Senior Inpatient Coder - Appeals & DRG Lead

Westchester Medical Center Health Network; Town of Mount Pleasant (NY); On-site; USD 85,000 - 120,000; Full time

Job summary

Westchester Medical Center Health Network is seeking an experienced Senior Inpatient Coder to address insurance denials and code complex records using ICD-10-CM/PCS. The role includes providing technical guidance and leading coding activities in collaboration with hospital staff.

The ideal candidate holds a CCS certification, minimum three years in inpatient acute care coding, and strong knowledge of AHA guidelines.

Qualifications

• Minimum of three years in inpatient coding in acute care.
• Proficient in ICD-10-CM and ICD-10-PCS coding.
• Pass coding assessment before hire.
• Current CCS certification required; RHIA/RHIT preferred.
• Ability to train junior coders and guide others.

Responsibilities

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies AHA guidelines to support diagnoses and procedures.
• Analyzes patterns in coding errors and reports to leadership.
• Participates in mandated medical record review processes.
• Assigns and records accurate codes for diagnoses and procedures as documented by the attending physician.
• Queries physicians for documentation clarification.
• Ensures factors for DRG assignment are present and diagnoses ranked properly.
• Contacts to obtain clarifications.
• Compiles and updates the appeal log detailing denials, hospital's reply, and follow-up responses.
• Provides information to staff regarding documentation and DRGs.
• Abstracts information to compile reports.
• May train lower level coders and provide guidance.
• Resolves bill holds to maintain DNFB and coding queue.
• Acts as liaison between Patient Accounting and Coding.

Skills

ICD-10-CM/PCS coding

Inpatient coding

Leadership / training

Communication skills

Education

High School diploma

30 credits toward Associate/Bachelor degree

Tools

Grouper system

AHA Guidelines

Job description

Westchester Medical Center Health Network is seeking an experienced Senior Inpatient Coder to address insurance denials and code complex records using ICD-10-CM/PCS. The role includes providing technical guidance and leading coding activities in collaboration with hospital staff.

The ideal candidate holds a CCS certification, minimum three years in inpatient acute care coding, and strong knowledge of AHA guidelines.