Role Summary

The Medical Coder – Inpatient DRG (IPDRG) is responsible for reviewing inpatient medical records and assigning accurate diagnostic and procedural codes based on clinical documentation. This role determines principal and secondary diagnoses and procedures, and assigns appropriate DRG classifications and related indicators that impact hospital reimbursement and quality reporting.

The position requires strong knowledge of medical coding standards, regulatory compliance, and inpatient hospital coding systems.

Key Responsibilities

Documentation Review & Code Assignment

• Review inpatient health records to determine principal and secondary diagnoses and procedures 
• Assign ICD-10-CM and ICD-10-PCS codes following official coding guidelines 
• Assign MS-DRG and APR-DRG classifications accurately 
• Identify Present on Admission (POA), Severity of Illness (SOI), Risk of Mortality (ROM), Hospital Acquired Conditions (HAC), and Patient Safety Indicators (PSI) 
• Use encoder software and coding tools to support accurate code assignment 
• Ensure compliance with Medicare, CDC, CMS, AHA, and AHIMA coding guidelines 
• Review clinical documentation to ensure coding accuracy and reduce denial risks 
• Handle inpatient claim edits and combined account scenarios (e.g., 72-hour rule) 
• Maintain productivity and quality standards for inpatient coding 
• Protect patient health information in compliance with HIPAA 

Query Management & Documentation Clarification

• Apply compliant coding query practices when documentation is unclear or incomplete 
• Communicate with physicians, Clinical Documentation Improvement (CDI) teams, and healthcare providers for clarification 
• Track and follow up on missing or incomplete documentation using EMR systems 
• Ensure timely resolution of documentation issues to support coding completion 

HIM Collaboration & Revenue Cycle Support

• Collaborate with Health Information Management (HIM) and Patient Financial Services (PFS) teams 
• Support resolution of billing, claims, denials, and reimbursement-related issues 
• Assist in ensuring accurate and complete hospital reimbursement outcomes 

Coding Compliance & Continuous Learning

• Maintain required continuing education units (CEUs) for coding credentials 
• Stay updated on changes in inpatient coding guidelines, regulations, and reimbursement policies 
• Identify and escalate workflow or system issues to leadership 
• Ensure adherence to ethical coding standards and regulatory requirements 
• Perform data abstraction for required clinical and billing elements 
• Maintain knowledge of applicable federal, state, and local healthcare regulations 

Qualifications

Required

• Bachelor’s degree in allied health or related field 
• Minimum 2 years of inpatient DRG coding experience 
• Active coding certification: CCS, CIC, or CDIP 
• Strong knowledge of ICD-10-CM/PCS coding systems and MS-DRG/APR-DRG assignment 
• Understanding of POA, SOI, ROM, HAC, and PSI indicators 
• Familiarity with HIPAA regulations and healthcare compliance standards 
• Experience using EMR systems (Epic, Cerner, Meditech, or similar) 
• Strong English communication skills (written and verbal, B2 level or higher) 

Preferred

• Master’s degree in healthcare, business, or related field 
• Nursing background (PHRN or USRN license preferred) 
• Experience with coding tools such as 3M, Encoder Pro, Codify, or other CAC systems 
• Proficiency in Microsoft Office (Excel, Word, PowerPoint, Outlook, SharePoint) 
• Prior experience in US healthcare systems (providers or payers) 

Key Performance Indicators (KPIs)

• Coding Productivity: ≥ 95% target compliance 
• DRG Accuracy Rate: ≥ 95% 
• Overall Coding Accuracy: ≥ 95% 
• Query Compliance: 100% adherence to AHIMA/ACDIS standards 

Core Skills & Competencies

• Strong attention to detail and accuracy 
• Analytical and critical thinking skills 
• Ability to work independently and make sound decisions 
• Strong communication and collaboration skills 
• Experience working in a matrixed environment 
• Professionalism in handling internal and external stakeholders 
• Integrity and adherence to ethical coding standards