Hospital Coding Resource

Summary

Under the general direction of the Director of Health Information Management Services/Privacy Officer and the specific supervision of the Manager Coding. This position serves as an expert resource for supporting multi-facility hospital coding operations, clinical documentation, manual and AI-assisted coding workflows.

The role supports multiple disciplines that may include Inpatient, outpatient, emergency, observation, and specialty services. This position ensures the highest standards of coding accuracy, integrity, and compliance through expert analysis of clinical documentation, active validation of manual coding results, and engagement in audit and denial mitigation workflows.

The Hospital Coding Resource validates AI generated output, responds to coding and documentation inquiries, leads training efforts, resolves backend edits, and collaborates across departments to enhance compliance and accurate reimbursement. This role is structured to support both remote and on-site environments and is a critical contributor to continuous quality improvement, coder development, and regulatory compliance.

Education

Minimum: High school diploma or equivalent (required) Preferred: Associate's or Bachelor's degree in Health Information Management or related field.

Certification, Registration & Licensure

One of the Following Certifications Required: Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT). CPC credentialed coders with hospital-based experience may be considered.

Experience

• Minimum of 4 years hospital coding experience required.

Responsibilities

Preferred -Experience with AI-assisted coding platforms, auditing, denials response, and remote environments strongly preferred -Demonstrated ability to educate, coach, and mentor coders at all skill levels

Core Responsibilities

• Serves as an SME in coding regulations (ICD-10-CM, ICD-10-PCS, MS-DRG, CPT, NCCI, LCD/NCD, MUE, OCE).
• Validates coding for accuracy, completeness, and compliance using encoder tools and AI-assisted platforms.
• Demonstrates competency to perform role by completing yearly competency testing related to a combination of organizational compliance education, departmental operations, and regulatory coding standards.
• Maintains continuing education and credentials by completing required CEU education focused on current knowledge of coding updates, regulatory guidance (CMS, AMA), and Coding Clinic releases.
• Queries providers in accordance with query guidelines and compliant query best practices.
• Reviews and resolves back-end claim denials/ edits; collaborates with Patient Financial Services and billing staff to support clean claim generation.
• Provides audit feedback to Coders, develops coding education plans, and leads peer training initiatives. Reports audit results and education plan to Leadership.
• Supports system upgrades, through workflow testing, and optimization of AIassisted technology.
• Escalates documentation issues and system anomalies to departments that may impact coding output.
• Conducts and supports coding quality reviews with statistical summaries and provides suggested improvement plans to manager.
• Collaborates with management, revenue integrity, and clinical stakeholders to streamline coding workflows and improve coding outcomes.
• Presents a professional image in all communications (in person or virtual) and fosters a culture of accountability, ethics, and continuous learning.
• Meets deadlines and maintains availability during scheduled working hours.
• Provides expert support in emergency coverage, special project work, and urgent audits.
• Maintains ethical coding practices and demonstrates confidentiality, integrity, and team collaboration always.
• Maintains a secure and private home workstation and Protects patient privacy and ensures data integrity in compliance with HIPAA and facility policies.
• Ensures full functionality of remote systems (VPN, encoder, dual monitors, video conferencing, headset, secure email/chat)
• Participates in daily/weekly virtual huddles, screen-sharing education sessions, and documentation reviews.
• Respond promptly to requests via email or secure messaging platforms.
• Adheres to all remote work policies and system access security protocols.

Knowledge and Skills

• Mastery of ICD-10-CM, ICD-10-PCS, MS-DRG, CPT, and HCPCS Level II
• Knowledge of coding regulatory sources: CMS, AHA Coding Clinic, AMA CPT Assistant
• Proficient in AI-assisted coding platform, encoders EHR systems, and data reporting tools.
• Proficient in Microsoft Office tools (Word, Power Point, Excel), particularly for documentation, data tracking, and team collaboration utilizing virtual platforms.
• Able to work independently with minimal supervision, maintaining high performance and productivity standards in a remote
• Analytical mindset with ability to interpret trends, identify patterns, and recommend improvements.
• The ability to adapt quickly and master complex coding scenarios often encountered in a teaching facility or multispecialty healthcare settings.
• Experience with cross-functional collaboration in remote and on-site teams
• Willing to work flexible hours, including weekends or evenings if needed, to support business needs and workflow turnaround times.
• Ability to analyze documentation to support

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Physical and Work Requirements

• This position is classified as SEDENTARY per the Dictionary of Occupational Titles.
• It primarily involves prolonged periods of sitting while using a computer and engaging in virtual communication platforms.
• The employee may occasionally be required to lift or carry items weighing up to ten pounds, such as reference materials or office equipment.

While performing the duties of this job, the employee is regularly required to:

• Sit at a desk or workstation for extended periods.
• Perform repetitive tasks involving keyboarding and data entry.
• Use auditory and visual perception to interpret documentation, communicate via headset, or video calls, and navigate electronic systems.

Additional information

Occasional physical movements may include reaching, bending, or standing briefly. Specific vision abilities required include close vision, peripheral vision, depth perception, and the ability to adjust focus to digital screens.

The noise level in a remote setting is typically quiet. Employees are expected to provide a work environment conducive to focused, uninterrupted tasks, with minimal background distractions when participating in meetings or collaborative virtual sessions.