Medical Auditor- Inpatient

Role: Medical Auditor- Inpatient
Location: Remote-USA
Emp Type: Full Time

Job Summary:

The Medical Auditor Inpatient is responsible for performing comprehensive reviews of inpatient medical records to ensure the accuracy and integrity of clinical documentation, coding, and billing practices. The position ensures compliance with official coding guidelines, regulatory requirements, and payer-specific rules to support appropriate reimbursement and reduce organizational risk.

Key Responsibilities:

• Conduct detailed inpatient medical record audits to validate coding accuracy, MS-DRG assignment, and documentation completeness.
• Evaluate ICD-10-CM and ICD-10-PCS code selections for consistency with clinical documentation and coding guidelines.
• Verify appropriate use of modifiers, present-on-admission (POA) indicators, and discharge disposition codes.
• Identify documentation deficiencies, coding errors, and opportunities for improvement.
• Provide written audit findings and recommendations to coding teams and leadership.
• Collaborate with Coding, CDI, and Compliance teams to resolve discrepancies and enhance documentation practices.
• Assist in developing and delivering coder and provider education based on audit results and trends.
• Monitor coding accuracy rates, maintain audit logs, and prepare performance reports for leadership.
• Stay current on updates to coding guidelines, payer policies, and CMS regulations.
• Support internal and external audit responses, compliance reviews, and risk mitigation activities.

Qualifications:

• Certifications (required):
• AHIMA or AAPC credential such as RHIA, RHIT, CCS, CCS-P, CDIP, or CPC.
• Experience:
• Minimum 3 5 years of inpatient coding experience in an acute care hospital setting.
• Prior auditing experience strongly preferred.
• Knowledge & Skills:
• Expert knowledge of ICD-10-CM/PCS, MS-DRG, and inpatient coding guidelines.
• Strong understanding of clinical documentation, reimbursement methodologies, and compliance regulations.
• Excellent attention to detail, analytical thinking, and written communication skills.