Sr. Inpatient Clinical Coder

The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a critical role in ensuring coding accuracy, regulatory compliance, and appropriate reimbursement across inpatient and outpatient services. In this role, you will conduct detailed retrospective claims reviews, provide expert-level coding analysis, and support cross-functional teams including medical directors, claims operations, and quality management. This position is ideal for a highly analytical professional who thrives in a fast-paced, remote environment and is passionate about accuracy, compliance, and continuous improvement in healthcare operations. Duties & Responsibilities Serve as a subject matter expert for ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding Perform DRG validation and retrospective medical claims reviews Analyze inpatient and outpatient claims for coding accuracy and reimbursement determinations Prepare clear, detailed determination letters and written review outcomes Identify coding discrepancies, potential fraud, and quality concerns Provide training, mentorship, and guidance to clinical coding staff Collaborate with cross-functional teams to support coding inquiries and review findings Research and apply medical policies, benefits, limitations, and current coding guidelines Ensure timely completion of coding reviews in alignment with performance standards Maintain accurate and thorough documentation within medical management and claims systems Escalate complex or high‑risk cases to the Medical Director as appropriate Required Qualifications High School Diploma or GED Active credential in one of the following: Certified Coding Specialist (CCS) Minimum of five (5) years of clinical coding experience (facility and/or professional) Minimum of three (3) years of inpatient and/or outpatient claims processing experience Experience working in a fast‑paced, production‑driven environment Ability to obtain and maintain a favorable background investigation Desired Qualifications Experience within managed care, health insurance, or private healthcare industry Familiarity with government healthcare programs and regulatory guidelines Advanced expertise in inpatient facility coding and DRG validation Strong analytical, critical thinking, and problem‑solving skills High attention to detail with strong organizational capabilities Ability to manage large volumes of complex information independently Effective communication and collaboration across multidisciplinary teams Proficiency in Microsoft Word, Excel, and multi‑system environments Location & Work Type 100% Remote (must reside in an approved state) Full‑time position Independent home office work environment required Prolonged computer use and sitting required Flexibility to support varying work schedules as needed #J-18808-Ljbffr