Coding Quality Auditor and Specialist, HB Coding, Full-time, Days (Remote)

📋 Description

• • Serve as the definitive authority on clinical documentation and coding quality for Northwestern Medicine (NM), safeguarding the integrity of every inpatient record and ensuring that national rankings, payer contracts, and regulatory mandates are fully supported by precise, compliant data.
• • Own end-to-end quality audits of high-risk inpatient accounts—especially mortality reviews—scrutinizing DRG, principal diagnosis, secondary diagnoses, PCS, POA indicators, and every other data element that feeds Vizient, U.S. News & World Report, CMS Star Ratings, Leapfrog, and internal dashboards.
• • Translate audit findings into actionable intelligence: build root-cause analyses, craft data-driven action plans, and design teaching tools that elevate physician documentation and coder performance across the health system.
• • Act as the primary educator to clinical teams, medical staff, and coding professionals, distilling complex coding guidelines and quality regulations into clear, practical guidance that drives measurable improvement in quality metrics.
• • Partner daily with Clinical Documentation Integrity (CDI) nurses, physicians, CMOs, and Medical Directors to close documentation gaps in real time, ensuring that the clinical story is complete, accurate, and fully compliant.
• • Lead or co-lead advanced, enterprise-level projects—Risk Adjustment, HAC/PSI reviews, Quality Abstraction & Analysis, and non-traditional initiatives—balancing multiple work queues while maintaining the highest accuracy and turnaround standards.
• • Collaborate with IT, Analytics, and Innovation teams to design and implement cutting-edge workflow solutions that automate quality checks, reduce manual effort, and future-proof NM’s data infrastructure.
• • Engage external consultants and third-party partners to refine methodologies, validate results, and continuously raise the bar for quality performance.
• • Represent the organization in executive and clinical forums, presenting audit outcomes, strategic recommendations, and educational updates that influence policy and practice across the system.
• • Maintain an advanced, up-to-the-minute command of evolving national quality agendas, coding regulations (ICD-10-CM/PCS, CPT, CMS, AHIMA, AHA), and payer-specific requirements, ensuring NM remains ahead of industry shifts.
• • Champion a culture of continuous improvement by identifying systemic issues, piloting innovative fixes, and measuring success through transparent KPIs that resonate from bedside to boardroom.
• • Work 100 % remotely while demonstrating the flexibility to attend occasional onsite meetings in the Chicago area, fostering relationships that strengthen interdepartmental alignment and accelerate change adoption.