The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a critical role in ensuring coding accuracy, regulatory compliance, and appropriate reimbursement across inpatient and outpatient services.
In this role, you will conduct detailed retrospective claims reviews, provide expert-level coding analysis, and support cross-functional teams including medical directors, claims operations, and quality management. This position is ideal for a highly analytical professional who thrives in a fast-paced, remote environment and is passionate about accuracy, compliance, and continuous improvement in healthcare operations.
Duties & Responsibilities
Serve as a subject matter expert for ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding
Perform DRG validation and retrospective medical claims reviews
Analyze inpatient and outpatient claims for coding accuracy and reimbursement determinations
Prepare clear, detailed determination letters and...