[Hiring] Medical Coder @Pena4 Inc

Role Description

The Medical Coder (IP) is responsible for accurately assigning ICD-10-CM/PCS diagnosis and procedure codes for inpatient hospital services. This role ensures coded data is complete, compliant, and supports appropriate reimbursement, quality reporting, and regulatory requirements.

• 100% REMOTE
• Position Type: W2 Regular Employment
• At least 5 years of IP PCS Coding experience, required
• CCS certificate is required.
• Schedule: Monday - Friday, full-time hours
• Shift: Regular day shift hours
• System Experience: EPIC | Power Chart | 3M | Cerner
• Start Date: Immediately
• Must complete and pass an IP coding assessment test and successfully code 5 charts.

Qualifications

• Minimum of five (5) years of HIM and inpatient facility coding experience
• Associates degree required in Health Information Management, Healthcare Administration, other healthcare related fields, or Business Administration or Management, Bachelor’s degree preferred
• Candidates with significant relevant experience and demonstrated expertise may be considered in place of formal educational requirements.
• CCS required
• Additional credentials preferred (RHIA, RHIT, CCS-P, CPC, CPMA, COC, CIC, CRC)

Requirements

• Review complete inpatient medical records to accurately determine the principal and secondary diagnoses, procedures, and complications
• Assign accurate ICD-10-CM and ICD-10-PCS codes for diagnoses and procedures
• Accurately sequences diagnoses and procedures
• Ensure documentation supports MS-DRG assignment and severity of illness (SOI) and risk of mortality (ROM)
• Strive to obtain the optimal DRG assignments on each medical record coded with assistance of computer system
• Apply official coding guidelines, UHDDS definitions, and payer-specific requirements
• Query providers for clarification when documentation is incomplete, inconsistent, or unclear
• Appropriately hold accounts when more information is required for accurate code/DRG assignment
• Contact appropriate staff, leadership or medical staff as needed
• Meet established productivity and accuracy benchmarks
• Demonstrate a consistent level of productivity and performance
• Code a minimum of 2 inpatient charts per hour
• Maintain a monthly coding accuracy and DRG accuracy rate of 95% or above
• Collaborate with CDI, compliance, and billing teams to resolve coding issues
• Participate in internal audits, external audits, and education initiatives
• Works as a team member to meet department and client specific goals
• Complete all assignments in conscientious and reliable manner
• Medical coders are expected to generate revenue by performing billable hours equal to 1 (one) times annual salary
• Ensure compliance with ICD-10-CM/PCS, MS-DRG/APR-DRG, and payer specific requirements
• AHA official coding guidelines, coding clinics, CMS and AHIMA standards of ethical coding, and other regulatory standards
• Client-specific coding guidelines, policies and procedures except when in conflict with official coding guidelines
• Maintain confidentiality and comply with HIPAA regulations
• Regularly reviews coding literature to stay current on new or revised coding guidelines
• Maintains appropriate certifications from AHIMA/AAPC
• Expresses interest in and pursues continuing education
• Perform additional duties as assigned and assist with other tasks as requested.

Benefits

• Work alongside passionate teams
• Gain valuable skills
• Help shape how Pena4 connects with clients around the world
• Unmatched opportunities and rewards across the globe
• Inclusive work ethics and environment
• Range of benefits to support employees and their eligible family members