Inpatient Clinical & Coding Specialist - Senior

Todd & Weld, LLP; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company seeks a Clinical & Coding Specialist-Senior responsible for reviewing complex clinical decisions and coding evaluations. Ideal candidates possess strong analytical and critical thinking skills. They will train others, support audits, and ensure compliance in healthcare coding practices. Required qualifications include specific certifications and substantial clinical experience.

Benefits

Benefits included

Paid time off

Qualifications

• Minimum 4 years experience in a clinical setting or coding system (ICD-10/PCS).
• Certified in any of: CIC, RHIA, RHIT, CCDS, or CCS-H required.
• Subject matter expert in coding systems and inpatient clinical expertise.

Responsibilities

• Review coding and clinical decisions on complex cases.
• Train team members and evaluate audits.
• Support leadership in Hospital Audit.

Skills

Analytical thinking

Critical thinking

Team collaboration

Communication skills

Process management

Education

Associates degree

Bachelor’s degree

Tools

Microsoft Word

Excel

Citrix

VPN

EMR access

Job description

The Clinical & Coding Specialist-Senior will be responsible for reviewing coding and clinical decisions on cases involving complex clinical presentations with correlating coding complexity. They will aid in training other team members, evaluating appeals, and sharing audit trends across the team. Expertise and proficiency demonstrated by long-standing, consistent results, advanced coding knowledge, and auditing skills evidenced by their ability to train others, identify coding patterns, and share knowledge and audit tips across the team. The Clinical & Coding Specialist-Senior will support leadership in Hospital Audit to accomplish all aspects of the audit plan.

Associates degree required. Bachelor’s degree preferred. An additional two (2) years of experience will be considered in lieu of degree.

Minimum of one of the following certifications or licensures: Certified Inpatient Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN required. LPN or RN preferred.

Four (4) years of experience working in a clinical setting or utilizing a coding system (ICD-10 or PCS) required. Coding audit experience in an inpatient setting preferred.

Knowledge of ICD-10-CM and ICD-10-PCS coding systems, as well as respective reimbursement methodologies associated with each coding system, preferred.

Experience and proficiency reviewing healthcare delivery against clinical quality and financial guidelines.

Analytical and critical thinking skills. Ability to ensure clinical information translates correctly into claim coding compliance. Ability to prepare quantitative and qualitative studies post-audit. Ability to recalculate reimbursement following audit in accordance with corporate contracts and policies.

Autonomous worker, minimal supervision, including process management skills. Subject matter expert in coding systems and inpatient clinical expertise.

Effective team collaboration skills and ability to facilitate teams internally and externally.

Understanding of organizational and audit/reimbursement business strategies.

Strong organizational, verbal, and written communication skills. Ability to communicate effectively with personnel and providers.

Proficiency in PC/Windows, Microsoft Word, Excel, and experience with remote access tools like Citrix, VPN, EMR access.

Knowledge of facility contract reimbursement policies.

Examples of embodying IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Hiring Compensation Range: $33.50 - $38.00 hourly.

Compensation varies based on skills, education, location, and experience. Benefits and paid time off included. Salary range subject to change.

As an Equal Opportunity / Affirmative Action Employer, Independent Health does not discriminate in employment practices based on protected characteristics under applicable law.