Clinical Documentation and Coding Denials Auditor

Inova Health is looking for a dedicated Clinical Doc and Coding Denials Auditor to join the team. This role will be Full-time Monday through Friday, fully remote.

This position is eligible for remote work for candidates residing in the following states – VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.

• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

Clinical Doc and Coding Denials Auditor Job Responsibilities:

• Independently reviews, evaluates, and resolves complex payer DRG denials and downgrades related to clinical validity, medical necessity, coding accuracy, and documentation integrity, utilizing advanced clinical, coding, and regulatory expertise to identify root causes and determine denial validity through analysis of clinical documentation, payer policies, published clinical references, and official coding guidelines.
• Exercises independent judgment and direct decision-making authority regarding denial disposition, including acceptance, appeal, escalation, and performance of second and third-level appeals activities.
• Conducts pre- and post- bill clinical documentation and coding audits of denied encounters utilizing Epic, Solventum Encompass 360, and other audit technologies.
• Prepares complex appeal letters and supporting documentation utilizing clinical evidence, coding guidelines, regulatory requirements, and payer policy interpretation.
• Represents the organization in payer peer-to-peer reviews and denial discussions and supports HIM senior leadership with denial analysis and trends for Joint Operating Committee (JOC) meetings and other reimbursement-related engagements.
• Collaborates with CDI, Coding, Revenue Integrity, physician leadership, and CDI Physician Advisors to identify denial trends, reimbursement risks, documentation improvement opportunities, and denial prevention strategies.
• Provides education and consultative guidance to physicians, coding professionals, CDI teams, and operational leadership regarding coding compliance, documentation integrity, clinical validation, and reimbursement optimization.
• Utilizes reporting tools, work queues, and database applications to analyze denial outcomes, maintain audit documentation, and support operational and strategic decision-making.
• Performs additional audit, educational, reimbursement integrity, and denial management responsibilities as assigned.

Minimum Requirements:

• Education: Bachelor’s degree in nursing or a health information-related field
• Experience: 7 years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD, or non-clinical advanced degree in a healthcare-related field
• Certification: Either CCS or CCDS is required