[Hiring] Medical Coder @Acentra Health, LLC

Role Description

Acentra Health is looking for a Medical Coder to join our growing team.

The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical validity of reported diagnoses and procedures. This role evaluates coding accuracy, DRG assignment, reimbursement impact, and regulatory compliance in accordance with official coding guidelines, CMS regulations, payer policies, and organizational standards. The reviewer retrieves, analyzes, and documents medical record information to support appropriate reimbursement, documentation integrity, and audit outcomes for hospital inpatient services.

Responsibilities:

• Review medical record documentation and accurately code the primary/secondary diagnoses and procedures using ICD-9-CM and CPT-4 coding conventions.
• Review inpatient medical records to validate the accuracy and appropriateness of reported primary and secondary diagnoses and procedures using ICD-10-CM/PCS guidelines.
• Evaluate diagnosis and procedure sequencing to ensure compliance with official coding guidelines and payer requirements.
• Review and validate MS-DRG assignment based on documented clinical conditions, procedures, and applicable coding rules.
• Assess clinical documentation support for reported diagnoses, particularly those with reimbursement, quality, or compliance impact.
• Conduct clinical validation reviews to determine whether diagnoses are supported by clinical indicators within the medical record.
• Apply CMS regulations, including medical necessity criteria and the Two-Midnight Rule, when evaluating admission status and level of care.
• Identify, document, and clearly communicate audit findings, including:
  • Coding discrepancies
  • Clinical validation concerns
  • DRG or reimbursement risk
  • Admission status issues
• Abstract and compile audit data to support accurate reimbursement and compliance reporting.
• Utilize coding software, encoder/grouper tools, and electronic medical record systems to complete reviews efficiently and accurately.
• Meet productivity, quality, and contract deliverable standards in a production-driven environment.
• Maintain compliance with all corporate policies, including HIPAA Privacy and Security Rules.
• Serve as backup support for other administrative or audit-related functions as needed.

Qualifications

• High school diploma or GED.
• Minimum of 2 years of progressive, hands-on acute care inpatient coding experience, including DRG auditing or review experience.
• Active possession of one of more of the following certifications:
  • CCS or CCA or CDIP (AHIMA)
  • CPMA (AAPC)
  • CCDS (ACDIS)
• Demonstrated proficiency in ICD-10-CM and ICD-10-PCS.
• Strong working knowledge of inpatient coding guidelines, DRG reimbursement methodology, and CMS and payer regulations.
• Proven ability to independently review inpatient medical records and validate diagnoses, procedures, as well as MS-DRG assignment.
• Experience reviewing inpatient medical records.
• Familiarity with electronic health records, encoder/grouper tools, and coding software.
• Strong analytical skills with exceptional attention to detail.
• Effective written and verbal communication skills.
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Ability to meet deadlines with accuracy in a fast-paced, production-focused environment.
• Commitment to ongoing learning and professional development.

Requirements

• Advanced experience and knowledge of clinical validation audits, admission status, medical necessity reviews, and payer-specific audit processes.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.
• And more.

Company Description

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.