Inpatient DRG Coding Coder/SME

Calpion/Plutus Health; Dallas (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

Calpion/Plutus Health is seeking an experienced Inpatient DRG Coding specialist/SME to support coding operations. The role combines hands-on inpatient coding, chart auditing, coder training, and oversight of daily workflow to ensure accurate, compliant coding.

The ideal candidate has strong expertise in ICD-10-CM, ICD-10-PCS, CPT, DRG assignment, and inpatient coding guidelines, with experience mentoring coders and resolving complex questions. HIPAA and confidentiality are essential.

Qualifications

• 4–7 years of US acute-care inpatient coding experience.
• Active CCS or CIC/CPC certification.
• Strong knowledge of ICD-10-CM/PCS, CPT, UHDDS and inpatient guidelines.
• Experience with MS-DRG assignment, CC/MCC validation, and POA indicators.
• Experience auditing inpatient charts and providing coder feedback.
• SME / senior coder / auditor / trainer experience.
• Strong medical terminology, anatomy, physiology, and procedures.
• Ability to interpret clinical documentation and apply guidance accurately.
• Strong analytical, communication, organizational, and problem-solving skills.
• Ability to manage competing priorities while meeting quality targets.

Responsibilities

• Manage daily inpatient coding workflows and prioritize work queues.
• Review records and assign accurate ICD-10-CM/PCS codes.
• Apply Official Guidelines, UHDDS definitions, and facility/payer rules.
• Validate principal/secondary diagnoses and DRG assignments.
• Review documentation for POA indicators and CC/MCC decisions.
• Escalate complex inpatient coding questions and DRG discrepancies.
• Conduct routine chart audits and provide actionable feedback.
• Collaborate with CDI and other teams to address documentation gaps.
• Prepare training materials and deliver onboarding and updates.
• Monitor quality, productivity, and backlog against standards.
• Identify recurring errors and implement corrective actions.
• Support coding-related denial reviews and appeals with documentation.

Skills

CCS certification

Inpatient coding

DRG assignment

SME / trainer

Auditing

Communication

HIPAA compliance

Education

AHIMA CCS or CIC/CPC certification

RHIA or RHIT credentials (preferred)

Tools

Epic

Oracle Health / Cerner

3M coding tools

Job description

Position Summary

We are seeking an experienced Inpatient DRG Coding specialist/Subject Matter Expert (SME) to support coding operations. This role combines hands‑on inpatient coding, chart auditing, coder training, and oversight of daily workflow to ensure accurate, compliant, and timely coding.

The ideal candidate will have strong expertise in ICD-10-CM, CPT, ICD-10-PCS, DRG assignment, and inpatient coding guidelines, along with experience mentoring coders and resolving complex coding questions.

Key Responsibilities

• Manage daily inpatient coding workflows, prioritize work queues, and support timely completion of assigned cases.
• Review inpatient medical records and assign accurate diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS.
• Apply current Official Guidelines for Coding and Reporting, UHDDS definitions, and applicable facility and payer requirements.
• Validate principal diagnosis, secondary diagnoses, principal procedures, and appropriate DRG assignment.
• Review documentation supporting complications and comorbidities, major complications and comorbidities, and present-on-admission indicators.
• Serve as the escalation point for complex inpatient coding questions and DRG discrepancies.
• Conduct routine chart audits, document findings, and provide actionable feedback to improve coding accuracy and consistency.
• Partner with Clinical Documentation Integrity (CDI) and other relevant teams to address incomplete, conflicting, or unclear documentation through established query processes.
• Prepare training materials and conduct onboarding, refresher training, and updates on coding changes.
• Monitor individual and team quality, productivity, turnaround time, and backlog against established standards.
• Identify recurring errors, perform root-cause analysis, and implement corrective actions.
• Support coding-related denial reviews and appeals by validating code assignments and supporting documentation.
• Understand client requirements and communicate operational updates, quality trends, and escalations.
• Maintain patient confidentiality and follow HIPAA requirements and organizational policies.

Required Qualifications

• 4–7 years of medical coding experience, including substantial hands‑on experience in US acute‑care inpatient hospital coding.
• Active Certified Coding Specialist (CCS) certification from AHIMA or Certified Inpatient Coder (CIC)/CPC certification from AAPC.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, UHDDS definitions, and inpatient coding guidelines.
• Experience with MS-DRG assignment, sequencing, CC/MCC validation, and present-on-admission indicators.
• Experience auditing inpatient charts, resolving coding discrepancies, and providing coder feedback.
• Demonstrated experience as an SME, senior coder, auditor, trainer, or team lead.
• Strong understanding of medical terminology, anatomy, physiology, disease processes, and surgical procedures.
• Ability to interpret clinical documentation and apply coding guidance accurately.
• Strong analytical, communication, organizational, and problem‑solving skills.
• Ability to manage competing priorities while meeting quality and productivity expectations.

Preferred Qualifications

• Experience with APR-DRG methodology and payer‑specific DRG requirements.
• Experience coding complex medical and surgical inpatient cases.
• Familiarity with Epic, Oracle Health/Cerner, 3M coding and grouping tools, or comparable platforms.
• Experience collaborating with CDI, Health Information Management, revenue cycle, and clinical teams.
• Experience managing team workloads, reporting performance, and implementing quality improvement initiatives.
• RHIA or RHIT credentials in addition to an inpatient coding certification.

Education

High school diploma or equivalent required. An associate or bachelor’s degree in health information management, Health Information Technology, or a related field is preferred.

Key Performance Measures

• Coding and DRG accuracy against established quality standards.
• Achievement of individual and team productivity targets.
• Timely completion of coding and audit work queues.
• Reduction in recurring coding errors and rework.
• Effective training, coaching, and resolution of coding escalations.