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Medical Coder, Inpatient
Aptive Resources. Review inpatient records in CPRS and assign accurate ICD-10-CM and ICD-10-PCS codes and DRGs .
Core Competencies
Role fitCore Competencies
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Demonstrates expertise in inpatient coding, including ICD-10-CM, ICD-10-PCS, and DRG assignment, while ensuring compliance with VHA guidelines and maintaining high accuracy rates. Proficient in using industry-standard encoders and knowledgeable in medical terminology and coding ethics.
Highest-signal resume keywords
ICD-10-CM CodingICD-10-PCS CodingDRG AssignmentRHIA/RHIT/CCS/CPC-H CredentialHealth Information Management
ATS Keywords
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Hard Skills
Inpatient CodingData AbstractionMedical TerminologyAnatomy and PhysiologyPathophysiologyPharmacologyReimbursement MethodsCoding Guidelines ComplianceVHA HandbooksEncoder Proficiency
Soft Skills
Attention to DetailCommunicationProblem-SolvingCollaborationEthical Judgment
Tools & Technologies
VistA3M EncoderOptum Encoder
Certifications & Qualifications
RHIARHITCCSCPC-H
Industry Keywords
Health Information ManagementVeterans AffairsCoding ClinicAHIMA StandardsPrivacy and Information Security
About the role
Key responsibilities & impact- Review inpatient records in CPRS and assign accurate ICD-10-CM and ICD-10-PCS codes and DRGs
- Complete Patient Treatment File (PTF) transactions (101, 401, 501, 601, 701/702, and 801) according to VHA Handbooks 1907.03 and 1907.04
- Abstract required data and enter it in VistA through the VA-approved encoder
- Decide whether an episode is billable and record the reason when it is not
- Code according to the Cooperating Parties' guidelines, AHA Coding Clinic, and VHA Handbook for Coding Guidelines, prioritizing VHA guidance when conflicts arise
- Exclude symptoms that are part of a confirmed diagnosis and findings that do not affect current care
- Send questions about conflicting, unclear, or incomplete documentation to the supervisor
- Re-review coded records when the VA questions them before billing or after claim denial, then correct codes or support them with coding references
- Maintain at least 95% accuracy and meet each facility's turnaround times
- Support Health Information Management Service operations at Veterans Affairs medical centers across Georgia, Alabama, and South Carolina
Requirements
What you’ll need- An active RHIA, RHIT, CCS, or CPC-H credential; CCS is preferred
- At least 2 years of recent inpatient facility coding experience, including ICD-10-PCS and DRG assignment
- Completion of an accredited coding, HIM, or health information technician program
- Formal training in anatomy and physiology, medical terminology, pathophysiology, pharmacology, and reimbursement methods
- Proficiency with an industry-standard encoder, such as 3M or Optum
- US citizenship
- Ability to pass a federal background investigation (NACI) and fingerprinting
- A private, secure home workspace with reliable high-speed internet
- Complete the VA's annual Privacy and Information Security Awareness and HIPAA training (TMS 10176 and 10203) before starting, and annually thereafter
- Follow AHIMA's Standards of Ethical Coding and VA confidentiality rules
Benefits
Comp & perks- Aptive provides the laptop, encoder, and reference materials
- 100% remote work from home
- 12-month base period plus four 12-month option periods