Lead HIM Coding Specialist, Health Information Management, Full Time, Day

Valley Health System (New Jersey); Paramus (NJ); On-site; USD 56,000 - 70,000; Full time

Benefits offered by this job

Medical insurance

Dental & Vision discounts

Life insurance

Job summary

Valley Health System is seeking a Lead HIM Coding Specialist to act as a subject matter expert in inpatient coding and DRG validation. You will perform high-level reviews of coded data to ensure compliance with federal regulations and hospital policies, and collaborate with CDI, Coding, and Compliance to strengthen audit readiness.

Role emphasizes proactive denial prevention, trend analysis, and mentorship of coding staff, with a focus on DRG integrity and revenue integrity across the

Qualifications

• Minimum of 5 years inpatient coding in an acute care hospital.
• Minimum of 2 years in DRG validation, coding audit leadership, or CDI collaboration.
• Experience analyzing denial trends and audit outcomes.
• Advanced use of EHRs, encoders, and data analytics tools.

Responsibilities

• Lead high-level second-level reviews of coded data for accuracy and compliance.
• Audit MS-DRG/APR-DRG assignments and drive documentation improvements.
• Collaborate with CDI, Coding, and Compliance teams to identify trends and mitigate risk.
• Mentor and educate coding staff; oversee pre- and post-bill audits.

Skills

ICD-10-CM/PCS

MS-DRG/APR-DRG

DRG reimbursement

Regulatory knowledge

Clinical documentation reviews

Data analytics

Communication

CDI collaboration

Education

High school diploma

CCS certification

Associate or bachelor's degree preferred

RHIT/RHIA/CDIP/CDDS/CPC preferred

Tools

Meditech

EPIC

Cerner

3M Encoder

TruCode

Job description

Position SummaryThe Lead HIM Coding Specialist serves as a subject matter expert in inpatient coding and DRG validation and is responsible for performing high-level second-level reviews of coded data to ensure compliance with federal regulations, coding guidelines, and hospital policies. This role audits for accurate MS-DRG/APR-DRG assignment and drives improvements in documentation practices and revenue integrity. The Lead HIM Coding Specialist collaborates closely with CDI, Coding, and Compliance teams to identify trends, mitigate risk, and strengthen audit readiness. This position is instrumental in proactive denial prevention, strategic focus audits, and provides mentorship to coding staff.EducationHigh School Diploma or equivalent required. Certified Coding Specialist (CCS) required. Associate or bachelor’s degree in health information management, Health Sciences, or related field preferred. RHIT, RHIA, CDIP, CCDS, or CPC certifications preferred.ExperienceMinimum of 5 years of inpatient coding experience in an acute care hospitalMinimum of 2 years in DRG validation, coding audit leadership, or CDI collaborationDemonstrated experience in managing and analyzing denial trends, audit outcomes, and documentation variancesExperience working with CDI queries and payer clinical validation denials preferredAdvanced use of EHRs (Meditech, EPIC, Cerner), encoders (3M, Truc ode), and data analytics tools (Excel, Power Point, or Word)SkillsExpertise in ICD-10-CM/PCS and MS-DRG/APR-DRG assignmentProficiency in DRG reimbursement methodologies, clinical indicators, and coding rules across payersStrong regulatory knowledge including CMS, OIG work plans, PEPPER targets, and HACs/PSIsAbility to conduct complex clinical documentation reviews and support DRG integrity with providersSkilled in developing and delivering coder education and clinical documentation trainingHigh proficiency in data analytics to identify trends, conduct root cause analysis, and generate strategic reportingAdvanced communication and negotiation skills to collaborate with CDI, providers, and revenue cycle stakeholdersDemonstrated ability to manage pre- and post-bill audit workflows with minimal supervisionFamiliarity with risk adjustment models, severity of illness (SOI), risk of mortality (ROM), and case mix index (CMI) trendingJob LocationThe Valley Health System-RidgewoodShiftDay (United States of America)BenefitsMedical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)Group Term Life Insurance and AD&D(Full Time Employees)Flexible Spending Accounts and Commuter Benefit PlansSupplemental Voluntary Benefits ( e.g. Short-term and Long-term Disability, Whole Life Insurance, Legal Support, etc.)6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended IllnessRetirement PlanTuition AssistanceEmployee Assistance Program (EAP)Valley Health LifeStyles Fitness Center Membership DiscountDay Care Discounts for Various Daycare FacilitiesSalaryJoining Valley Health System means becoming part of a dedicated team that values the highest quality of care in a supportive environment. In our commitment to high performance and reliability, we encourage and recognize exceptional individual performance through our industry leading compensation practices including a starting salary and benefits in accordance with your role, experience, education, and licensure. Actual individual salaries vary depending on these factors. The salary listed does not include other forms of compensation or benefits.Pay Range: $41.30 - $51.62 (per hour)EEO StatementValley Health System does not discriminate on the basis of ancestry, age, atypical hereditary cellular or blood trait, civil union status, color, creed, disability, domestic partnership, gender, gender identity or expression, familial status, genetic information, liability for service in the Armed Forces of the United States, marital status, medical condition or illness, mental or physical handicap, national origin, nationality, perceived disability, pregnancy, race, refusal to submit to genetic testing or make available results of such tests, religion, sex, sexual orientation, veteran’s status or any other protected basis, in accordance with all applicable Federal, State and Local laws. This applies to all areas of employment, including recruitment, hiring, training and development, promotion, transfer, termination, layoff, compensation, benefits, social and recreational programs, and all other conditions and privileges of employment.