Ensures precise coding and high‑quality data, promoting consistency and efficiency in inpatient and outpatient services through ongoing ICD‑10‑CM and CPT coding validation, as well as accurate MS‑DRG, APR‑DRG, and/or outpatient APC assignment.

Responsibilities include:
• Conducting coding quality reviews of inpatient records to confirm correct ICD‑10‑CM codes, appropriate DRG grouping, and identification of missed secondary diagnoses or procedures, while ensuring compliance with all DRG regulations and reporting requirements.
• Verifying data accuracy before bill submission and performing retrospective coding audits as needed.
• Reviewing outpatient encounters for data quality, validating ICD‑10‑CM, CPT, and HCPCS Level II codes, modifiers, APC grouping, and identifying missed secondary diagnoses or procedures, ensuring adherence to outpatient coding rules.
• Confirming medical necessity and adherence to local medical review policies.
• Continuously assessing clinical documentation for completeness and consistency in inpatient records that affect code selection, DRG assignment, and reimbursement, and escalating concerns to the department manager.
• Training coding staff and educating healthcare providers on coding guidelines, documentation standards, medical terminology, disease processes, and their relevance to MS‑DRG, APR‑DRG, outpatient APC, and other data quality practices.
• Maintaining up‑to‑date knowledge of coding certification requirements.
• Reviewing LifeChart coding validator errors and CED work queues, identifying coding or charge-related issues for leadership.
• Conducting routine coding validation audits and preparing coder accuracy reports for the director.
• Following the AHIMA Standards of Ethical Coding, monitoring staff for compliance, and reporting concerns to the Coding Manager.
• Providing direction to coding staff when management is unavailable.

Basic Knowledge:
• Completion of a coding certification program.
• Understanding of medical record content.
• Training in medical terminology, medical science, disease processes, anatomy, and physiology.
• Ability to interpret clinical documentation relevant to coding.
• Strong writing skills for compliant physician queries.
• Computer proficiency, including researching regulatory requirements and navigating electronic medical records.
• Coding specialist certification required.

Experience:
• Five years of coding optimization experience in an acute care setting.
• Prior auditing experience or strong coding training preferred.
• Ability to work independently within departmental policies, referring complex issues to a supervisor when clarification is needed.