Inpatient/Outpatient Sr Internal Quality Reviewer

Job Description & Requirements

Inpatient/Outpatient Sr Internal Quality Reviewer

StartDate: 9/29/2025 Pay Rate: $45.00 - $60.00

Inpatient/Outpatient Senior Internal Quality Reviewer

Job Summary

Senior Internal Quality Reviewer, Health Information Management will have the primary responsibility of being an expert resource to the Manager of Internal Quality, Lead Auditors, Fellow Auditors, Coding Work Force Managers, and Coder staff.

This position is accountable for auditing and providing education for Inpatient Coders as well as Revenue Cycle Solutions Consultants and will ensure client satisfaction.

A dedicated schedule of 20 hours per week is required.

Job Responsibilities

• Conducts initial pre-bill and/or onboarding reviews and monthly audits for Revenue Cycle Solutions Consultants per designated schedule.
• Audits and analyzes coded data to identify aberrant coding practices that do not fall in line with established coding policies and procedures. Coordinate and provide feedback to coders and when necessary, Work Force Managers.
• Continuously meets productivity expectations, per complexity indices, determined for each client specifically to the area audited.
• Maintains daily schedule and covers audits for Inpatient Coding and assists when gaps are identified.
• Proactively takes action to ensure all client commitments are met.
• Completes all assigned audits by the 5th of the following month.
• Responds to management within 1 - 2 business hours, unless otherwise determined by the manager.
• Responds to Coding Consultant Rebuttal responses within 24 hours for Pre-bill/Onboarding Audits and within 24 hours for Monthly Audits.
• Compiles and follows through on all processes entailed in audits and client obligations.
• Identifies trends in inpatient coding, as well as DRG validation and recommends focus areas for further coding education to WFM and Internal Quality Manager.
• Adheres to the ‘Standard Terminology for Auditor Recommendations’ Policy.
• Utilizes industry-recognized references to support their review findings, such as the ICD-10 Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics.
• Updates systems with all vital audit information within 24 hrs. of an audit being finalized.
• Assists in providing client and coder assistance with coding, query writing and audit questions, as requested.
• Assists in providing education to coders when audits are below 95%, as requested.
• Performs miscellaneous job-related duties, as assigned.
• Communicate issues as needed to Manager, Internal Quality.
• Provides timely communication in response to customer-related issues, as well as any internal audit-related questions, to ensure a successful experience.
• Develops and maintains supportive and positive relationships with all employees.
  
  

Education

• Bachelor's Degree | Preferred
  
  

Certifications

• Certified Coding Specialist (CCS) | American Health Information Management Association (AHIMA) | OR Certified Professional Coder (CPC) | American Academy of Professional Coders (AAPC) | Required
• Certified Professional Medical Auditor (CPMA) (AAPC) | Preferred
• Registered Health Information Administrator (RHIA) | American Health Information Management Association (AHIMA) | Preferred
• Registered Health Information Technician (RHIT) | American Health Information Management Association (AHIMA) | Preferred
  
  

Minimum Work Experience

• 3 years of coding and/or auditing experience.
• Experience with various Encoder software programs.
• Basic understanding of healthcare billing/accounting systems/healthcare revenue cycle.
• Understanding of physician query processes.
  
  

Key Skills

• Excellent organizational and computer technical skills.
• Proficiency with MS Word, Excel, and PowerPoint.
• Ability to use coding references such as (Coding Clinic, Current Procedural Terminology Assistant, etc.).
• Ability to perform multiple audits and meet deadlines.
• Ability to handle conflict and offer actionable resolution
  
  

Facility Location

Rated as one of “America’s most livable communities,” and referred to as North Carolina’s “City of the Arts,” Winston-Salem has a lot to offer its residents. Located halfway between Atlanta, Georgia and Washington, D.C., Winston-Salem is an important city in the South Atlantic Region and a hub for the industries of medicine and finance.

Job Benefits

Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement
  
  

About The Company

At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.