Coding Quality Review (CQR) Specialist

Job Description

Job Description

This is a remote position.

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

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.

Key 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

Requirements

Must-Have Qualifications (Strict Requirements)

RHIA, RHIT, or CCS certification (Required)

3+ years of hands-on MS-DRG inpatient coding audit experience (Required)

Experience auditing across all body systems (No specialization-only coders)

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

Must meet 95% accuracy and productivity benchmarks

Proficiency in current coding guidelines and compliance tools

Strong attention to detail and ability to work independently in a virtual environment

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

Preferred Qualifications

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

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