Senior Inpatient Coder — DRG & Compliance (Remote)

TEEMA Group; Florida; Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare solutions provider is seeking a Senior Clinical Coder to serve as a subject matter expert in medical coding and DRG validation. This fully remote, full-time position requires extensive experience in coding accuracy, regulatory compliance, and reimbursement processes for both inpatient and outpatient services. The ideal candidate will thrive in a fast-paced environment and is skilled in utilizing ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems. Strong analytical abilities and effective communication skills are essential for success in this role.

Qualifications

• Minimum of five years of clinical coding experience.
• Three years of inpatient and/or outpatient claims processing experience.
• Ability to obtain and maintain a favorable background investigation.

Responsibilities

• Conduct detailed retrospective claims reviews.
• Support cross-functional teams including medical directors.
• Ensure coding accuracy and regulatory compliance.

Skills

ICD-10-CM coding

ICD-10-PCS coding

CPT coding

HCPCS coding

Analytical skills

Attention to detail

Problem-solving skills

Effective communication

Education

High School Diploma or GED

Certified Coding Specialist (CCS)

Tools

Microsoft Word

Microsoft Excel

Job description

The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a critical role in ensuring coding accuracy, regulatory compliance, and appropriate reimbursement across inpatient and outpatient services.

In this role, you will conduct detailed retrospective claims reviews, provide expert-level coding analysis, and support cross-functional teams including medical directors, claims operations, and quality management. This position is ideal for a highly analytical professional who thrives in a fast-paced, remote environment and is passionate about accuracy, compliance, and continuous improvement in healthcare operations.

Duties & 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

Required Qualifications

High School Diploma or GED

Active credential in one of the following:

Certified Coding Specialist (CCS)

Minimum of five (5) years of clinical coding experience (facility and/or professional)

Minimum of three (3) years of inpatient and/or outpatient claims processing experience

Experience working in a fast-paced, production-driven environment

Ability to obtain and maintain a favorable background investigation

Desired Qualifications

Experience within managed care, health insurance, or private healthcare industry

Familiarity with government healthcare programs and regulatory guidelines

Advanced expertise in inpatient facility coding and DRG validation

Strong analytical, critical thinking, and problem-solving skills

High attention to detail with strong organizational capabilities

Ability to manage large volumes of complex information independently

Effective communication and collaboration across multidisciplinary teams

Proficiency in Microsoft Word, Excel, and multi-system environments

Location & Work Type

100% Remote (must reside in an approved state)
Full-time position

Independent home office work environment required

Prolonged computer use and sitting required

Flexibility to support varying work schedules as needed