Coder Specialist - Inpatient

Advocate Health•Milwaukee, WI

2d•$33 - $50•Remote

About The Position

The Coder Specialist - Inpatient supports a mix of inpatient community and academic coding, including cardiology, neurology, and oncology. The role reviews complex inpatient documentation and assigns diagnosis and procedure codes using ICD-10-CM/PCS, CPT, and HCPCS while following official coding guidelines and applicable federal and insurance regulations. Work is performed using an EMR and/or computer-assisted coding software. The specialist handles high-dollar and long-length-of-stay cases across patient types and serves as a coding subject matter expert to department leaders and peers. The position collaborates with Clinical Documentation Improvement and Quality teams to align DRGs and reconcile Medicare cases with CDI working DRGs. It also communicates with clinicians about disease processes, participates in payer audits and meetings, and attends clinical-team meetings concerning complex specialty coding updates. The specialist maintains coding expertise through continuing education and research, protects patient confidentiality, and reports perceived non-compliant practices. The role is full-time, Monday through Friday, eight hours per day, totaling 40 hours per week. Remote work may be approved for employees working from specified registered states.

Requirements

Coding certification issued by AAPC or AHIMA.
Associate's degree in Health Information Management or a related field.
Typically, seven years of inpatient coding experience in an acute-care tertiary facility, including experience in revenue cycle processes, Clinical Documentation Improvement, research, and health information workflows.
Advanced proficiency in ICD, CPT, and HCPCS coding guidelines.
Advanced knowledge of medical terminology, anatomy, and physiology.
Excellent computer skills, including Microsoft Office, electronic mail, and exposure to or experience with electronic coding systems or applications.
Excellent oral and written communication and interpersonal skills.
Strong organization, prioritization, and reading comprehension skills.
Strong analytical skills and attention to detail.
Ability to work independently and exercise independent judgment and decision-making.
Ability to meet deadlines in a fast-paced environment.
Ability to take initiative and collaborate with others.
Ability to sit for extended periods and continuously concentrate.
Ability to operate equipment necessary to perform the job.

Responsibilities

Review complex inpatient documentation and assign diagnosis and procedure codes using ICD-10-CM/PCS, CPT, and HCPCS.
Ensure code selection follows official coding guidelines and federal and insurance regulations using an EMR and/or computer-assisted coding software.
Follow organizational and department policies and procedures to support efficient work processes.
Code high-dollar and long-length-of-stay cases for all patient types.
Apply query guidelines and coding standards; follow up to obtain clarification of inaccurate documentation as appropriate.
Serve as a subject matter expert for coding department leaders and peers, and recommend policy or procedure modifications when needed to align with government regulations.
Maintain continuing education by attending webinars and reviewing updated CPT Assistant guidelines and coding clinics; research coding topics and issues.
Follow AHIMA Standards of Ethical Coding and official coding guidelines, using ethical judgment in assigning and sequencing codes for appropriate insurance reimbursement.
Collaborate with Clinical Documentation Improvement and Quality teams to align DRGs and reconcile each Medicare case with CDI working DRGs.
Communicate with clinicians about disease processes to support accurate coding.
Participate in payer audits and meetings as a coding resource when requested.
Attend clinical-team meetings regarding code updates for complex specialties.
Maintain confidentiality of patient records and report perceived non-compliant practices to the coding leader or compliance officer.
Meet or exceed departmental quality standards of 95% or more and productivity standards of 100%, including productivity expectations supporting discharged-not-final-billed (DNFB).
Perform other related duties as assigned.