Clinical Coding Auditor & Trainer

Clinical Coding Auditor & Trainer

Location: Remote (U.S.) – Must be willing to travel to New York twice a year for onsite meetings or training sessions.

Position Type: Full Time

This role is responsible for conducting clinical documentation and coding audits to ensure compliance with federal regulations, payer requirements, and company policies. The focus is on DRG validation, inpatient medical record auditing, and education/training for clinical and coding teams.

Key Responsibilities

• Conduct DRG validation and inpatient coding audits to ensure medical record accuracy and compliance.
• Provide training and education to clinical, coding, and quality staff on coding guidelines, audit findings, and process improvements.
• Review clinical documentation and coding practices for adherence to federal and payer standards (CMS, AHIMA, AAPC, etc.).
• Evaluate and recommend process improvements to enhance coding accuracy and quality of medical record documentation.
• Collaborate with compliance, reimbursement, and medical review teams to ensure audit consistency and alignment.
• Prepare detailed audit reports summarizing findings, trends, and recommendations for corrective action.
• Review patient correspondence and letters for grammatical accuracy and clarity.
• Stay updated on current coding guidelines, industry regulations, and DRG reimbursement models.
• Participate in special projects, audit planning, and workflow optimization initiatives.

Required Qualifications

• Licensure: RN, PA, MD, APRN, DO, or MBBS license (valid and active).
• Education: Associate's degree in Nursing or equivalent healthcare education/experience.
• Experience: Minimum 4+ years of DRG and/or medical record audit experience and at least 1 year of clinical experience in a hospital setting.
• Certifications: Valid/current CPC or CIC certification (AAPC preferred) or CCS certification (AHIMA).
• Strong written and verbal communication skills, including English grammar proficiency.
• Ability to work independently, manage audit deadlines, and communicate audit findings clearly.
• Must be willing to travel to New York twice per year for meetings or training.

Preferred / Nice-to-Have Qualifications

• Experience in inpatient coding within hospital or managed care environments.
• RHIA/RHIT credentials preferred.
• Prior experience providing coding training or audit education.
• Familiarity with managed care processes, utilization review, or healthcare compliance.
• Strong attention to detail and analytical abilities.