Sr. Inpatient Clinical Coder

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

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