Medical Record Coding Auditor

Job Title : Remote Coding Auditor (DRG / Outpatient Focus)

Location : Remote – .-based preferred Schedule : Flexible hours; must be available for meetings in Central Time Zone

Position Summary :

We are seeking an experienced Coding Auditor with strong knowledge of DRG and Outpatient coding principles. The ideal candidate will have either prior AI integration experience or be open to learning about emerging AI tools and workflows. This position offers remote flexibility within the United States and requires availability for periodic Central Time meetings.

Key Responsibilities :

Conduct routine and focused audits to ensure compliance with ICD-10, CPT, HCPCS, and payer guidelines

Analyze clinical documentation for accurate code assignment in alignment with internal policies and healthcare regulations

Identify coding discrepancies, trends, and areas for improvement; recommend corrective actions

Design and deliver educational sessions on coding updates, documentation best practices, and compliance requirements

Collaborate with revenue cycle teams to optimize claims submission and reduce coding-related denials

Contribute to development of coding procedures to uphold federal and state compliance standards

Stay current with evolving payer rules, CMS guidelines, and regulatory changes; disseminate updates to stakeholders

Compile audit findings into detailed reports and present actionable insights to management

Support external and internal compliance audits by validating coding accuracy and documentation standards

Review denied insurance claims to identify and resolve coding-related errors

Required Skills & Abilities :

Proficient in ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG classifications, and medical terminology

Familiarity with Medicare, Medicaid, and payer-specific reimbursement policies

Understanding of medical necessity criteria across major payors

Skilled in EHR platforms and coding software applications

Strong analytical, communication, and problem-solving skills

Ability to work independently and manage multiple projects with attention to detail

Education & Certification Requirements :

Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred

Current certification required : CPC, CCS, or equivalent

Minimum 5 years of hands-on medical coding experience, with 2–3 years in a coding audit capacity

Preferred Qualifications :

Experience with large healthcare networks, hospital systems, or multi-specialty group practices

Additional certifications such as CIC or COC

Familiarity with risk adjustment models and HCC coding

Comfort answering coding-related questions from senior leadership regarding accounts receivable