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