Inpatient/Outpatient Coding Auditor

Accountabilities • Independently audit inpatient and outpatient facility coding for accuracy, documentation support, regulatory compliance, and reimbursement impact.

• Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, evaluation and management, modifier, bundling, present-on-admission, procedure, and DRG assignments.

• Assess inpatient hospitalizations and outpatient encounters across clinics, urgent care, radiology, laboratory, ancillary services, observation, and ambulatory surgery.

• Evaluate principal and secondary diagnoses, procedures, documentation sufficiency, billability, and adherence to applicable coding guidance.

• Identify incorrect, missing, duplicate, unbundled, unsupported, upcoded, downcoded, or otherwise noncompliant codes and data elements.

• Review electronic health record documentation and approved audit tools according to established sampling and audit requirements.

• Document audit findings with supporting authority, financial impact, risk assessment, and recommended corrective actions.

• Maintain a minimum audit accuracy of 95% and participate in calibration activities to support consistency across reviewers.

• Contribute to audit work plans, data collection tools, facility-level reports, consolidated reporting, and progress updates.

• Present preliminary and final findings to health information management leadership, management, designated facility personnel, and other stakeholders.

• Develop and deliver facility-specific coding education, support exit conferences, and explain findings using authoritative coding guidance.

• Protect confidential healthcare information and comply with applicable privacy, security, training, credentialing, reporting, and access requirements.

• Maintain required credentials and meet all established audit schedules, turnaround times, and quality standards.

Requirements

• Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential from an accepted professional organization.

• At least two years of experience in the applicable inpatient and/or outpatient coding specialty.

• At least three years of consultant experience reviewing medical records in large tertiary-care hospitals and outpatient organizations with primary care and subspecialty services.

• At least three years of education and training experience, including the ability to present audit findings and provide facility-specific coding education.

• Strong working knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, DRGs, modifiers, bundling rules, reimbursement methodologies, documentation requirements, and coding compliance.

• Demonstrated ability to identify coding discrepancies, assess documentation sufficiency, determine financial impact, and support findings with authoritative guidance.

• Ability to maintain at least 95% audit accuracy while meeting reporting and turnaround requirements.

• Strong analytical, written, verbal, presentation, and interpersonal communication skills.

• Ability to work independently while collaborating effectively with health information management leadership, facility personnel, and other stakeholders.

• Strong attention to detail, organization, documentation, and quality control.

• U.S. citizenship and English-language proficiency required for system access.

• Ability to complete a Low Risk NACI background investigation and all required privacy, information-security, and mandatory training.

• Ability to work securely from an approved location within the United States while protecting sensitive healthcare information.

• Candidates must be prepared to provide a current resume, signed Letter of Intent, completed candidate cover page, proof of active credentials, and two current client references specific to the individual reviewer.

Benefits

• Compensation: Estimated total compensation of $38.00 per hour .

• Work arrangement: Fully remote within the United States.

• Employment: Full-time or part-time opportunities may be available depending on assigned workload.

• Contract assignment: Performance period is expected to run from January 1, 2027 through December 31, 2031, if all option periods are exercised.

• Professional impact: Opportunity to contribute to coding quality, compliance, reimbursement accuracy, and education across multiple healthcare facilities.

• Structured environment: Work within established audit methodologies, quality standards, coding guidance, and healthcare information management processes.

• Security and compliance support: Required privacy, security, onboarding, and training processes are provided as part of the assignment requirements.

• Career development: Exposure to complex inpatient and outpatient coding audits, facility-level education, quality improvement, and healthcare compliance activities.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether?

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