Pioneer Health Care Management Inc

Compensation

Full Description

Title: Medical Coder - Long Term Acute Care Hospital Reports to: Director of Operations Effective Date: 12.2025 Revise Date: Summary The Medical Coder – Long Term Acute Care Hospital is responsible for accurate and compliant coding of diagnoses, procedures, and services for inpatient, outpatient, and skilled nursing encounters. This role supports appropriate reimbursement under Medicare, Medicaid, and commercial payers while ensuring compliance with CMS, DRG, and hospital coding regulations. Core Responsibilities: • Assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes for inpatient encounters • Ensure accurate DRG/APR-DRG assignment and appropriate sequencing of diagnoses and procedures • Review operative reports, discharge summaries, progress notes, and ancillary documentation • Collaborate with CDI staff to clarify diagnoses and ensure complete, compliant documentation General Responsibilities: • Ensure compliance with CMS, Medicare, Medicaid, and payer-specific coding guidelines • Maintain productivity and accuracy standards • Resolve coding-related denials, edits, and payer inquiries • Participate in internal and external audits and corrective action plans • Stay current with annual code updates and regulatory changes • Maintain HIPAA compliance and patient confidentiality Minimum Qualifications: • High school diploma or equivalent required; associate or bachelor’s degree in Health Information Management or related field preferred • Minimum of 2–5 years of medical coding experience in hospital and/or skilled nursing settings • Demonstrated knowledge of Long Term Acute Care Hospital. Required / Preferred Certifications • Required: CPC, CCS, or CCS-P • Preferred: RHIT or RHIA • Hospital inpatient specialty certification a plus Skills & Competencies • Strong understanding of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS • Knowledge of DRG/APC-Assignment, and clinical terminology • Proficiency with EHR systems and encoder software • High attention to detail and strong analytical skill • Create and send compliant queries to physicians to clarify documentation for coding Ability to work independently and collaborate with multidisciplinary teams