Lead HIM Coding Specialist - Remote

Overview

The Lead HIM Coding Specialist serves as a subject matter expert in inpatient coding and DRG validation, ensuring compliance with regulations and improving documentation practices.

In Short

• Perform high-level second-level reviews of coded data.
• Audit for accurate MS-DRG/APR-DRG assignment.
• Collaborate with CDI, Coding, and Compliance teams.
• Drive improvements in documentation practices.
• Provide mentorship to coding staff.
• Manage and analyze denial trends and audit outcomes.
• Conduct complex clinical documentation reviews.
• Develop and deliver coder education and training.
• Utilize advanced EHRs and data analytics tools.
• Support DRG integrity with providers.

Requirements

• High School Diploma or equivalent required.
• Certified Coding Specialist (CCS) required.
• 5 years of inpatient coding experience.
• 2 years in DRG validation or coding audit leadership.
• Experience with CDI queries and payer clinical validation.
• Strong regulatory knowledge including CMS and OIG work plans.
• Ability to conduct complex clinical documentation reviews.
• Advanced communication and negotiation skills.
• Familiarity with risk adjustment models and case mix index trending.

Benefits

• Medical/Prescription, Dental & Vision Discount Program.
• Group Term Life Insurance and AD&D.
• Flexible Spending Accounts and Commuter Benefit Plans.
• Paid Holidays and Paid Time Off.
• Retirement Plan and Tuition Assistance.
• Employee Assistance Program (EAP).
• Discounts for Day Care Facilities.