[Hiring] Coding Quality Auditor @City of Hope

Role Description

The Inpatient Coding Quality Auditor is an exempt professional role responsible for independently evaluating the accuracy, consistency, compliance, quality, and effectiveness of inpatient coding activities across City of Hope. The role ensures consistent application of Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and organizational coding standards.

• Conduct routine, targeted, pre-bill, and retrospective coding audits to evaluate coding accuracy, DRG assignment accuracy, abstraction quality, coding compliance, reimbursement integrity, and adherence to standards.
• Review selected inpatient encounters to validate diagnosis assignment, procedure assignment, abstracting accuracy, reimbursement classifications, and data integrity.
• Evaluate adherence to coding policies, query practices, and regulatory requirements while identifying coding opportunities, risks, and compliance concerns.
• Perform independent validation reviews of complex diagnosis coding, procedure coding, MS-DRG assignment, APR-DRG assignment, quality reporting elements, and abstracted data.
• Monitor coding compliance risk areas, Coding Clinic updates, CMS guidance, payer audit findings, and emerging regulatory requirements.
• Provide recommendations to support regulatory readiness and coding excellence.
• Conduct routine and focused audits of coding staff activities to evaluate coding accuracy, consistency, abstraction quality, compliance, and productivity-to-quality balance.
• Prepare audit findings, coding quality reports, scorecards, and recommendations to support continuous improvement.
• Monitor and trend coder-specific quality findings to identify opportunities for coaching and performance improvement.

Qualifications

• Graduate of an accredited Health Information Management (HIM), Health Information Technology (HIT), Healthcare Administration, Nursing, or related healthcare program (Associate's degree or higher); or High School diploma, GED, or equivalent, AND completion of anatomy and physiology coursework.
• Seven (7) years of acute care inpatient coding experience within a hospital, academic medical center, cancer center, or integrated healthcare system environment.
• Demonstrated experience independently assigning ICD-10-CM and ICD-10-PCS codes for inpatient encounters.
• Demonstrated experience assigning MS-DRGs, APR-DRGs, and other applicable reimbursement classifications.
• Experience conducting coding audits, coding validation reviews, coding quality reviews, coding compliance reviews, or coding education activities.
• Experience evaluating coding accuracy, DRG assignment accuracy, coding compliance, abstracting quality, reimbursement integrity, and coding consistency.
• Experience applying Official Coding Guidelines, Coding Clinic guidance, CMS regulations, payer requirements, and organizational coding standards.
• Experience identifying coding trends, risks, compliance concerns, denial opportunities, or reimbursement issues through coding review activities.
• Experience providing feedback, education, coaching, or competency support related to coding quality and compliance.

Benefits

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

To learn more about our Comprehensive Benefits, please CLICK HERE .