Coding Quality Review Specialist

Coding Quality Review Specialist Compensation: $79,000–$97,000 annually Location: Nashville, TN Work Policy: Work from Home (U.S. only; not eligible in CA, AK, NY, CO) Stage: Established national healthcare services organization | 650+ hospital partners | 2,400+ physician practices

Who Are We? We are a national leader in revenue cycle services, partnering with hundreds of hospitals and thousands of physician practices across the country. Our organization is committed to accuracy, compliance, and integrity in medical coding to ensure appropriate reimbursement and data quality. Supporting a large healthcare network, we play a critical role in maintaining coding excellence and operational performance across multiple service centers.

What’s in It for You? Work from home in a highly structured, performance-driven environment. Be part of a respected national healthcare organization with strong ethical standards and operational scale. Join a specialized team focused on coding quality, compliance, and audit excellence. Contribute to data integrity and reimbursement accuracy that directly impacts patient care operations. Clear performance expectations with defined productivity (95%+) and accuracy (95%+) benchmarks. Opportunity to participate in special reviews and enterprise-wide quality initiatives.

What Will You Do? Lead, coordinate, and perform quality reviews for inpatient and outpatient coding across multiple service centers. Conduct routine, pre-bill, policy-driven, and incentive-driven coding audits. Ensure adherence to national coding guidelines, internal coding policies, and compliance standards. Apply expert-level knowledge of MS-DRG inpatient coding and auditing practices. Maintain or exceed 95% productivity and 95% accuracy standards. Review official data quality standards, coding guidelines, policies, and clinical resources to remain current. Participate in special projects and quality improvement initiatives. Support coding staff by reinforcing best practices and compliance standards.

What Will You Need? Undergraduate degree in HIM or HIT preferred (Associate’s or Bachelor’s). Active CCS, RHIA, RHIT and/or required credential. IP Coding Auditor experience for MS-DRG. Minimum 3 years of hands-on MS-DRG inpatient auditing experience in a hospital setting. Ideally 10+ years of overall inpatient coding experience. Experience across all body systems (no single-specialty focus). Strong knowledge of national coding guidelines and reimbursement methodologies. Ability to thrive in a remote, metrics-driven environment. Willingness to complete a mandatory 1-hour job shadow as part of the hiring process.

Additional Notes Physician coding experience will not be considered. Candidates must reside outside of California, Alaska, New York, and Colorado for remote eligibility.