Coding Quality Review (CQR) Specialist

Coding Quality Review (CQR) Specialist

Location: Remote (U.S.-based only; excludes CA, AK, NY, CO)

Position Type: Full-Time | Work From Home

Start Timeline: ASAP

About

A national leader in revenue cycle services supporting over 650 hospitals and 2,400 physician practices. The Coding Quality Review team ensures compliant, accurate coding that drives reimbursement accuracy and healthcare data integrity across the enterprise.

Compensation

• Hourly Rate: Midpoint of $42.28/hr (based on experience)
• Employment Type: W2
• FTEs on Team: 4

Role summary

The Coding Quality Review (CQR) Specialist is responsible for conducting high-quality audits of inpatient and outpatient medical coding across multiple HIM Service Centers (HSCs). This fully remote role is instrumental in maintaining adherence to national coding guidelines and company policies while improving coder accuracy and reimbursement compliance.

Responsibilities

• Lead and perform internal coding quality reviews (routine, pre-bill, policy-driven, incentive-based)
• Audit inpatient MS-DRG medical records across all body systems
• Maintain coding accuracy (95% minimum) and productivity standards
• Participate in special audits and compliance projects
• Stay current on coding guidelines, data standards, and company policies
• Review and interpret multiple medical and regulatory resources for audit support
• Support coder education and development across HSCs

Must-have qualifications

• RHIA, RHIT and/or mandatory

• Cannot be a recent graduate; requires 10+ years of coding and 3 years of auditing in MS-DRG inpatient medical records

• 3+ years of hands-on MS-DRG inpatient coding audit experience in a hospital/acute care setting (Required)

• Must have experience across all body systems (not specialized in one area)

• Minimum 10+ years of total coding experience in a hospital setting

• Must meet 95% accuracy and productivity benchmarks

• Proficiency in coding guidelines and compliance tools

• Strong attention to detail and ability to operate independently in a virtual environment

Note: Recent HIM grads and coders with no MS-DRG audit background will not be considered.

• No HCC Coders

Preferred qualifications

• Associate’s or Bachelor’s degree in Health Information Management (HIM) or Health Information Technology (HIT)

• IP Coding Auditor for MS-DRG

• Prior experience as a lead or educator in HIM coding QA/QC

• Familiarity with multi-facility audit processes or centralized coding platforms

• Experience participating in enterprise compliance audits or payer reviews