[Hiring] Inpatient Coding Quality Analyst (Auditor) @The Ohio State University

Role Description

The Inpatient Coding Quality Analyst serves as a subject matter expert responsible for validating the accuracy, completeness, and compliance of ICD‑10‑CM/PCS coding and MS‑DRG/APR‑DRG assignment through both random and targeted audits of inpatient medical records. This position plays a critical role in supporting organizational goals related to:

• Regulatory compliance
• Reimbursement integrity
• Data quality
• Audit readiness
• Institutional quality performance

The analyst independently evaluates complex clinical documentation and coding scenarios, resolves inpatient claim and coding edits, supports denial prevention and appeal activities, and collaborates with various stakeholders.

This role supports proactive identification and mitigation of DRG downgrade risk through targeted pre‑bill review, trend analysis, and feedback to coding leadership and CDI partners. The analyst provides actionable recommendations to improve coding accuracy, compliance, education strategy, and operational workflows.

The Inpatient Coding Quality Analyst is responsible for:

• Driving inpatient coding quality improvement, compliance assurance, and claim integrity within a complex academic medical center environment.
• Conducting pre‑bill and post‑bill audits of high‑risk, high‑dollar, and regulatory‑sensitive inpatient cases.
• Documenting audit results, trends, and recommendations to support continuous quality improvement and audit transparency.
• Resolving complex inpatient claim and coding edits, including medical necessity, DRG validation, and National Correct Coding Initiative (NCCI) edits.
• Supporting denial mitigation and appeal efforts, validating failed or rejected inpatient claims.
• Serving as a coding quality resource and educator, providing expert guidance to inpatient coding staff.
• Performing 100% pre‑bill review of inpatient mortality cases and targeted audits for stroke, cardiac device cases, and selected core measures.

Qualifications

• Associate degree in Health Information Management, Health Information Technology, or a related field.
• Minimum of 3–5 years of recent inpatient hospital coding experience in an academic medical center or complex acute‑care hospital setting.
• Demonstrated proficiency in ICD‑10‑CM and ICD‑10‑PCS coding.
• Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity.
• Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, and advanced inpatient claim edit frameworks.
• Experience using electronic health records (EHRs) and health information management systems.
• Strong written and verbal communication skills.

Requirements

• Bachelor’s degree in Health Information Administration, Health Information Management, or a related healthcare discipline (preferred).
• Prior experience in inpatient coding quality review, auditing, denial management, or compliance‑focused roles (preferred).
• Experience supporting mortality case review, risk‑adjusted outcomes, and quality reporting (preferred).
• Certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS) required.
• Maintain required continuing education credits (CEUs) in accordance with AHIMA credential standards.
• Participate in required coding, quality, audit, and departmental meetings.
• Complete all mandatory health system training and hospital‑based learning modules (CBLs) in a timely manner.
• Maintain current knowledge of inpatient coding guidelines, regulatory updates, and compliance initiatives.

Benefits

• Remote position
• Regular position type
• Scheduled hours: 40
• First shift

Company Description

The Ohio State University is an equal opportunity employer, including veterans and disability.