Senior Clinical Coder: Remote DRG & Compliance Expert

TEEMA; Town of Florida (NY); Remote; USD 90,000 - 120,000; Full time

Job summary

TEEMA seeks a Senior Clinical Coder to serve as a subject matter expert in ICD-10-CM/PCS, CPT, and HCPCS coding, performing DRG validation and retrospective claims reviews across inpatient and outpatient services in a fully remote environment.

You will collaborate with medical directors, claims operations, and quality management, prepare detailed determination letters, mentor coding staff, and ensure timely, compliant documentation while supporting ongoing process improvement.

Qualifications

• High School Diploma or GED.
• Active CCS credential.
• 5+ years of clinical coding experience (facility and/or professional).
• 3+ years of inpatient/outpatient claims processing experience.
• Experience in fast-paced, production-driven environment.
• Ability to obtain and maintain a favorable background check.

Responsibilities

• Serve as a subject matter expert for ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding.
• Perform DRG validation and retrospective medical claims reviews.
• Analyze inpatient and outpatient claims for coding accuracy and reimbursement determinations.
• Prepare clear, detailed determination letters and written review outcomes.
• Identify coding discrepancies, potential fraud, and quality concerns.
• Provide training, mentorship, and guidance to clinical coding staff.
• Collaborate with cross-functional teams to support coding inquiries and review findings.
• Research and apply medical policies, benefits, limitations, and current coding guidelines.
• Ensure timely completion of coding reviews in alignment with performance standards.
• Maintain accurate and thorough documentation within medical management and claims systems.
• Escalate complex or high‑risk cases to the Medical Director as appropriate.

Skills

Analytical thinking

Critical thinking

Problem solving

Communication

Education

High School Diploma or GED

CCS Credential

Tools

Microsoft Word

Excel

Job description

TEEMA seeks a Senior Clinical Coder to serve as a subject matter expert in ICD-10-CM/PCS, CPT, and HCPCS coding, performing DRG validation and retrospective claims reviews across inpatient and outpatient services in a fully remote environment.

You will collaborate with medical directors, claims operations, and quality management, prepare detailed determination letters, mentor coding staff, and ensure timely, compliant documentation while supporting ongoing process improvement.