A

Acentra Health

Modernizes public healthcare with claims solutions

Medical Coder - Inpatient, DRG Reviewer

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours
Full-timeUnited States$29.19 - $36 /hrIn-person

About the Job

Requirements

  • A high school diploma or GED is required.
  • At least 2 years of progressive hands-on experience in acute care inpatient coding, clinical documentation improvement, medical scribing, DRG auditing or review, or related healthcare documentation is required.
  • Active possession of one or more accepted certifications is required: CCS, CCA, or CDIP from AHIMA; CPMA, CRC, CIC, or CDEI from AAPC; or CCDS from ACDIS. CCS-P is not accepted.
  • Demonstrated proficiency in ICD-10-CM and ICD-10-PCS is required.
  • Working knowledge of inpatient coding guidelines, DRG reimbursement methodology, and CMS and payer regulations is required.
  • The candidate must be able to independently review inpatient medical records and validate diagnoses, procedures, and MS-DRG assignments.
  • Experience reviewing inpatient medical records is required.
  • Familiarity with electronic health records, encoder/grouper tools, and coding software is required.
  • Proficiency in Microsoft Office, including Word, Excel, and Outlook, is required.
  • The candidate must be able to meet deadlines accurately in a fast-paced, production-focused environment.
  • The candidate must comply with corporate policies, including HIPAA Privacy and Security Rules.

Responsibilities

  • Review medical record documentation and accurately code primary and secondary diagnoses and procedures using ICD-10-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 for compliance with official coding guidelines and payer requirements.
  • Review and validate MS-DRG assignments based on documented clinical conditions, procedures, and applicable coding rules.
  • Assess clinical documentation supporting reported diagnoses, particularly those with reimbursement, quality, or compliance impact.
  • Conduct clinical validation reviews to determine whether diagnoses are supported by clinical indicators in 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 communicate audit findings, including coding discrepancies, clinical validation concerns, DRG or reimbursement risk, and admission status issues.
  • Abstract and compile audit data to support accurate reimbursement and compliance reporting.
  • Use 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 corporate policies, including HIPAA Privacy and Security Rules.
  • Provide backup support for other administrative or audit-related functions as needed.
  • Perform other education- and experience-related duties as management may deem necessary.

Desired Qualifications

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

About the Company

Acentra Health

Modernizes public healthcare with claims solutions

Acentra Health helps public-sector health programs run better by combining deep knowledge of government health programs with clinical expertise and technology. It designs and delivers software and services for claims, encounter, and provider data to improve processing efficiency and reduce costs, while offering care-management and quality-oversight services that focus on clinically informed decision making. Its products connect providers, payers, and government agencies to streamline workflows and oversight across state and federal programs. The company differentiates itself through its blend of public-sector know-how, clinical focus, and technology, accelerated by the backing of Carlyle, with a goal of delivering measurable outcomes for priority populations. Overall, Acentra Health aims to improve health outcomes, increase program efficiency, and lower costs for government healthcare programs.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
McLean, VA
Founded
2023

Recently Posted Jobs

Explore more opportunities at Acentra Health

See more jobs