Inpatient DRG Coding Coder/SME

We are seeking an experienced Inpatient DRG Coding specialist/Subject Matter Expert (SME) to support coding operations.

Responsibilities

• This role combines hands-on inpatient coding, chart auditing, coder training, and oversight of daily workflow to ensure accurate, compliant, and timely coding.
• The ideal candidate will have strong expertise in ICD-10-CM, CPT, ICD-10-PCS, DRG assignment, and inpatient coding guidelines, along with experience mentoring coders and resolving complex coding questions.
• Manage daily inpatient coding workflows, prioritize work queues, and support timely completion of assigned cases.
• Review inpatient medical records and assign accurate diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS.
• Apply current Official Guidelines for Coding and Reporting, UHDDS definitions, and applicable facility and payer requirements.
• Validate principal diagnosis, secondary diagnoses, principal procedures, and appropriate DRG assignment.
• Review documentation supporting complications and comorbidities, major complications and comorbidities, and present-on-admission indicators.
• Serve as the escalation point for complex inpatient coding questions and DRG discrepancies.
• Conduct routine chart audits, document findings, and provide actionable feedback to improve coding accuracy and consistency.
• Partner with Clinical Documentation Integrity (CDI) and other relevant teams to address incomplete, conflicting, or unclear documentation through established query processes.
• Prepare training materials and conduct onboarding, refresher training, and updates on coding changes.
• Monitor individual and team quality, productivity, turnaround time, and backlog against established standards.
• Identify recurring errors, perform root-cause analysis, and implement corrective actions.
• Support coding-related denial reviews and appeals by validating code assignments and supporting documentation.
• Understand client requirements and communicate operational updates, quality trends, and escalations.
• Maintain patient confidentiality and follow HIPAA requirements and organizational policies.
• Achievement of individual and team productivity targets.
• Timely completion of coding and audit work queues.
• Reduction in recurring coding errors and rework.
• Effective training, coaching, and resolution of coding escalations.

Requirements

• Qualifications 4–7 years of medical coding experience, including substantial hands-on experience in US acute-care inpatient hospital coding.
• Active Certified Coding Specialist (CCS) certification from AHIMA or Certified Inpatient Coder (CIC)/CPC certification from AAPC.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, UHDDS definitions, and inpatient coding guidelines.
• Experience with MS-DRG assignment, sequencing, CC/MCC validation, and present-on-admission indicators.
• Experience auditing inpatient charts, resolving coding discrepancies, and providing coder feedback.
• Demonstrated experience as an SME, senior coder, auditor, trainer, or team lead.
• Strong understanding of medical terminology, anatomy, physiology, disease processes, and surgical procedures.
• Ability to interpret clinical documentation and apply coding guidance accurately.
• Strong analytical, communication, organizational, and problem-solving skills.
• Ability to manage competing priorities while meeting quality and productivity expectations.
• High school diploma or equivalent required.

Preferred

• Qualifications Experience with APR-DRG methodology and payer-specific DRG requirements.
• Experience coding complex medical and surgical inpatient cases.
• Familiarity with Epic, Oracle Health/Cerner, 3M coding and grouping tools, or comparable platforms.
• Experience collaborating with CDI, Health Information Management, revenue cycle, and clinical teams.
• Experience managing team workloads, reporting performance, and implementing quality improvement initiatives.
• RHIA or RHIT credentials in addition to an inpatient coding certification.
• An associate or bachelor’s degree in health information management, Health Information Technology, or a related field is preferred.
• Key Performance Measures Coding and DRG accuracy against established quality standards.