Clinical Coding Analyst (Clinical Validation & DRG Review)

Enjoin • ,

3d • $100,000 - $110,000 • Remote

About The Position

The Clinical Coding Analyst (CCA) performs pre-bill inpatient medical record reviews to identify coding opportunities, potential compliance risks, and documentation improvements that support accurate MS-DRG assignment and appropriate reimbursement. Using advanced knowledge of ICD-10-CM/PCS, AHA Coding Clinic guidance, Medicare regulations, and clinical validation, this position develops clear, evidence-based recommendations for clients. Working closely with Enjoin physicians and client coding and CDI teams, the Clinical Coding Analyst reviews complex cases, communicates findings, responds to rebuttals, and supports denial and quality-related initiatives. This is a fully remote position requiring strong analytical ability, sound judgment, accuracy, and the ability to consistently meet 24-hour turnaround expectations.

Requirements

• Active CCS, RHIT, RHIA, CDIP, or CCDS credential
• Minimum of four years of acute inpatient hospital coding, coding audit, and/or CDI experience within a large tertiary hospital
• Extensive knowledge of ICD-10-CM/PCS, Official Coding Guidelines, AHA Coding Clinic guidance, and MS-DRG methodology
• Experience working with electronic health record systems such as Epic, Cerner, or Meditech
• Previous experience working in a remote environment
• Strong clinical and coding analytical skills with the ability to identify opportunities, compliance risks, and unsupported documentation
• Excellent written and verbal communication skills
• Ability to clearly explain and defend coding recommendations
• Demonstrated initiative, resourcefulness, accuracy, and sound professional judgment
• Ability to work independently, manage competing priorities, and consistently meet required turnaround times
• Excellent planning and organizational skills
• Strong collaboration, teamwork, and adaptability
• Proficiency with Microsoft Word and Excel
• High-speed internet and a dedicated, secure workspace that supports compliance with HIPAA privacy and security requirements

Nice To Haves

• AHIMA-approved ICD-10-CM/PCS Trainer designation
• Experience supporting Clinical Documentation Integrity programs
• Experience reviewing coding or clinical denials
• Experience with APR, 30-day readmission, mortality, or other healthcare quality measures

Responsibilities

• Perform daily pre-bill reviews of inpatient medical records for assigned clients
• Identify revenue opportunities, coding compliance risks, and documentation concerns using ICD-10-CM/PCS guidelines, AHA Coding Clinic guidance, Medicare regulations, and clinical judgment
• Evaluate clinical indicators and documentation supporting diagnoses, procedures, and MS-DRG assignment
• Conduct verbal case reviews with Enjoin physicians for records involving potential MS-DRG changes or provider query opportunities
• Develop and submit clear, evidence-based client recommendations, including increased reimbursement, decreased reimbursement, and informational notifications
• Complete assigned reviews and deliver client recommendations within the required 24-hour turnaround time
• Respond to client questions and rebuttals in accordance with internal protocols and established service expectations
• Upload daily worklists and accurately record all required recommendation data in Enjoin’s MS-DRG database
• Support review and appeal activities involving Medicare and third-party payer denials processed through the MS-DRG Assurance program
• Review inclusion and exclusion criteria related to 30-day readmission and mortality quality measures for designated Medicare populations
• Maintain active access to all assigned client systems and ensure credentials remain current
• Utilize Enjoin tools and coding resources, including TruCode, the Enjoin I10 Wiki, and CDocT
• Maintain current knowledge of ICD-10-CM/PCS updates, AHA Coding Clinic guidance, Medicare regulations, and relevant industry developments
• Adhere to all company policies, procedures, confidentiality requirements, and compliance standards

Benefits

• Comprehensive medical, dental, and vision insurance
• 401(k) with company match
• Generous paid time off plus eight paid holidays
• 100% remote work environment with company-provided equipment
• Professional development, leadership training, and internal growth opportunities
• Recognition programs and performance-based rewards
• Employee wellness resources and discount programs
• White glove onboarding designed to set you up for success
• A collaborative, people-first culture recognized as a Great Place to Work® for three consecutive years

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed