Coding Integrity Specialist
Core
Conduct complex coding reviews and quality assurance for inpatient medical records to ensure accurate reimbursement, public reporting, and value-based payment compliance.
Role type
Senior IC coding integrity specialist (inpatient)
Builds
Accurate DRG assignments, reimbursement claims, and public reporting data for hospitals and health systems.
Domain
Healthcare revenue cycle management / Medical coding
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Inpatient medical coding, coding quality review, DRG assignment, medical record analysis, regulatory compliance (CMS/HAC/PSI), data trend analysis, system mapping feedback
Preferred skills
CCS credential, HIM degree, pre-bill/post-bill review, 360 coding reviews, automated notification systems
Technologies
Cloudmed DRG Validation, automated notification systems
Responsibilities
Conduct complex coding reviews related to reimbursement and public reporting; Collaborate with CDI teams to resolve documentation inconsistencies and DRG variances; Perform second-level pre-bill and post-bill account reviews for quality and risk; Identify coding trends requiring formal education and provide feedback on system updates; Validate proper coding for specific service lines to optimize case mix index reporting.
Seniority
Mid-Senior, hands-on IC
