Required: hands on inpatient coding audit experience
- Experience auditing complex inpatient cases such as trauma, critical care, neurology, or rehabilitation strongly preferred
Certifications
- One of the following active credential required:
- Certified Coding Specialist CCS
- Registered Health Information Technician RHIT
- Registered Health Information Administrator RHIA
- Certified Inpatient Coder CIC
WORK ENVIRONMENT:
- Fully remote position
- Must have their own equipment to work from
- Must have reliable internet and a secure work environment
- Must be based in EST or CST hours
Choose 1st Choice — we care about our people, offer great benefits, and create real opportunities to grow. With 20+ years of nationwide staffing success, we're here to help you thrive. We’re an equal opportunity employer and welcome all qualified applicants.
