Position SummaryThe Lead HIM Coding Specialist serves as a subject matter expert in inpatient coding and DRG validation and is responsible for performing high-level second-level reviews of coded data to ensure compliance with federal regulations, coding guidelines, and hospital policies. This role audits for accurate MS-DRG/APR-DRG assignment and drives improvements in documentation practices and revenue integrity. The Lead HIM Coding Specialist collaborates closely with CDI, Coding, and Compliance teams to identify trends, mitigate risk, and strengthen audit readiness. This position is instrumental in proactive denial prevention, strategic focus audits, and provides mentorship to coding staff.
Education
High School Diploma or equivalent required. Certified Coding Specialist (CCS) required. Associate or bachelor's degree in health information management, Health Sciences, or related field preferred. RHIT, RHIA, CDIP, CCDS, or CPC certifications preferred.
Experience
- Minimum of 5 years of inpatient coding experience in an acute care hospital
- Minimum of 2 years in DRG validation, coding audit leadership, or CDI collaboration
- Demonstrated experience in managing and analyzing denial trends, audit outcomes, and documentation variances
- Experience working with CDI queries and payer clinical validation denials preferred
- Advanced use of EHRs (Meditech, EPIC, Cerner), encoders (3M, Truc ode), and data analytics tools (Excel, Power Point, or Word)
Skills
- Expertise in ICD-10-CM/PCS and MS-DRG/APR-DRG assignment
- Proficiency in DRG reimbursement methodologies, clinical indicators, and coding rules across payers
- Strong regulatory knowledge including CMS, OIG work plans, PEPPER targets, and HACs/PSIs
- Ability to conduct complex clinical documentation reviews and support DRG integrity with providers
- Skilled in developing and delivering coder education and clinical documentation training
- High proficiency in data analytics to identify trends, conduct root cause analysis, and generate strategic reporting
- Advanced communication and negotiation skills to collaborate with CDI, providers, and revenue cycle stakeholders
- Demonstrated ability to manage pre- and post-bill audit workflows with minimal supervision
- Familiarity with risk adjustment models, severity of illness (SOI), risk of mortality (ROM), and case mix index (CMI) trending
Job LocationThe Valley Health System-Ridgewood
ShiftDay (United States of America)
Benefits- Medical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)
- Group Term Life Insurance and AD&D(Full Time Employees)
- Flexible Spending Accounts and Commuter Benefit Plans
- Supplemental Voluntary Benefits ( e.g. Short-term and Long-term Disability, Whole Life Insurance, Legal Support, etc.)
- 6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended Illness
- Retirement Plan
- Tuition Assistance
- Employee Assistance Program (EAP)
- Valley Health LifeStyles Fitness Center Membership Discount
- Day Care Discounts for Various Daycare Facilities
Salary
Joining Valley Health System means becoming part of a dedicated team that values the highest quality of care in a supportive environment. In our commitment to high performance and reliability, we encourage and recognize exceptional individual performance through our industry leading compensation practices including a starting salary and benefits in accordance with your role, experience, education, and licensure. Actual individual salaries vary depending on these factors. The salary listed does not include other forms of compensation or benefits.
Pay Range: $41.30 - $51.62 (per hour)
