Medical Coding Auditor Instructor

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding, documentation, and financial aspects. Conduct educational sessions or work with external professionals to effectively present findings to staff and physicians. (20%) Thoroughly validate coding systems (ICD-CM, ICD-PCS, CPT, and HCPCS Level II) to ensure accuracy and compliance with DRG/APC structures. Perform regular reviews of claim forms to ensure accurate code transfer from abstracting systems. (10%) Oversee the development and monitoring of inpatient case mix reports to identify patterns in DRG/APC assignments. Analyze identified issues and implement effective strategies for resolution. (10%) Analyze medical information to accurately classify it into payor-specific groups by coding diagnoses and procedures. (10%) Adhere to the Standards of Ethical Coding as established by the American Health Information Management Association and Corporate Compliance Coding Guidelines. (10%) Engage in additional assigned responsibilities, such as mentoring new staff and supporting special project audits. (10%) Coordinate or facilitate training for healthcare professionals on coding guidelines, documentation techniques, and clinical data quality management. Design and implement ongoing education programs for coders. (10%) Complete other duties as assigned. QUALIFICATIONS: Minimum: High school diploma/GED Certification from AAPC or AHIMA AHIMA Credentials (Inpatient or Outpatient): RHIT, CCS AAPC Credentials (Outpatient): CPC, COC, CPMA 5 years of experience in hospital or physician coding/auditing and educational methods (3 years for internal transfer candidates) In-depth knowledge of coding systems (ICD CM, ICD PCS, CPT/HCPCS) and DRG/APC structures. Strong analytical and communication skills. Preferred: Associate's Degree 3 years of experience in claims processing and data management Prior auditing and education/training experience in coding and reimbursement Disclaimer: This job description provides a general overview of the nature and essential duties associated with this position. It may not encompass all tasks, responsibilities, and qualifications required. Compliance Requirement: This position adheres to ethical and legal standards as outlined in the business conduct code and company policies. Employees may have access to confidential information that must be protected at all times in compliance with HIPAA and other relevant regulations. Pay Range Minimum: $27.36 Pay Range Maximum: $44.13 Base pay depends on various factors, including qualifications, experience, and internal equity. Highmark Health and its affiliates are committed to prohibiting discrimination in every form. We strive to maintain an inclusive environment for all employees. For accommodation requests, please contact HR Services Online. Req ID: J277789

Created: 2026-03-13