State Licensed Inpatient Coder

Job Summary

Working remotely, the full-time State Licensed Inpatient Coder will ensure accurate claims processing by reviewing DRG-related issues, identifying overpayments, and collaborating with clinical teams to uphold quality assurance standards.

Key responsibilities

• Review claims for DRG-related issues to drive accurate payments to providers
• Identify overpayments on inpatient services to ensure correct claims payments
• Engage in discussions with MDs to verify clinical rationale behind billed procedures

Required qualifications

• CCS or CIC certification is required
• Knowledge of DRG pricing methodology is required
• 1-2 years of experience in inpatient clinical coding is preferred
• Experience with Medicare or Medicare Advantage payment integrity or claims operations is preferred
• Strong computer skills in Excel and PowerPoint are necessary