Inpatient Medical Coder

The Medical Coder 3 for inpatient and ambulatory surgery abstracts clinical information from a variety of medical records, charts, and documents and assigns appropriate ICD-10-CM/PCS and CPT codes to patient records according to established procedures. The role works with coding databases, confirms DRG assignments, and operates under general supervision using pre-established guidelines and some independent judgment.

Responsibilities include:

• Coding and abstracting medical records
• Assisting the Business Office and external agencies with coding clarification related to reimbursement issues in a timely manner
• Supporting quality and performance initiatives
• Coordinating with other areas of the HIM department to ensure the necessary components are available for accurate coding and high-quality medical records
• Maintaining an accuracy rate of at least 93% and meeting productivity standards per 8-hour day
• Participating in problem-solving, data gathering, and chart auditing as needed
• Demonstrating professional communication and patient/customer service
• Attending meetings, educational programs, in-services, and training sessions
• Confirming DRG coding and APC assignment
• Sequencing diagnoses and surgeries appropriately and assigning accurate codes using coding guidelines
• Performing other duties as assigned