Sr. Inpatient Clinical Coder

Job Summary

Under the direction of the DRG Supervisor or designee, conducts retrospective medical claims review for coding and pricing determinations and / or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment. Subject matter expert on medical claims coding for outpatient and inpatient services. Provides coding-related information to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management and the claims subcontractor as needed. Functions as the designated recipient for factual network provider claim review requests. Develops determination letters. Provides support to non-clinical and clinical staff on coding and retrospective medical claims review processes.

Education & Experience

Required :

• High School Diploma or GED
• Current certification as Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Professional Coder.
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Minimum 5 years of clinical coding experience for facility and / or professional accounts
• Minimum 3 years of claims processing experience for inpatient and / or outpatient accounts
• Documented experience in a fast-paced environment

Preferred :

Key Responsibilities

Competencies

Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Independent Thinking / Self-Initiative : Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Information Management : Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Organizational Skills : Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis : Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Team-Building / Team Player : Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills : Advanced knowledge of ICD-10-CM, ICD-10 PCS HCPCS and CPT coding; advanced knowledge of utilization review processes and / or claims processing; ability to maintain the confidentiality and security requirements of medical records; proficient with Word and Excel; ability to meet department performance standards.

Working Conditions

Working Conditions :