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

What you must have:

• 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

Nice to have

• Experience in managed care, health insurance, or private healthcare industry
• Familiarity with government healthcare programs and guidelines

Core Competencies

• 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

Salary/Rate Range: $80,000 – $90,000 annually

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Other Information:

Work Environment

• 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

Thank you for your interest in this opportunity. If you are selected to move forward in the process, we will contact you directly. If you do not hear from us, we encourage you to continue visiting our website for other roles that may be a good fit.