Sr. Inpatient Clinical Coder

Serve as the SME for ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding

Perform DRG validation and retrospective medical claims reviews

Analyze inpatient and outpatient claims for coding accuracy and pricing determinations

Prepare determination letters and written review outcomes

Identify potential fraud, quality concerns, and coding discrepancies

Provide training and mentorship to clinical coding staff

Support cross-functional teams with coding guidance and review findings

Research medical policy, benefits, limitations, and current coding guidelines

Ensure timely completion of reviews in accordance with performance standards

Maintain accurate documentation within medical management and claims systems

Escalate complex cases to the Medical Director when appropriate

High School Diploma or GED

One of the following active credentials:

CIC – Certified Inpatient Coder

CCS – Certified Coding Specialist

RHIT – Registered Health Information Technician

Minimum 5+ years of clinical coding experience (facility and/or professional)

Minimum 3+ years of inpatient and/or outpatient claims processing experience

Experience working in a fast-paced production environment

Ability to obtain and maintain a favorable background investigation

U.S. Citizenship required

Experience in managed care, health insurance, or private healthcare industry

Familiarity with government healthcare programs and guidelines

Advanced inpatient facility coding & DRG validation expertise

Strong analytical and problem-solving skills

High attention to detail and organizational ability

Ability to manage large volumes of complex information

Independent, deadline-driven work style in a remote environment

Effective cross-functional communication and collaboration

Proficiency in Microsoft Word, Excel, and multi-system environments

100% Remote – must work from an approved state

Ability to work independently in a home office setting

Prolonged computer work and sitting required

Flexibility to support varying work schedules if needed