Medical Coding Auditor

We are looking for a Medical Coding Auditor to support coding appeal efforts for acute care accounts in Virginia. This position focuses on evaluating denied inpatient claims, applying coding standards, and developing well-supported appeal documentation based on clinical records and regulatory guidance. The ideal candidate brings strong judgment, deep knowledge of inpatient coding methodologies, and the ability to communicate findings clearly and effectively.

Responsibilities:
• Review denied inpatient accounts and prepare clear, evidence-based appeal submissions that support code assignment and reimbursement accuracy.
• Analyze clinical documentation alongside coding guidelines and industry regulations to identify discrepancies, compliance concerns, and potential billing issues.
• Use expertise in ICD-10-CM, ICD-10-PCS, and related coding frameworks to validate coding decisions and strengthen appeal outcomes.
• Research payer policies, government guidance, and applicable regulatory sources to support recommendations and resolve coding-related questions.
• Track trends, root causes, and claim examples through organized records and reporting tools to help improve appeal strategies and coding quality.
• Partner with client teams to build understanding of account-specific requirements and reinforce documentation and coding compliance expectations.
• Contribute to training and knowledge-sharing activities by explaining appeal results and coding considerations to coding staff and stakeholders.
• Maintain assigned productivity goals, stay current with coding updates, and provide responsive, thorough service in daily interactions.

Qualifications:

• At least 5 years of coding experience, including inpatient facility coding work.
• Hands-on experience managing coding appeals, denials, or claim edits in a healthcare setting.
• Strong knowledge of ICD-10 coding standards, medical record documentation, and reimbursement-related regulations.
• Active coding certification such as CCS, CCS-P, CPC, RHIA, RHIT, or another recognized credential.
• High school diploma or equivalent required.
• Ability to interpret clinical documentation and apply coding guidance with accuracy and objectivity.
• Proficiency in maintaining detailed audit records, spreadsheets, and supporting documentation for reporting and follow-up.

Compensation

$62,400.00-$66,185.60 Yearly

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