The Onsite Medical Coder is responsible for reviewing clinical documentation and assigning accurate diagnosis and procedure codes for inpatient and outpatient services in compliance with coding guidelines and regulatory requirements. This role also supports coding workflow management, coordination with outsourced coding partners, revenue cycle teams, and clinical staff to ensure accurate and timely coding across all three facilities.
Qualifications
- Certified Coding Specialist (CCS), RHIT, RHIA, CPC, or equivalent preferred.
- Experience coding inpatient and outpatient hospital records.
- Strong knowledge of ICD-10-CM, ICD-10-PCS, and CPT coding guidelines.
- Experience working with electronic medical records and coding workflows.
- Strong attention to detail, analytical skills, and ability to communicate with clinical and administrative teams.
Key Responsibilities
Medical Coding: Code inpatient, outpatient, physical therapy, and same-day surgery records according to coding guidelines.
Documentation Review: Ensure required documentation (e.g., pathology reports, H&P, discharge details) is complete before accounts are sent for coding.
Account Management: Manage SDS and inpatient accounts, place holds when documentation is missing, and transfer accounts to coding once complete.
Revenue Cycle Support: Review coding-related payor denials, identify missed procedures, and assist the Business Office with coding issues affecting reimbursement.
Coordination with Coders: Support outsourced coding teams by answering questions, clarifying diagnoses, and maintaining tracking logs.
Query Resolution: Review and resolve coding queries or escalate to physicians when documentation clarification is needed.
Quality & Compliance: Monitor coding accuracy, track errors, and ensure compliance with regulations and facility policies.
Education & Collaboration: Educate clinical staff on documentation requirements and collaborate with HIM, Case Management, and Revenue Cycle teams.
Work Environment
- Onsite position at College Medical Center.
- Provides coding and workflow support for all three affiliated facilities.
Pay Rate: $30.46-$38.07 per hour
