Inpatient Coding Quality Analyst (Auditor)
Core
Validates the accuracy, completeness, and compliance of ICD-10-CM/PCS coding and MS-DRG/APR-DRG assignment through random and targeted audits of inpatient medical records to support regulatory compliance and reimbursement integrity.
Role type
Inpatient Coding Quality Analyst (Auditor)
Builds
Audit reports, trend analyses, and actionable recommendations for coding accuracy and compliance.
Domain
Healthcare / Health Information Management / Inpatient Coding
Required skills
ICD-10-CM/PCS coding, MS-DRG/APR-DRG assignment, pre-bill and post-bill auditing, EHR and health information management systems, claim edit resolution, denial mitigation, regulatory compliance knowledge, data trend analysis
Preferred skills
RHIA/RHIT/CCS certification, mortality case review, risk-adjusted outcomes reporting, academic medical center experience, denial management
Technologies
IHIS, encoder, abstracting, audit/reporting applications, EHRs
Responsibilities
Conduct pre-bill and post-bill audits of high-risk inpatient cases; resolve complex claim and coding edits; support denial mitigation and appeal activities; provide coding quality education and guidance to staff; document audit results and trends; perform 100% pre-bill review of inpatient mortality cases.
Seniority
Mid-level, hands-on IC
