Inpatient Coding Specialist III

Mass General Brigham•Somerville, MA

5d•Remote

About The Position

The Inpatient Coding Specialist is responsible for the accurate and timely assignment of ICD-10-CM/PCS codes and DRGs for inpatient encounters in compliance with federal regulations, payer guidelines, and organizational policies. This role ensures data integrity, supports revenue cycle optimization, and maintains adherence to coding and documentation standards.

Requirements

High School Diploma or Equivalent required
2+ years of medical coding experience required
In-depth knowledge of medical coding systems, including ICD-10/PCS and their application in hospital billing.
Strong understanding of coding guidelines, regulations, and industry best practices.
Adhere to AHIMA standards of ethical coding and HIPAA regulations.
Analyze full inpatient charts to ensure complete, compliant documentation.
Determine the appropriate Diagnosis Related Group (DRG) to maximize appropriate reimbursement.
Strong communication and interpersonal skills to effectively collaborate with healthcare providers, coders, and other stakeholders.
Strong problem-solving skills to address coding-related challenges and implement effective solutions.
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
Maintain established accuracy rates (typically 95% or higher) and daily coding quotas

Nice To Haves

Associate's Degree Medical Billing and Coding preferred
Inpatient coding experience strongly preferred

Responsibilities

Review inpatient medical records (e.g., H&P, progress notes, operative reports, discharge summaries) to assign appropriate ICD-10-CM and ICD-10-PCS codes
Accurately assign MS-DRG/APR-DRG based on clinical documentation and coding guidelines
Ensure compliance with Official Coding Guidelines, AHA Coding Clinic, CMS regulations, and payer-specific requirements
Identify documentation gaps and initiate physician queries in accordance with compliant query practices
Validate and reconcile CAC (Computer Assisted Coding) suggestions, if applicable
Meet or exceed productivity and quality benchmarks established by the organization
Participate in internal and external coding audits; incorporate feedback into coding practice
Collaborate with CDI, Quality, and Revenue Cycle teams to improve documentation and reimbursement outcomes
Maintain confidentiality and compliance with HIPAA regulations