Medical Coder - Inpatient (DRG Reviewer)

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

7h•Remote

About The Position

Acentra Health is looking for a Medical Coder-Inpatient to join their growing team. The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical validity of reported diagnoses and procedures. This role evaluates coding accuracy, DRG assignment, reimbursement impact, and regulatory compliance in accordance with official coding guidelines, CMS regulations, payer policies, and organizational standards. The reviewer retrieves, analyzes, and documents medical record information to support appropriate reimbursement, documentation integrity, and audit outcomes for hospital inpatient services.

Requirements

High school diploma or GED.
Minimum of 2 years of progressive hands-on experience in acute care inpatient coding, clinical documentation improvement (CDI), medical scribing, DRG auditing/review, or related healthcare documentation experience
Active possession of one or more of the following certification(s): CCS or CCA or CDIP (AHIMA) | Please Note: CCS-P is not accepted for this position, CPMA, CRC, CIC or CDEI (AAPC), CCDS (ACDIS)
Demonstrated proficiency in ICD-10-CM and ICD-10-PCS
Strong working knowledge of: Inpatient coding guidelines, DRG reimbursement methodology and CMS and payer regulations
Proven ability to independently review inpatient medical records and validate: Diagnoses, Procedures, as well as MS-DRG assignment
Experience reviewing inpatient medical records
Familiarity with electronic health records, encoder/grouper tools, and coding software
Strong analytical skills with exceptional attention to detail
Effective written and verbal communication skills
Proficiency in Microsoft Office (Word, Excel, Outlook)
Ability to meet deadlines with accuracy in a fast-paced, production-focused environment
Commitment to ongoing learning and professional development.

Nice To Haves

Advanced experience and knowledge of clinical validation audits, admission status, medical necessity reviews and payer-specific audit processes

Responsibilities

Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and CPT-4 coding conventions.
Review inpatient medical records to validate the accuracy and appropriateness of reported primary and secondary diagnoses and procedures using ICD-10-CM/PCS guidelines.
Evaluate diagnosis and procedure sequencing to ensure compliance with official coding guidelines and payer requirements.
Review and validate MS-DRG assignment based on documented clinical conditions, procedures, and applicable coding rules.
Assess clinical documentation support for reported diagnoses, particularly those with reimbursement, quality, or compliance impact.
Conduct clinical validation reviews to determine whether diagnoses are supported by clinical indicators within the medical record.
Apply CMS regulations, including medical necessity criteria and the Two-Midnight Rule, when evaluating admission status and level of care.
Identify, document, and clearly communicate audit findings, including: Coding discrepancies, Clinical validation concerns, DRG or reimbursement risk, Admission status issues.
Abstract and compile audit data to support accurate reimbursement and compliance reporting.
Utilize coding software, encoder/grouper tools, and electronic medical record systems to complete reviews efficiently and accurately.
Meet productivity, quality, and contract deliverable standards in a production-driven environment.
Maintain compliance with all corporate policies, including HIPAA Privacy and Security Rules.
Serve as backup support for other administrative or audit-related functions as needed.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.