UI Health Care's Joint Office for Compliance is seeking a Senior Compliance Inpatient Auditor to perform compliance-focused audits of inpatient medical records, coding, billing, and documentation practices to ensure adherence to federal and state regulations, payor requirements, organizational policies, and industry standards. This position evaluates coding accuracy, documentation integrity, MS-DRG assignment, and reimbursement compliance while identifying opportunities for education, risk mitigation, and process improvement.

Key Responsibilities:

• Conduct inpatient coding and documentation audits in accordance with organizational policies, CMS regulations, Official Coding Guidelines, and payor requirements.
• Review medical records to validate ICD-10-CM and ICD-10-PCS code assignment, principal diagnosis selection, procedure coding, Present on Admission (POA) indicators, and MS-DRG assignment by ensuring codes are fully supported by documented clinical indicators.
• Evaluate compliance with Medicare, Medicaid, and commercial payor billing requirements.
• Research and interpret coding, billing, and regulatory guidance to support audit findings and recommendations.
• Analyze audit results to identify trends, compliance risks, educational opportunities, and potential overpayment concerns.
• Prepare detailed written audit reports that clearly communicate findings, regulatory support, financial implications, and corrective action recommendations.
• Follow-up with key stakeholders to ensure completion and implementation of corrective actions.
• Assist with compliance investigations involving inpatient coding, billing, and documentation concerns.
• Utilize RAT-STATS to identify random samples and statistical values in extrapolating overpayments.
• Collaborate with Health Information Management (HIM), Coding, CDI, Patient Financial Services, Revenue Integrity, and Compliance teams to address identified issues.
• Conduct audit meetings and education sessions with coding professionals, CDI staff, providers, and leadership regarding audit findings and regulatory requirements.
• Perform professional coding and documentation audits on an as needed basis in accordance with organizational policies, CMS regulations, Official Coding Guidelines, and payor requirements.
• Monitor regulatory updates and changes to coding guidelines, CMS rules, and payor policies affecting inpatient reimbursement and compliance.
• Maintain audit documentation, workpapers, and supporting evidence in accordance with departmental standards.
• Participate in development and maintenance of audit methodologies, policies, procedures, and educational materials.

Required Qualifications:

• A bachelor's degree in health information management or related field, or equivalent combination of education and experience is required.
• Active coding credential such as RHIT, RHIA, CCS, CCS-P, CIC, or CPC through a nationally recognized credentialing body such as AHIMA or AAPC.
• 5 years of inpatient coding experience.
• Extensive knowledge of
  
  • ICD-10-CM and ICD-10-PCS coding
  • MS-DRG methodology
  • Official Coding Guidelines
  • CMS inpatient billing regulations
  • Medicare and Medicaid reimbursement requirements
  • Clinical documentation requirements
• Strong analytical, investigative, and problem-solving skills.
• Excellent written, verbal, and presentation skills.
• Proficiency with electronic medical records, encoder applications, DRG validation tools, and Microsoft Office applications.
• Demonstrated experience working effectively in a welcoming and respectful workplace environment.

Desired Qualifications:

• Prior inpatient coding audit or compliance audit experience.
• Inpatient coder certification.
• 1-3 years professional coding experience including CPT and HCPCS coding.
• Experience conducting provider or coder education.
• Experience in an academic medical center or teaching hospital environment.
• Knowledge of OIG Work Plan priorities, compliance program requirements, and overpayment investigation processes.
• Experience with statistical sampling methodologies and audit data analysis.
• Familiarity with CDI practices and documentation improvement initiatives.

Application Process: To be considered, applicants must upload a cover letter and resume (under the submission of relevant materials) that clearly address how they meet the listed required and desired qualifications of this position. Job openings are posted for a minimum of 7 calendar days. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification.

• Up to 5 professional references will be requested at a later step in the recruitment process. For questions, contact Sharon Walther at [email protected].

This position is not eligible for University sponsorship for employment authorization now or in the future.

This position is eligible for hybrid work within Iowa and will require a work arrangement form to be completed upon the start of your employment. Per policy, work arrangements will be reviewed annually, and must comply with the remote work program and related policies and employee travel policy when working at a remote location.