Hospital Inpatient Coder

Cedars-Sinai•United States,

8h•$44 - $68•Remote

About The Position

Working under the general direction of a coding supervisor, the Hospital Inpatient Coder reviews medical documentation and assigns ICD-10-CM and ICD-10-PCS codes in accordance with standard coding guidelines. The role identifies principal diagnoses, comorbidities and complications, present-on-admission indicators, and code sequencing to determine the most appropriate DRG for each patient stay. The coder maintains knowledge of Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined Diagnosis Related Groups (APR-DRG), and code capture for statistical purposes, including Social Determinants of Health (SDOH), Hierarchical Conditions (HCC), and severity-impacting conditions. The position translates medical records and health information—including diagnoses, procedures, and treatment—into standardized codes for patients receiving services within Cedars-Sinai Health System and its affiliates. It abstracts required data elements for reporting and statistical capture, resolves inpatient edits and alerts, collaborates with Clinical Documentation Integrity (CDI) team members, and identifies documentation improvement opportunities. The role is approved for remote work in Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, and Texas.

Requirements

High school diploma or GED.
At least 3 years of work experience assigning codes in a healthcare setting and performing similar coding duties.
One of the following certifications or credentials is required upon hire: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Coding Specialist—Physician (CCS-P).

Responsibilities

Review medical documentation and health information in electronic systems and assign applicable ICD-10-CM and ICD-10-PCS codes within productivity and quality standards.
Identify principal diagnoses, comorbidities and complications, present-on-admission indicators, and appropriate sequencing to determine the most appropriate DRG.
Abstract required data elements accurately and promptly for reporting and statistical capture, and enter coded and abstracted information into assigned systems.
Apply knowledge of coding requirements and the impact of categories such as SDOH and PSI.
Resolve complex inpatient edits and alerts accurately using current guidelines.
Communicate with CDI team members about complex clinical scenarios and align clinical and coding approaches for a complete coding profile.
Use anatomy, physiology, and clinical practice knowledge to support code assignment and CDI discussions.
Identify opportunities for documentation improvement and seek clarification from physicians.
Focus learning on advanced-level coding concepts.