Inpatient Coding Quality Analyst, Auditor

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The Ohio State University, Main Campus

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 1870

📚 Education

Education

The Ohio State University, Main Campus is a public research university located in Columbus, Ohio. It offers a comprehensive education with a wide array of undergraduate, graduate, and professional programs. The university is engaged in numerous research initiatives and partnerships, providing opportunities for students, faculty, and industry partners to collaborate. Ohio State promotes a vibrant student life with various academic, recreational, and wellness services to support student needs. It also emphasizes community involvement and leadership development, fostering an inclusive environment on its multiple campuses across Ohio.

📋 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. • Evaluates complex clinical documentation and coding scenarios, resolves inpatient claim and coding edits, supports denial prevention and appeal activities, and collaborates with Revenue Cycle, Central Business Office (CBO), CDI, Compliance, Internal Audit, and clinical stakeholders. • Provides actionable recommendations to improve coding accuracy, compliance, education strategy, and operational workflows. • Conducts pre-bill and post-bill audits of high-risk, high-dollar, and regulatory-sensitive inpatient cases to ensure accurate code assignment. • Supports denial mitigation and appeal efforts, validates failed or rejected inpatient claims, and collaborates with Revenue Cycle teams to ensure accurate and compliant billing. • Serves as a coding quality resource and educator, providing expert guidance to inpatient coding staff and participating in formal education sessions.

🎯 Requirements

• 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, including validation of principal diagnosis, CCs/MCCs, procedures, POA indicators, and MS‑DRG/APR‑DRG assignment. • Experience reviewing complex inpatient medical records for coding accuracy, compliance, and DRG integrity, including high-severity and high-risk cases. • Working knowledge of CMS IPPS regulations, OIG compliance expectations, payer audits, DRG validation, and advanced inpatient claim edit frameworks. • Experience using electronic health records (EHRs) and health information management systems, including encoder, abstracting, and audit/reporting applications. • Ability to apply independent judgment in evaluating coding, documentation, compliance risk, and audit findings. • Strong written and verbal communication skills, including the ability to provide clear, educational feedback to coding staff and collaborate with CDI, Revenue Cycle, Quality, and Compliance partners.

🏖️ Benefits

• Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost. • Paid time off, including sick and vacation time and 11 holidays. • State retirement plan or an alternative retirement plan, both with generous employer contributions.