Inpatient Coding Specialist

Insight Global; Palo Alto (CA); On-site; USD 98,000 - 135,000; Full time

Job summary

Insight Global seeks an experienced medical coder to assign ICD-10-CM/PCS codes for inpatient services, abstract data for DRG grouping, and ensure compliance with AHIMA ethics and coding standards. Proficiency with Epic and 3M Encoder/CDIS is required, along with RHIA/RHIT/CCS credentials.

The role emphasizes accurate coding, data abstraction, and adherence to federal and state regulations, with a productivity target of 2 charts per hour and involvement in diverse medical record types.

Qualifications

• Completed coder proficiency exam (pre-hire).
• Adheres to AHIMA Code of Ethics and UHDDS standards.
• Uses ICD-10-CM/PCS and CPT-4 conventions to code entries and group MS-DRGs/APR-DRGs.
• Knowledge of MS-DRGs and APR-DRGs grouping schemes.
• Complies with CCI and CMS guidelines for medical coding and billing.
• Understanding of medical records terminology and regulations.

Responsibilities

• Review, abstract, and assign ICD-10-CM/PCS codes to inpatient services.
• Abstract documentation to support DRG grouping and accurate reimbursement.
• Ensure compliance with third-party, state, and federal regulations.
• Identify missing information and obtain clarifications as needed.
• Use Epic, 3M tools, and MS Office to validate and document coding.
• Meet departmental productivity standards (2 charts/hour).
• Maintain accurate data for payment grouping and coding audits.

Skills

Coder Proficiency Exam

AHIMA Code of Ethics

ICD-10-CM/PCS coding

MS-DRG/APR-DRG knowledge

CCI and CMS compliance

Medical records terminology & regs

RHIA/RHIT/CCS certification

Productivity: 2 charts/hour

Solventum (3M)

Education

RHIA/RHIT/CCS certification

Tools

Epic

3M Encoder

3M CDIS

3M Audit Expert

MS Office

Job description

Job Description

Requires review of medical record documentation to accurately assign International Classification of Diseases (ICD-10-CM/PCS), as well as to assign Medicare Severity Diagnosis Related Group (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) and abstract specific data elements for each account in compliance with federal and state regulations. This position codes various (most) patient types of inpatient records and follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics, as well as all American Hospital Association (AHA) Coding Clinic guidance. Reviews, abstracts and assigns accurate and ethical ICD-10-CM and ICD-10-PCS codes to inpatient services. Ensures compliance with third party, State and Federal regulations. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures and other services provided. Obtains missing information and/or clarifies existing information. Completes volume of work from work queues per departmental productivity standards. Groups codes and completed product into payment group. Analyzes information for optimal and appropriate reimbursement. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures. Uses appropriate software to validate information. Utilizes Epic, 3M Coding and Reimbursement System (Encoder), 3M CDIS, 3M Audit Expert, MS Office, and other software as appropriate to compile and validate medical information.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [e-mail] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

• Successful completion of the Coder Proficiency Exam (pre-hire)
• Ability to comply with the American Health Information Management Association’s Code of Ethics and Standards and apply Uniform Hospital Discharge Data Set (UHDDS) standards
• Ability to utilize the ICD-10-CM/PCS and CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record documentation; assign accurate codes for grouping of MS-DRGs and APR-DRGs
• Knowledge of diagnosis/procedure DRG grouping schemes such as MS-DRGs and APR-DRGs
• Knowledge of CCI (Correct Coding Initiatives) and CMS compliance issues
• Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
• RHIA (Registered Health Information Administrator) or RHIT -(Registered Health Information Technician) or CCS (Certified Coding Specialist)
• Meet productivity expectations of 2 charts per hour (14 charts/day) based on 7 hours of coding time Epic
• Solventum (3M)
• Minimum 3 years of experience in an academic medical center