Senior Compliance Coordinator - Inpatient Audit

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 over payment 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 over payments.
• 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, work papers, and supporting evidence in accordance with departmental standards.
• Participate in development and maintenance of audit methodologies, policies, procedures, and educational materials.

• 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.

• 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 over payment investigation processes.
• Experience with statistical sampling methodologies and audit data analysis.
• Familiarity with CDI practices and documentation improvement initiatives. Additional Information
  • Classification
    
    Title:
    
    Senior Compliance Coordinator
  • Appointment Type:
    Professional and Scientific
  • Schedule:
    
    Full-time
  • Work Modality Options:
    Hybrid within Iowa
  Compensation
  • Pay Level: 4B
  Contact Information
  • Organization:
    Healthcare
  • Contact Name:
    Sharon Walther
  • Contact Email: sharon-walther

  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.