OverviewAbout the RoleThe primary purpose of the Inpatient Coding Data Quality Auditor/Educator is to ensure the consistent processing of claims and collection of data to optimize DRG reimbursement and produce quality data that accurately reflects the severity andintensity of hospital inpatient services. Audits inpatient coded records, provides continuing education of all inpatient coding staff and facilitates the inpatient coding work flow.ResponsibilitiesWhat You'll DoPerforms daily data quality reviews on inpatient records to validate ICD-10 diagnosis and procedure codesEnsures accuracy, proper sequencing, and adherence to coding guidelines on all casesReviews cases identified as OIG-focused DRGs, transfer DRGs, and other target areas as neededVerifies the accuracy and appropriateness of the selected DRGCommunicates coding corrections to coders and explains the rationale for educational purposesUtilizes audit tracking tools to identify coding error types by coderPrepares written rebuttals for DRG reassignments or appeals, when requestedProvides supporting documentation to third-party payers to ensure compliance and accurate reimbursementReviews physician queries for appropriateness and follows up to ensure timely responsesAdheres to AHIMA Standards of Ethical CodingMonitors coding staff for potential violations and reports concerns to the ManagerContinuously evaluates clinical documentation qualityIdentifies incomplete or inconsistent documentation impacting code selection, DRG grouping, and reimbursementEscalates documentation concerns as neededQualificationsWhat You'll BringBachelor's degree in Health Information Management or a related field requiredRHIA or RHIT certification preferredCCS certification requiredIf not CCS certified,



must obtain CCS certification from AHIMA within 60 days of hire or within 60 days of the next available examMinimum of 3 years of hospital inpatient coding experienceExperience with ICD-9 and ICD-10 diagnosis and procedure codingExperience with DRG assignmentExperience in a tertiary care or teaching hospital environment preferredKnowledge of complex services including surgical, transplant, trauma, neurosurgery, OB/GYN, and neonatologyKnowledge of medical terminology, anatomy and physiology, and disease processes requiredKnowledge of Coding Clinic, POA, and query guidelines requiredKnowledge of CMS, Medicaid, and third-party payer coding, billing, and compliance regulations requiredExperience with encoder systems (e.G., Clintegrity 360) preferredExperience with Epic electronic health record preferredAbility to manage multiple and changing prioritiesMust be detail-oriented, accurate, and organizedAbility to work independentlyStrong verbal and written communication skillsAdditional related experience may be substituted for the degree requirement on a year-for-year basisWhat We OfferMedical & Prescription Drug CoverageDental & Vision InsuranceHealth Savings Account (HSA) & Flexible Spending Account (FSA)Short- & Long-Term Disability InsurancePension PlanPet InsuranceEmployee Assistance Program (EAP)Professional DevelopmentCompensationIn compliance with Current Jersey's Pay Transparency Act, the salary range for this position is PS/32S: $98,288 - $118,941- $142,009 per year. University Hospital considers multiple factors when determining compensation, including (but not limited to) the scope and responsibilities of the position, the candidate's relevant work experience, education and training, key skills, internal equity, market data, and organizational needs. The expected salary range for this position is in accordance with the New Jersey Pay Transparency Law; final compensation willbe commensurate with experience and qualifications.About UsUniversity Hospital is one of the nation's leading academic medical centers. As the principal teaching affiliate of Rutgers New Jersey Medical School and the only state-certified Level 1 Trauma Center in Northern New Jersey, University Hospital is training the next generation of physicians and advancing science to discovery while taking exceptional care of patients, regardless of their financial situation. #J-18808-Ljbffr

📌 Coordinator, Human Resources & Administration (Toronto)
🏢 The Institute for Performance and Learning
📍 Toronto