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

01 The Valley Hospital; Ridgewood (NJ); On-site; USD 118,341,000 - 147,913,000; Full time

Benefits offered by this job

Medical/Dental/Vision Discount Program

Group Term Life Insurance and AD&D

Flexible Spending Accounts and Commut/

Job summary

Valley Health System in Ridgewood 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 second-level reviews of coded data, drive documentation improvements, and collaborate with CDI, Coding, and Compliance teams to strengthen audit readiness and revenue integrity.

The role requires CCS certification, 5+ years in inpatient coding, and experience with DRG methodologies and auditors.

Qualifications

• Inpatient coding experience in an acute care hospital.
• Minimum of 5 years inpatient coding experience.
• Minimum of 2 years in DRG validation, coding audit leadership, or CDI collaboration.
• Experience with denial trends analysis and documentation variances.

Responsibilities

• Perform high-level second-level reviews of coded data for accuracy and DRG validation.
• Audit MS-DRG/APR-DRG assignments and drive documentation improvements.
• Mentor and educate coding staff; lead coder training initiatives.
• Collaborate with CDI, Coding, and Compliance to identify trends and mitigate risk.
• Support audit readiness and proactive denial prevention.

Skills

ICD-10-CM/PCS expertise

MS-DRG/APR-DRG knowledge

DRG reimbursement knowledge

CMS/OIG compliance knowledge

data analytics

communication and negotiation

CDI collaboration

audits and denial trends

pre- and post-bill audit workflows

Education

CCS certification

AS/BS in HIM or related field

RHIT/RHIA/CDIP/CCDS/CPC certifications preferred

Tools

Meditech

EPIC

Cerner

3M encoder

TruCode

Excel

Job description

Position Summary

The 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.

Education

High 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.

Experience

Minimum of 5 years of inpatient coding experience in an acute care hospital Minimum of 2 years in DRG validation, coding audit leadership, or CDI collaboration Demonstrated experience in managing and analyzing denial trends, audit outcomes, and documentation variances Experience working with CDI queries and payer clinical validation denials preferred Advanced use of EHRs (Meditech, EPIC, Cerner), encoders (3M, Truc ode), and data analytics tools (Excel, Power Point, or Word)

Skills

Expertise in ICD-10-CM/PCS and MS-DRG/APR-DRG assignment Proficiency in DRG reimbursement methodologies, clinical indicators, and coding rules across payers Strong regulatory knowledge including CMS, OIG work plans, PEPPER targets, and HACs/PSIs Ability to conduct complex clinical documentation reviews and support DRG integrity with providers Skilled in developing and delivering coder education and clinical documentation training High proficiency in data analytics to identify trends, conduct root cause analysis, and generate strategic reporting Advanced communication and negotiation skills to collaborate with CDI, providers, and revenue cycle stakeholders Demonstrated ability to manage pre- and post-bill audit workflows with minimal supervision Familiarity with risk adjustment models, severity of illness (SOI), risk of mortality (ROM), and case mix index (CMI) trending

Job Location

The Valley Health System-Ridgewood Shift Day (United States of America)

Benefits

• Medical/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 Plans
• Supplemental 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 Illness Retirement Plan
• Tuition Assistance
• Employee Assistance Program (EAP)
• Valley Health LifeStyles Fitness Center Membership Discount
• Day Care Discounts for Various Daycare Facilities

Salary

Joining 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 Statement

Valley 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.

Culture

Valley Health System is proud of our commitment to improving the lives of our patients, our staff, and the communities we serve. When you join Valley, you’re joining a team of people who believe in delivering quality care in a supportive environment where top performance is both nurtured and recognized. Our culture is built on going the extra mile, doing what’s right, and always striving to be better together.