Medical Coder - Inpatient (DRG Reviewer)

Acentra Health; McLean (VA); On-site; USD 40,000 - 50,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Retirement savings

Job summary

Acentra Health is seeking a Medical Coder-Inpatient to join our team in McLean, VA. The role focuses on reviewing inpatient documentation to ensure accurate diagnoses and procedures using ICD-10-CM and CPT-4, validating MS-DRG assignments, and ensuring regulatory compliance.

Responsibilities include auditing inpatient records, communicating findings, and supporting reimbursement and compliance activities in a production-driven environment.

Qualifications

• 2+ years of experience in acute care inpatient coding, CDI, medical scribing, DRG auditing/review, or related healthcare documentation experience
• Active possession of one or more professional certifications (see above)
• Proficient in ICD-10-CM and ICD-10-PCS
• Strong knowledge of inpatient coding guidelines, DRG reimbursement, CMS and payer regulations
• Ability to independently review inpatient medical records and validate diagnoses and procedures
• Experience with electronic health records and coding software
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office and meeting deadlines in a fast-paced environment
• Commitment to ongoing learning and professional development

Responsibilities

• Review inpatient medical record documentation and accurately code primary/secondary diagnoses and procedures using ICD-10-CM and CPT-4 conventions
• Validate accuracy of reported diagnoses and procedures against guidelines and payer requirements
• Evaluate diagnosis and procedure sequencing for compliance with coding guidelines
• Assess MS-DRG assignment based on documented conditions and rules
• Identify and communicate audit findings including coding discrepancies and DRG or reimbursement risk
• Abstract and compile audit data to support accurate reimbursement and compliance
• Utilize coding software and encoder/grouper tools effectively
• Maintain HIPAA compliance and support other audit-related functions

Skills

Attention to detail

Analytical skills

Effective communication

Time management

Education

High school diploma or GED

Inpatient coding certifications preferred (CCS/CCA/CDIP/CPMA/CRC/CIC/CDEI)

Tools

ICD-10-CM/ICD-10-PCS coding

ICD coding software

Encoder/Grouper tools

EMR/EHR systems

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities

Acentra Health is looking for a Medical Coder-Inpatient to join our growing team.

Job Summary:

The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical validity of reported diagnoses and procedures. This role evaluates coding accuracy, DRG assignment, reimbursement impact, and regulatory compliance in accordance with official coding guidelines, CMS regulations, payer policies, and organizational standards. The reviewer retrieves, analyzes, and documents medical record information to support appropriate reimbursement, documentation integrity, and audit outcomes for hospital inpatient services.

Responsibilities:

• Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and CPT-4 coding conventions.
• Review inpatient medical records to validate the accuracy and appropriateness of reported primary and secondary diagnoses and procedures using ICD-10-CM/PCS guidelines.
• Evaluate diagnosis and procedure sequencing to ensure compliance with official coding guidelines and payer requirements.
• Review and validate MS-DRG assignment based on documented clinical conditions, procedures, and applicable coding rules.
• Assess clinical documentation support for reported diagnoses, particularly those with reimbursement, quality, or compliance impact.
• Conduct clinical validation reviews to determine whether diagnoses are supported by clinical indicators within the medical record.
• Apply CMS regulations, including medical necessity criteria and the Two-Midnight Rule, when evaluating admission status and level of care.
• Identify, document, and clearly communicate audit findings, including:
  • Coding discrepancies
  • Clinical validation concerns
  • DRG or reimbursement risk
  • Admission status issues
• Abstract and compile audit data to support accurate reimbursement and compliance reporting.
• Utilize coding software, encoder/grouper tools, and electronic medical record systems to complete reviews efficiently and accurately.
• Meet productivity, quality, and contract deliverable standards in a production-driven environment.
• Maintain compliance with all corporate policies, including HIPAA Privacy and Security Rules.
• Serve as backup support for other administrative or audit-related functions as needed.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

Required Qualifications

• High school diploma or GED.
• Minimum of 2 years of progressive hands-on experience in acute care inpatient coding, clinical documentation improvement (CDI), medical scribing, DRG auditing/review, or related healthcare documentation experience
• Active possession of one or more of the following certification(s)
  • CCS or CCA or CDIP (AHIMA) | Please Note: CCS-P is not accepted for this position
  • CPMA, CRC, CIC or CDEI (AAPC)
  • CCDS (ACDIS)
• Demonstrated proficiency in ICD-10-CM and ICD-10-PCS
• Strong working knowledge of: Inpatient coding guidelines, DRG reimbursement methodology and CMS and payer regulations
• Proven ability to independently review inpatient medical records and validate: Diagnoses, Procedures, as well as MS-DRG assignment
• Experience reviewing inpatient medical records
• Familiarity with electronic health records, encoder/grouper tools, and coding software
• Strong analytical skills with exceptional attention to detail
• Effective written and verbal communication skills
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Ability to meet deadlines with accuracy in a fast-paced, production-focused environment
• Commitment to ongoing learning and professional development.

Preferred Qualifications

• Advanced experience and knowledge of clinical validation audits, admission status, medical necessity reviews and payer-specific audit processes

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Pay Range

USD $29.19 - USD $36.00 /Hr.