Senior HIM & Coding Consultant

• Review clinical documentation to ensure coding accuracy and billing compliance.
• Evaluate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding practices.
• Assess documentation quality and identify coding gaps affecting reimbursement.
• Support claim reconstruction by validating coded encounters and supporting documentation.
• Collaborate with HIM, Coding, Clinical Documentation Integrity (CDI), Revenue Integrity, and Patient Financial Services teams.
• Review denied claims and identify documentation or coding issues contributing to payment delays.
• Recommend process improvements that enhance coding accuracy and revenue cycle performance.
• Assist with documentation audits and coding validation efforts.
• Produce findings and recommendations for project leadership.

• 7+ years of Health Information Management (HIM) and hospital coding experience.
• Extensive knowledge of: ICD-10-CM ICD-10-PCS CPT HCPCS MS-DRGs APCs
• Strong understanding of hospital revenue cycle operations and reimbursement methodologies.
• Experience with Clinical Documentation Improvement (CDI) initiatives.
• Experience working with acute care hospitals or integrated health systems.
• Strong analytical, communication, and documentation skills.
• Preferred Qualifications RHIA, RHIT, CCS, CCS-P, CPC, or other HIM/coding certifications.
• Experience with revenue cycle optimization or recovery initiatives.
• Experience with hospital EHR platforms such as Paragon, Epic, Cerner, or Meditech.
• Healthcare consulting experience.
• Knowledge of Revenue Integrity and coding compliance.

Demonstrates extensive expertise in Health Information Management and hospital coding, with a strong focus on ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding practices. Proven ability to enhance coding accuracy and revenue cycle performance through collaboration and process improvement initiatives.

• Health Information Management (HIM)
• ICD-10-CM Coding
• CPT Coding
• Clinical Documentation Improvement (CDI)
• Revenue Cycle Optimization

• ICD-10-PCS Coding
• HCPCS Coding
• MS-DRGs Knowledge
• APCs Knowledge
• Coding Compliance
• Documentation Audits
• Coding Validation
• Reimbursement Methodologies
• Analytical Skills
• Documentation Skills

• Communication Skills
• Collaboration Skills
• Problem-Solving Skills

• RHIA
• RHIT
• CCS
• CCS-P
• CPC

• Revenue Integrity
• Healthcare Consulting
• Coding Practices
• Billing Compliance
• Claim Reconstruction

• EHR Platforms
• Paragon
• Epic
• Cerner
• Meditech