Reviews and analyzes complex clinical documentation to assign accurate diagnosis and procedure codes that support compliant reimbursement and quality reporting.
This role focuses on inpatient coding accuracy, including severity of illness, risk of mortality, and regulatory compliance. The specialist serves as a technical resource through documentation clarification, audit support, education, and mentoring to improve coding quality and consistency across the organization.
Key responsibilities include:
- Reviewing complex inpatient medical records and assigning accurate codes
- Determining principal diagnoses, secondary conditions, complications, procedures, POA indicators, hospital-acquired conditions, and discharge dispositions
- Applying MS-DRG and APR-DRG methodologies
- Entering coded data into designated systems to meet accuracy, productivity, and turnaround standards
- Querying providers to clarify documentation and resolve advanced coding edits and discrepancies
- Supporting coding audits, peer reviews, and quality assurance activities
- Educating providers and team members on coding rules and documentation standards
- Mentoring and training coding team members
- Maintaining confidentiality and regulatory compliance
- Participating in meetings, committees, and department projects as assigned
Requirements & Qualifications
Required knowledge and skills
- Knowledge of ICD-10-CM, CPT, and HCPCS coding principles and guidelines
- Knowledge of medical terminology, anatomy, physiology, and disease processes relevant to code assignment
- Proficiency with computer hardware, software applications, electronic health records, and coding systems
- Ability to review and analyze clinical documentation and apply coding guidelines, payer policies, and regulatory requirements accurately
- Strong verbal and written communication skills
- Ability to problem solve, think critically, work independently, and maintain confidentiality
- Ability to prioritize work demands and maintain regular attendance
Education and experience
- High school diploma or equivalent required
- Completion of formal coursework in ICD-10-CM, CPT, and medical coding principles from an accredited or approved program required
- Two years of inpatient medical coding experience, including high-complexity cases
- Advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG/APR-DRG methodologies, POA indicators, and quality reporting concepts
Certifications
One of the following is required:
- RHIA
- RHIT
- CCS
- CCSP
- CPC
- CIC
Location
Nebraska, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
1 month ago
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