Inpatient Medical Coder

About the job

Job Title: Inpatient Medical Coder

Location: Negotiable

Comp: $30-35/hr

Benefits: For eligible employees, we offer medical, dental, vision, and 401K.

Position Summary:

We are seeking an experienced and detail-oriented Inpatient Coder to accurately assign ICD-10-CM and PCS codes to inpatient medical records for proper billing, reimbursement, and data reporting. The ideal candidate will have a strong understanding of coding guidelines, medical terminology, anatomy, and compliance requirements, as well as the ability to work independently in a fast-paced healthcare environment.

Responsibilities:

• Review and analyze inpatient medical records to identify appropriate ICD-10-CM diagnosis and PCS procedure codes.

• Ensure coding accuracy and compliance with federal regulations, payer requirements, and official coding guidelines.

• Assign DRGs (Diagnosis-Related Groups) to inpatient cases to optimize reimbursement accuracy and documentation integrity.

• Collaborate with physicians and clinical documentation specialists (CDS) to clarify documentation and resolve discrepancies.

• Maintain up-to-date knowledge of coding changes, regulatory updates, and hospital-specific policies.

• Verify the accuracy and completeness of coded data to support quality assurance and performance improvement initiatives.

• Utilize electronic health records (EHR) systems and encoder software to efficiently code and abstract patient information.

• Meet productivity and accuracy standards set by the organization.

• Ensure compliance with HIPAA regulations and patient confidentiality protocols.

• Participate in continuing education and training to maintain coding certifications and expertise.

Qualifications:

• High school diploma or equivalent required; associate or bachelor’s degree in Health Information Management or related field preferred.

• Certification required: CCA, CCS, CPC, or RHIT/RHIA .

• Minimum of 2 years of inpatient coding experience in a hospital or acute care setting preferred.

• Strong knowledge of ICD-10-CM and PCS coding systems, DRG assignment, and medical terminology.

• Proficient with EHR and coding software (e.g., EPIC, 3M Encoder, TruCode).

• Excellent analytical, organizational, and communication skills.

• Ability to work independently while maintaining accuracy and productivity standards.

Key Skills:

• ICD-10-CM & PCS Coding | DRG Assignment | Clinical Documentation Improvement (CDI) | Compliance & Auditing | EHR Systems | HIPAA | Attention to Detail | Medical Terminology | Reimbursement Optimization | Analytical Thinking