Lead HIM Coding Specialist, Health Information Management, Full Time, Day
About The Position
The Lead HIM Coding Specialist serves as a subject matter expert in inpatient coding and DRG validation and is responsible for performing high-level second-level reviews of coded data to ensure compliance with federal regulations, coding guidelines, and hospital policies. This role audits for accurate MS-DRG/APR-DRG assignment and drives improvements in documentation practices and revenue integrity. The Lead HIM Coding Specialist collaborates closely with CDI, Coding, and Compliance teams to identify trends, mitigate risk, and strengthen audit readiness. This position is instrumental in proactive denial prevention, strategic focus audits, and provides mentorship to coding staff.
Requirements
- High School Diploma or equivalent required.
- Certified Coding Specialist (CCS) required.
- Minimum of 5 years of inpatient coding experience in an acute care hospital.
- Minimum of 2 years in DRG validation, coding audit leadership, or CDI collaboration.
- Demonstrated experience in managing and analyzing denial trends, audit outcomes, and documentation variances.
- Advanced use of EHRs (Meditech, EPIC, Cerner), encoders (3M, Truc ode), and data analytics tools (Excel, Power Point, or Word).
- Expertise in ICD-10-CM/PCS and MS-DRG/APR-DRG assignment.
- Proficiency in DRG reimbursement methodologies, clinical indicators, and coding rules across payers.
- Strong regulatory knowledge including CMS, OIG work plans, PEPPER targets, and HACs/PSIs.
- High proficiency in data analytics to identify trends, conduct root cause analysis, and generate strategic reporting.
- Advanced communication and negotiation skills to collaborate with CDI, providers, and revenue cycle stakeholders.
- Familiarity with risk adjustment models, severity of illness (SOI), risk of mortality (ROM), and case mix index (CMI) trending.
Nice To Haves
- Associate or bachelor’s degree in health information management, Health Sciences, or related field preferred.
- RHIT, RHIA, CDIP, CCDS, or CPC certifications preferred.
- Experience working with CDI queries and payer clinical validation denials preferred.
Responsibilities
- Performing high-level second-level reviews of coded data to ensure compliance with federal regulations, coding guidelines, and hospital policies.
- Auditing for accurate MS-DRG/APR-DRG assignment.
- Driving improvements in documentation practices and revenue integrity.
- Collaborating with CDI, Coding, and Compliance teams to identify trends, mitigate risk, and strengthen audit readiness.
- Proactive denial prevention and strategic focus audits.
- Providing mentorship to coding staff.
- Conducting complex clinical documentation reviews and supporting DRG integrity with providers.
- Developing and delivering coder education and clinical documentation training.
- Managing pre- and post-bill audit workflows with minimal supervision.
Benefits
- Medical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)
- Group Term Life Insurance and AD&D(Full Time Employees)
- Flexible Spending Accounts and Commuter Benefit Plans
- Supplemental Voluntary Benefits ( e.g. Short-term and Long-term Disability, Whole Life Insurance, Legal Support, etc.)
- 6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended Illness
- Retirement Plan
- Tuition Assistance
- Employee Assistance Program (EAP)
- Valley Health LifeStyles Fitness Center Membership Discount
- Day Care Discounts for Various Daycare Facilities
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
