Medical Coding Auditor & Educator

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Date: Jul 10, 2019

Location: Newport Beach, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

Under the Direction of the Coding Manager, the Coding Quality Auditor and Educator facilitates departmental, interdepartmental, and external coding audits to ensure quality completeness and accuracy of coding as well as compliance with Acute Care Facility Federal and State Regulations and appropriate reporting. As Coding Quality Auditor and Educator, you will possess demonstrated knowledge of applicable healthcare code sets such as ICD-10-CM, ICD-10-PCS, and CPT-4.  Additionally, you will maintain a thorough understanding of the NCCI (National Correct Coding Initiative), DRG / APC payment classifications, and Medicare Conditions of Participation. As Coding Quality Auditor and Educator you will continually provide department education based on audit findings.


Other duties may include:

  • Serving as subject matter expert on hospital performance improvement committees.
  • Responding to coding questions from outside departments and providing coding references and guidelines.
  • Performing retrospective and concurrent audits to ensure coding accuracy and proper reporting.
  • Performing daily focused coding pre-bill reviews using coding compliance software.
  • Completing daily reviews in a timely manner and meeting department productivity guidelines.
  • Identifying documentation discrepancies in support of services billed including ICD10/CPT/HCPCS and other third party payer codes, DRG assignment, and APC code assignment.
  • Recognizing medical necessity of services and reimbursement over-payments and under-payments.
  • Demonstrating the ability to analyze coded data to identify areas of risk and provide suggestions for correction action.
  • Working closely with the HIM Director/Coding Manager to develop internal and external audit plans.
  • Facilitating quarterly external audits.
  • Preparing and presenting reports for pre-bill and retrospective coding audits.
  • Serving as liaison between Coding and CDI teams related to appropriate coding queries and documentation concepts.
  • Developing and delivering education sessions to Hospital Departments, Coders, CDI and physicians related to audit findings.
  • Reporting any compliance and/or risk issues to the compliance department and providing suggestions on process improvement.

Hoag employees consistently maintain a high standard of professional communication, appearance and conduct. They’re driven to excel and they’re deeply passionate about their work. To that end, we’ll expect you to participate in our continuous quality improvement process and maintain a working knowledge of departmental and hospital standards, policies and procedures.

We’re keen on following safety measures and infection control protocols, being attentive to details, and having intimate knowledge of the populations we serve.


Hoag is the Place to Be

We believe that when you join Hoag, you become part of a family. We’re deeply committed to giving back to those who help us serve our community, making your ongoing growth and development our priority. In addition to Pay for Performance salary increases, and sponsored training opportunities, Hoag employees enjoy:

  • Annual performance incentives
  • Safe Harbor bonuses
  • Competitive 401 (k) 
  • Generous Paid Time Off (PTO)
  • Tuition Reimbursement
  • On-site childcare at our Newport Beach location
  • Excellent Medical, Dental and Vision coverage
  • On-site Wellness Centers at our Irvine and Newport Beach campuses that include discounted services for massage therapy, acupuncture, mediation and mindfulness, yoga, Pilates and fitness coaches

We look for passion, an ownership mentality, and out-of-the box thinking. If this is you and Hoag sounds like home, please apply. A member our Talent Acquisition Team will contact you if they want to know more.



  • Bachelor’s degree or equivalent education/experience.
  • 8 – 10 Years of hands-on Inpatient/DRG and Outpatient coding, auditing and related work.
  • CCS credential.
  • Strong knowledge of CMS Conditions of Participation, Medicare and Medi-Cal hospital documentation requirements, and Official Coding Guidelines.
  • Strong knowledge of ICD-10/CPT/HCPCS/DRG coding rules, acute care hospital facility charge capture and reimbursement methodologies.
  • Experience with Diagnosis-Related Groups and Medicare Severity Diagnosis Related Groups, Ambulatory Payment Classification, International Classification of Disease, Healthcare Common Procedure Coding System, Current Procedural Terminology, and All Patients Refined Diagnosis Related Groups.
  • Excellent oral and written communication skills and attention to detail.


There’s no Place Like Hoag

Recently, Hoag was recognized as the highest ranked hospital in Orange County in a 2018-2019 U.S. News & World Report. The organization was also ranked the #4 hospital in the Los Angeles Metro Area and the #8 hospital in California.

We’re an industry leader at the cornerstone of exceptional patient care – but we can’t do it without you.To learn more about us and see our culture in action, check out this video on YouTube -


Join the conversation and follow us on Twitter, Instagram and LinkedIn @hoagcareers.

Hoag is an equal opportunity employer.

Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Medical, Audit, Social Media, Special Medicine, Medical Coding, Healthcare, Finance, Marketing

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