The Coding Auditor will be responsible for conducting comprehensive audits of medical records and coded accounts to assess the accuracy and appropriateness of diagnosis and procedure coding.
The role requires strong knowledge of medical coding standards, clinical documentation, coding guidelines, and healthcare revenue cycle processes.
The successful candidate will identify coding errors, documentation gaps, compliance risks, and revenue-impacting issues, while providing constructive feedback and recommendations to improve coding quality and overall revenue cycle performance.
What you'll do
- 1. Medical Coding Audits
- Conduct retrospective and prospective audits of medical records and coded encounters.
- Review diagnosis and procedure codes for accuracy, completeness, specificity, and compliance.
- Validate coding against the clinical documentation available in the medical record.
- Identify overcoding, undercoding, incorrect coding, missed diagnoses, incorrect sequencing, and other coding discrepancies.
- Review inpatient and/or outpatient coding based on assigned client requirements.
- Validate the accuracy of DRG assignment where applicable.
- Assess the financial and operational impact of identified coding errors.
- 2. Compliance & Quality Assurance
- Ensure coding practices comply with applicable Saudi healthcare regulations, payer requirements, and approved coding standards.
- Apply ICD-10-AM, ACHI, ACS and other applicable coding standards according to the client's coding environment.
- Support compliance with Ministry of Health and other relevant Saudi healthcare requirements.
- Identify potential compliance risks and escalate significant findings appropriately.
- Maintain confidentiality and security of patient information in accordance with applicable regulations and company policies.
- 3. Clinical Documentation Review
- Assess the relationship between clinical documentation and assigned codes.
- Identify documentation deficiencies that may affect coding accuracy, reimbursement, DRG assignment, or quality reporting.
- Provide recommendations for improving documentation quality.
- Collaborate with Clinical Documentation Improvement (CDI) teams when clarification or additional documentation is required.
- 4. Audit Reporting
- Prepare detailed coding audit reports highlighting:
- Audit findings
- Coding errors
- Documentation gaps
- Root causes
- Financial/revenue impact where applicable
- Compliance risks
- Recommended corrective actions
- Track audit results and identify recurring coding trends.
- Prepare regular quality and performance reports for management and clients.
- Maintain accurate audit records and supporting documentation.
- 5. Training & Continuous Improvement
- Provide feedback and education to medical coders based on audit findings.
- Support coding quality improvement initiatives.
- Participate in coding calibration sessions and knowledge-sharing activities.
- Assist in developing coding guidelines, audit tools, checklists, and standard operating procedures.
- Keep up to date with changes in coding standards, regulations, payer requirements, and healthcare practices.
- 6. Client & Internal Collaboration
- Work closely with e-Sehha coding, CDI, RCM, clinical, and technology teams.
- Participate in client meetings and coding quality discussions when required.
- Communicate audit findings clearly and professionally to healthcare clients.
- Support implementation and optimization of coding audit programs for hospitals and healthcare organizations.
- Work with technology and AI teams to improve automated coding and audit workflows where applicable.
What we're looking for
- Bachelor's degree or diploma in:
- Health Information Management
- Medical Coding
- Health Informatics
- Healthcare Administration
- Nursing or a related healthcare discipline.
- Minimum 5 years of relevant experience in medical coding, coding auditing, or healthcare revenue cycle management.
- Strong practical experience in medical record review and coding quality auditing.
- Experience working with hospital coding environments is highly preferred.
- Experience with inpatient and/or outpatient coding.
- Strong knowledge of ICD-10-AM and ACHI coding standards where applicable.
- Knowledge of Australian Coding Standards (ACS) is preferred.
- Knowledge of DRG systems and grouping principles is highly preferred.
- Experience with Saudi healthcare organizations and/or the Saudi healthcare market is an advantage.
- Strong understanding of clinical documentation and its impact on coding and reimbursement.