Certified Professional Coder

Job Summary:
This position is responsible for leading audits of hospital billing and coding practices, including desk audits, bill verification, DRG validation/utilization review audits, and credit balance reviews. The role also supports audit protocol development, trend analysis, special projects, and provides guidance on ICD-10-CM coding, DRG assignments, payments, and auditing processes.

Key Responsibilities:

• Lead and finalize hospital billing and coding audits
• Identify billing discrepancies and coordinate improper claim payment referrals
• Analyze and report audit error trends related to documentation and billing practices
• Compile audit statistics and present findings to internal teams and regulatory agencies
• Review and improve audit processes and clinical data review initiatives
• Train and onboard new staff on audit procedures
• Support compliance with healthcare laws, regulations, and company policies
• Perform additional special projects as assigned

Education & Experience:

• High School Diploma/GED required
• Bachelors Degree in Health Information Management preferred or equivalent relevant experience
• Minimum 3 years of experience in a medical records department within an acute care hospital or healthcare facility
• Experience with DRG validation, utilization review audits, and ICD-10-CM education required

Required Certifications & Licensure:

• Active RN License required
• CCS or RHIT/RHIA Certification required

Preferred Certifications:

• CCS
• CCS-P
• CCA

Preferred Knowledge:

• Experience with ACCESS Software preferred