Inpatient Coding Quality Analyst (Auditor)

Job Details

Job Title: Inpatient Coding Quality Analyst (Auditor)

Department: Health System Shared Services | MIM CDI and Coding

Remote Position

Scope of Position

After inpatient medical records are coded within Medical Information Management (MIM), the Inpatient Coding Quality Analyst serves as a subject matter expert responsible for validating the accuracy, completeness, and compliance of ICD-10-CM/PCS coding and MS-DRG/APR-DRG assignment through both random and targeted audits of inpatient medical records.

This position plays a critical role in supporting organizational goals related to regulatory compliance, reimbursement integrity, data quality, audit readiness, and institutional quality performance. The analyst independently evaluates complex clinical documentation and coding scenarios, resolves inpatient claim and coding edits, supports denial prevention and appeal activities, and collaborates with Revenue Cycle, Central Business Office (CBO), CDI, Compliance, Internal Audit, and clinical stakeholders.

This role supports proactive identification and mitigation of DRG downgrade risk through targeted pre-bill review, trend analysis, and feedback to coding leadership and CDI partners. The analyst provides actionable recommendations to improve coding accuracy, compliance, education strategy, and operational workflows.

Position Summary

The Inpatient Coding Quality Analyst is responsible for driving inpatient coding quality improvement, compliance assurance, and claim integrity within a complex academic medical center environment. This role requires advanced knowledge of ICD-10-CM/PCS coding guidelines, Medicare Severity Diagnosis Related Groups (MS-DRGs), APR-DRGs, and payer-specific inpatient billing and audit requirements.

The analyst conducts pre-bill and post-bill audits of high-risk, high-dollar, and regulatory-sensitive inpatient cases to ensure accurate code assignment and DRG/APR-DRG outcomes that reflect the patient’s clinical severity, resource utilization, and services provided. Using IHIS and other abstracting, encoding, and reporting systems, the analyst documents audit results, trends, and recommendations to support continuous quality improvement and audit transparency.

In addition to audit responsibilities, the analyst resolves complex inpatient claim and coding edits, including medical necessity, DRG validation, and National Correct Coding Initiative (NCCI) and other payer-driven edit frameworks. The analyst supports denial mitigation and appeal efforts, validates failed or rejected inpatient claims, and collaborates with Revenue Cycle teams to ensure accurate and compliant billing.

The analyst serves as a coding quality resource and educator, providing expert guidance to inpatient coding staff, participating in formal education sessions, and contributing to the development of coding guidelines, reference materials, and standard operating procedures.

This role performs 100% pre-bill review of inpatient mortality cases and targeted audits for stroke, cardiac device cases, and selected core measures. Audit activities support accurate mortality reporting, institutional quality metrics, and national benchmarking outcomes, including Vizient and U.S. News & World Report (USNWR) rankings.

Minimum Qualifications – For Hire

Required

• Associate degree in Health Information Management, Health Information Technology, or a related field.
• Minimum of 3–5 years of recent inpatient hospital coding experience in an academic medical center or complex acute-care hospital setting.
• Demonstrated proficiency in ICD-10-CM and ICD-10-PCS coding, including validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS-DRG/APR-DRG assignment.
• Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity, including high-severity and high-risk cases.
• Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and advanced inpatient claim edit frameworks.
• Experience using electronic health records (EHRs) and health information management systems, including encoder, abstracting, and audit/reporting applications.
• Ability to apply independent judgment in evaluating coding, documentation, compliance risk, and audit findings.
• Strong written and verbal communication skills, including the ability to provide clear, educational feedback to coding staff and collaborate with CDI, Revenue Cycle, Quality, and Compliance partners.

Preferred

• Bachelor’s degree in Health Information Administration, Health Information Management, or a related healthcare discipline.
• Prior experience in inpatient coding quality review, auditing, denial management, or compliance-focused roles.
• Experience supporting mortality case review, risk-adjusted outcomes, and quality reporting (e.g., SOI/ROM, Vizient, USNWR, PSI/HAC).
• Experience in an academic medical center or multi-hospital health system environment.

Certification Requirements

• One of the following credentials required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) – AHIMA
• Certification must be maintained in good standing.

Ongoing Requirements

• Maintain required continuing education credits (CEUs) in accordance with AHIMA credential standards.
• Participate in required coding, quality, audit, and departmental meetings.
• Complete all mandatory health system training and hospital-based learning modules (CBLs) in a timely manner.
• Maintain current knowledge of inpatient coding guidelines, regulatory updates, and compliance initiatives.