Medical Record Coder Inpatient

Inova Systems Operations is looking for a dedicated Medical Records Coder 4 for Inpatient. This role will be full-time day shift with a negotiable schedule.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.

Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

Work/Life Balance: offering paid time off and paid parental leave.

Medical Records Coder 4 – Inpatient -
Job Responsibilities:

The Medical Records Coder 4 Inpatient will assign ICD-10-CM/PCS codes for appropriate Diagnosis Related Group assignments. This role will assign appropriate discharge dispositions/destinations, admission sources, procedure dates and performing providers. Assigning accurate and complete Present on Admission status indicators is of vital importance. Ensuring that Coding records are in line with productivity standards and quality expectations is required.

• Assigns Diagnosis Related Groups that are supported by medical record documentation for Inpatient records.
• Assigns Discharge Disposition that is supported by medical record documentation for Inpatient records.
• Ensures that coded records align with productivity standards and quality expectations.
• Assigns accurate/complete ICD-10-CM/PCS codes and Present on Admission status indicators that are supported by medical record documentation for Inpatient records.

Minimum Qualifications :

• Education: High School Diploma or GED
• Experience
  :
  Two years of experience directly related to facility inpatient coding in ICD-10-CM/PCS.
• Certification
  :
  Registered Health Information Administrator; RHIA, RHIT or CCS certification.

• Code and abstract patient records accurately and efficiently, ensuring compliance with ICD-10-CM/PCS guidelines.
• Review and analyze medical records to identify relevant diagnoses, procedures, and other clinical information.
• Assign appropriate ICD-10-CM/PCS codes based on the documentation provided by healthcare professionals.
• Collaborate with physicians and other healthcare providers to clarify and obtain additional information when needed.
• Maintain a high level of coding accuracy and productivity, meeting departmental standards and timelines.
• Stay updated with coding guidelines, regulations, and industry best practices to ensure compliance.
• Participate in quality improvement initiatives and audits to maintain the integrity of medical records.
• Provide coding education and support to less experienced coders, fostering a culture of continuous learning.
• Assist with special projects and initiatives as assigned by the coding supervisor or manager.

• Minimum of two years of recent experience in acute care facility inpatient coding is required.
• Proficiency in ICD-10-CM/PCS coding is essential, with a strong understanding of coding guidelines and regulations.
• Experience in a Level I Trauma Center environment is preferred but not mandatory.
• Excellent attention to detail and the ability to work independently with minimal supervision.
• Strong analytical and problem-solving skills, with the ability to interpret complex medical information.
• Proficiency in medical terminology and anatomy is a must.
• Excellent communication skills, both written and verbal, to effectively collaborate with healthcare professionals.
• Ability to work in a fast-paced environment and manage multiple priorities simultaneously.
• Proficiency in using electronic health record (EHR) systems and coding software.
• A commitment to ongoing professional development and staying updated with coding advancements.

We are Inova, Northern Virginia’s leading nonprofit healthcare…