Coding Specialist III

Summary General Summary: Reviews and analyzes complex clinical documentation to accurately assign diagnosis and procedure codes that support compliant reimbursement and quality reporting. Applies expert‑level knowledge of inpatient coding rules to ensure accurate severity of illness, risk of mortality, and regulatory compliance. Serves as a technical resource through documentation clarification, audit support, education, and mentoring to strengthen coding quality and consistency across the organization. Principal Job Functions:

• Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• Reviews complex inpatient medical records to identify and assign accurate codes.
• Determines principal diagnoses, secondary conditions, complications, procedures, present on admission (POA) indicators, hospital‑acquired conditions, and discharge dispositions.
• Applies MS-DRG and APR-DRG methodologies to support accurate reimbursement, severity of illness, risk of mortality, and quality outcomes.
• Enters coded data into designated systems to meet established accuracy, productivity, and turnaround standards.
• Queries providers to clarify documentation and resolves advanced coding edits and discrepancies.
• Supports coding audits, peer reviews, and quality assurance activities for compliance and accuracy.
• Educates providers and team members on coding rules, documentation standards, and best practices.
• Mentors and trains coding team members to build technical knowledge and consistency.
• Maintains confidentiality and adheres to ethical coding and regulatory requirements.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Participates in meetings, committees and department projects as assigned.
• Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”). Required Knowledge, Skills and Abilities: Knowledge of ICD-10-CM, CPT, and HCPCS coding principles and guidelines. Knowledge of medical terminology, anatomy, physiology, and disease processes relevant to code assignment Knowledge of computer hardware equipment and software applications relevant to work functions. Ability to meet accuracy, productivity, and turnaround standards using electronic health record and billing systems. Ability to review and analyze clinical documentation to determine appropriate diagnosis and procedure code assignment. Ability to apply coding guidelines, payer policies, and regulatory requirements accurately and consistently. Ability to communicate effectively both verbally and in writing. Ability to perform crucial conversations with desired outcomes. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff. Ability to problem solve and engage independent critical thinking skills. Ability to maintain confidentiality relevant to sensitive information. Ability to prioritize work demands and work with minimal supervision. Ability to maintain regular and punctual attendance. Education and Experience: High school diploma or equivalent required. Completion of formal coursework in ICD‑10‑CM, CPT and medical coding principles from an accredited or approved program required. Two (2) years of inpatient medical coding experience, including high‑complexity cases; advanced knowledge of ICD‑10‑CM, ICD‑10‑PCS, MS‑DRG/APR‑DRG methodologies, POA indicators, and quality reporting concepts; proficiency with electronic health records and coding systems. Other Credentials / Certifications: Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) Certified Coding Specialist (CCS) Certified Coding Specialist – Physician‑Based (CCS‑P) Certified Professional Coder (CPC) Certified Inpatient Coder (CIC) Physical Requirements:

• Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)
• DOT) – Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

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