Hospital Inpatient Coding and DRG Analyst - FT - Day - HIM Facility Coding Remote

Capital Health System, Inc.; United States; Remote; USD 65,000 - 84,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

Retirement Savings Plan

Paid Time-Off

Job summary

Capital Health is seeking an experienced Hospital Coder Inpatient Senior Coder to review and code complex inpatient records using ICD-10-CM, ICD-10-PCS, and MS-DRG grouping. This SME collaborates with CDI, quality, and revenue cycle teams to ensure accurate reimbursement and regulatory compliance.

Qualifications include CCS certification, four years coding experience, encoder/EMR proficiency, and strong organizational and communication skills.

Qualifications

• High School diploma or equivalent; Associate's degree preferred.
• Certified Coding Specialist (CCS) required.
• Four years medical or hospital coding experience.
• Encoder and EMR systems experience; strong communication skills.

Responsibilities

• Code complex inpatient records using ICD-10-CM/PCS and MS-DRG/APR-DRG grouping.
• Lead regulatory updates and DRG changes; SME on DRGs.
• Collaborate with CDI, quality, and revenue cycle teams for optimal reimbursement and compliance.
• Provide guidance and training to inpatient coding staff and leadership.
• Support external audits and maintenance of coding policies.

Skills

Communication skills

Organization

Multitasking

Attention to detail

Education

High School diploma or equivalent

Associate's degree preferred

CCS certification

Tools

Encoder

EMR systems

Job description

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $64,625.60 - $84,448.00 Scheduled Weekly Hours: 40

Position Overview

Hospital Coder Inpatient Senior Coder is an expert-level coding professional responsible for accurately reviewing and coding complex inpatient medical records using ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, and appropriate MS-DRG/APR-DRG grouping methodologies. This role serves as a subject matter expert within the coding department, performing second level reviews, mentoring staff, and collaboration with Clinical Documentation Improvement (CDI), quality, and revenue cycle teams to ensure optimal reimbursement and compliance with regulatory guidelines.

Requirements

• Education: High School diploma or equivalent. Associate's degree preferred.
• Certified Coding Specialist (CCS) required.
• Experience: Four years medical or hospital coding experience.
• Other Credentials: CCS knowledge and skills: Prior experience with an encoder and EMR computer systems. Possesses excellent organizational, interpersonal, verbal, and written communication skills.
• Special Training: Instructed in DRG assignment and application of requirements needed to comply with federal and local regulations.
• Mental, Behavioral and Emotional Abilities: Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast-paced environment.

Essential Functions

• Responsible for accurately reviewing and coding complex inpatient medical records using ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, and appropriate MS-DRG/APR-DRG grouping methodologies.
• Acts as lead resource on new regulatory updates, ICD-10 CM and Procedure code changes, and reimbursement methodologies.
• Acts as the subject matter expert (SME) onDRGs.
• Assists with analyzing coding data to identify trends, opportunities for improvement and point risk areas.
• Scrutinizes medical record documentation to identify trends, knowledge gaps, and documentation deficiencies.
• Verifies accurate assignment of diagnoses and procedures within the medical record to comply with federal and state regulations.
• Participates in creating a collaborative environment to promote excellence in coding and outcomes.
• Supports provider education and collaborates with revenue cycle team to ensure optimal reimbursement and compliance with all regulatory guidelines.
• Collaborates with Clinical Documentation Improvement (CDI), revenue integrity, billing, and compliance departments to ensure optimal DRG assignment.
• Provides internal monitoring of coding and related data and provides detailed feedback to inpatient coding staff as well as leadership.
• Assists in developing and maintaining coding policies, reference materials, and workflow improvements.
• Supports preparation for external audits and ensure corrective actions are implemented.
• Develops and delivers departmental specific training sessions, coding updates, and targeted education based on audit findings.
• Research complex coding scenarios and payer rules; communicates updates to the team.
• Assists in the management of the DNFB to ensure minimal number of uncoded days.
• Maintains coding credentials and up-to-date knowledge of inpatient coding changes.
• Provides guidance in daily workflow, prioritization, and problem resolution.
• Adapts to changing department demands required to maintain high level of performance.
• Performs other duties as assigned.

Physical Demands and Work Environment

Frequent physical demands include: Occasional physical demands include: Standing , Walking , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Talk or Hear Continuous physical demands include: Sitting , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include: Accurate NearVision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A

Benefits

• Medical Plan Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits –Long Term Disability (LTD)
• Disability Benefits –Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance - Voluntary Life
• Spouse - Voluntary Life
• Employee - Voluntary Life
• Child Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program

Equal Opportunity Employer NoticeCapital Health Benefits