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This role focuses on ensuring the accuracy and integrity of medical coding data.

Perform audits on coded medical records utilizing ICD-10 and CPT standards, ensuring strict adherence to HIPAA regulations.

Identify, interpret, and evaluate any inconsistencies, discrepancies, or inaccuracies within received medical data, promptly alerting and querying the responsible parties, coders, and supervisors.

Meet established quality and productivity benchmarks for auditing, along with required turnaround times.

Educate coders by providing constructive feedback on identified errors and analyze trends to report and conduct sessions on observed error patterns.

Participate in or lead calibration calls involving Subject Matter Experts, auditors, and trainers, and report any observed malpractices during coder audits. Educate coders on the latest coding updates, clearly distinguishing between educational feedback and actual errors.

Review rebuttals with a high degree of integrity and comply with all applicable company policies, procedures, and business directives, including those related to work location, team assignments, schedules, and flexible work arrangements.

Requires a graduate or postgraduate degree, along with a certified coder credential from AAPC or AHIMA (CCS, CPC, CPC-A, or CIC).

Possess 6+ years of hands-on experience in IP DRG Coding. Must have a strong understanding of IP-DRG methodology, ICD-10-CM/PCS guidelines, Coding Clinic guidance, and US Healthcare Revenue Cycle Management (RCM) systems.

Demonstrate thorough knowledge of medical terminology, human anatomy, physiology, and pathophysiology. Include a solid understanding of interpreting medication types and dosages.

Exhibit proven English communication skills and the ability to provide detailed, accurate feedback on errors. Capable of conducting or providing training based on error trends and leading calibration sessions between SMEs, auditors, and trainers.