Inpatient Coding Review Specialist (H)
University of MiamiAbout the role
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The University of Miami/UHealth -Health Information Management Departmenthas an exciting opportunity for a full-time Inpatient Coding Review Specialist (H) to work remotely.
The Inpatient Coding Review Specialist (H) under the general direction of the Inpatient Coding Manager works closely with the University of Miami Health’s Clinical Documentation Improvement Specialists (CDIS) as well as Quality Management Analysts to ensure accurate and compliant coding on all Mortality cases prior to billing. The Inpatient Coding Review Specialist also performs quality reviews that specifically focus on the identification and validation of Hospital Acquired Conditions (HACs), Patient Safety Indicators (PSIs), Present on Admission status, complications, and comorbidities that impact USNWR rankings and Vizient quality measures.
CORE JOB FUNCTIONS
Reviews, analyzes, and interprets the complete electronic medical record (EMR) after initial coding to identify missed coding opportunities supported by documentation, enhancing severity of illness and risk of mortality indicators through the provider query process.
Validates the assigned principal diagnosis, significant secondary ICD-10-CM diagnosis codes, Present On Admission (POA) indicators, and ICD-10-PCS procedure codes to ensure compliance with ICD-10-CM/PCS Official Coding Guidelines, UHDDS, and regulatory requirements for accurate MS-DRG assignment.
Ensures accurate capture of Severity of Illness (SOI) and Risk of Mortality (ROM) indicators.
Applies knowledge of the Elixhauser Comorbidity Index and Vizient quality measure logic, focusing on specialty-specific conditions that impact MCC/CC capture and quality data reporting.
Collaborates with CDI, quality teams, and physicians to clarify ambiguous or incomplete documentation through the provider query process, initiates queries when necessary.
Participates in meetings with CDI, providers, and colleagues to discuss coding findings, share expertise, and defend coding decisions using documentation and official guidelines.
Conducts POA reviews for cases marked “No” and provides feedback to leadership for coder education and improvement.
Reviews denial cases and provides detailed feedback to the Revenue Cycle Director and Audit Specialists.
Assists in resolving claim edits across all accounts, regardless of the initial coder assignment.
Performs initial inpatient coding when primary responsibilities are complete or additional hours are approved.
Meets or exceeds established quality and productivity benchmarks set by leadership.
Adheres to University and unit-level policies and procedures and safeguards University assets.
This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.
CORE QUALIFICATIONS
High School diploma or equivalent
Refer to department description for applicable certification requirements
Minimum 5 years of relevant experience
Learning Agility: Ability to learn new procedures, technologies, and protocols, and adapt to changing priorities and work demands.
Teamwork: Ability to work collaboratively with others and contribute to a team environment.
Technical Proficiency: Skilled in using office software, technology, and relevant computer applications.
Communication: Strong and clear written and verbal communication skills for interacting with colleagues and stakeholders.
Any relevant education, certifications and/or work experience may be considere
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