Description:
Role Summary
Responsible for reviewing inpatient coding to validate accuracy, compliance, and documentation support. This role identifies risks, ensures consistency in DRG assignment, and provides actionable feedback to improve coding quality.
Core Responsibilities
- Perform retrospective and/or concurrent audits of inpatient coding.
- Validate ICD-10-CM/PCS code assignment and MS-DRG/APR-DRG accuracy.
- Follow and adhere to AHIMA’s Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
- Identify trends, risks, and opportunities for coding improvement.
- Provide clear, actionable audit feedback and education to client & internal coding staff.
- Maintain established quality metrics (e.g., =95% coding accuracy) and meet productivity standards.
Requirements:
Minimum Qualifications
- Credentials: CCS, RHIA, or RHIT (active).
- Experience: Minimum 3+ years of inpatient coding and at least 2 years of auditing experience. In lieu of auditing experience, 7+ years of coding experience is required.
- Skills & Knowledge: Strong knowledge of ICD-10-CM/PCS, MS-DRG/APR-DRG assignment, and Coding Clinic guidance. Strong analytical and written communication skills.
Client & Specialty Alignments
- Specialty Expectations: Strong understanding of methodologies to validate documentation impacting severity, risk, and reimbursement. Experience auditing across complex, multi-diagnosis inpatient cases and knowledge of documentation requirements impacting DRG shifts.
Work Model & Employment Tracks
- Work Model: 100% remote, independent, quality-focused work environment with collaboration across coding, audit, CDI, and client teams.
- Full-Time (FT): Standard production aligned to client or project needs.
- Part-Time / PRN / Project-Based: Flexible support for backlog, specialty coverage, or targeted initiatives.
- Note: Some positions may require evening or weekend coverage based on client needs or project scope.
Client & Specialty Alignments
- BayCare Requirements: 5+ years inpatient coding experience required, with experience in larger, complex hospital environments strongly preferred. Must demonstrate consistent performance at established productivity and quality benchmarks.
- Emory Requirements: 5+ years inpatient coding experience required. Strong emphasis on coding accuracy, consistency, and adherence to client-specific guidelines and documentation standards.
Why Sage Clinical RCM
- National exposure to diverse, high-acuity health systems and specialties.
- Quality-first culture with realistic expectations (not volume-only).
- Flexible work options (FT, PT, and PRN).
- Opportunity to expand into other audit, education, and advisory services.