Coordinate coding audits and education functions for LCMC system coding services, managing edit and denial coding work queues for inpatient, outpatient and ambulatory records.
Responsibilities
Review cases for accurate coding and sequencing of ICD-10-CM/PCS and CPT codes
Work coding edits work queues and provide feedback and education to coding staff
Utilize retrospective edit tool to address documentation issues
Review discrepancies between Clinical Documentation Specialist (CDS) DRG and Coder DRG
RN focused on verifying that coded diagnoses, procedures, revenue codes, and corresponding reimbursement methodologies accurately reflect the member's documented clinical condition, services rendered, and billed charges.
Responsibilities
Provides support for inpatient and outpatient clinical claim review activities.
Assess medical records for clinical accuracy, acuity alignment, and documentation integrity.
Reviews inpatient and/or outpatient claims to ensure diagnoses, procedures, revenue codes, itemized charges, and Diagnostic Related Groups (DRG) assignments accurately reflect the documented clinical condition and services provided.
Integrates ICD‑10 coding principles, DRG methodologies, revenue code logic, and evidence‑based clinical guidelines when reviewing claims.
Performs DRG validation reviews by verifying principal and secondary diagnoses, complications/comorbidities, procedure coding, severity level, and correct grouping logic.
Requirements
Registered Nurse (RN)
Nice to have: Certified Coding Specialist (CCS)
Nice to have: Registered Health Information Administrator (RHIA)
Nice to have: Registered Health Information Technician (RHIT)
The position involves reviewing medical records for appropriate provider documentation to support principal diagnosis, comorbidities, complications, and procedures to validate coding and DRG assignment accuracy.
Compensation
Level I: Grade E4: Minimum $65,346- Maximum $117,622 Level II: Grade E5: Minimum $71,880 - Maximum $129,384 Level III: Grade E6: Minimum: $79,068 - Maximum $142,322
Responsibilities
Analyzes and audits acute inpatient claims
Integrates medical chart coding principles, clinical guidelines, and objectivity in medical audit activities
Draws on advanced ICD-10 coding expertise
Adheres to official coding guidelines, coding clinic determinations, and CMS/regulatory compliance guidelines
Establishes national and best practice benchmarks and measures performance
Requirements
Associate or bachelor’s degree in health information management
Educates providers and serves as the subject matter expert for provider documentation, advising on complete and accurate outpatient documentation and acting as liaison between providers and coders.
Responsibilities
Educates providers on documentation standards
Advises providers on complete and accurate outpatient documentation
Acts as liaison between providers and coders
Performs audits of medical records to ensure complete and accurate documentation and coding
Multifacility responsibility for ensuring all aspects of coding is carried out accurately and efficiently through chart reviews, problem account resolution, and coding education according to established rules and regulatory guidelines across Orlando Health System.
Responsibilities
Performs focused review for accuracy of principal and secondary diagnoses, co-morbid conditions and complications, procedure code assignments, and other abstracted elements.
Assigns accurate ICD-10-CM and ICD-10-PCS or CPT-4 codes utilizing an electronic encoder application.
Acts as a subject matter expert on coding guidelines and responds to internal and external requests.
Participates and provides expert feedback during coding section meetings and coding education.
Develops and presents educational materials to key stakeholders.
The Clinical Documentation Specialist (CDS) 1 is responsible for extensive record review, and interaction with physicians, HIM coding professionals, nursing staff and other patient care givers to ensure the accurate representation of patient severity of illness and quality of care.
Responsibilities
Provides extensive and accurate reviews of medical records within specified timelines.
Recognizes opportunities for documentation improvement to support severity of illness and quality of care and then formulates clinically credible documentation clarifications/queries.
Follows up on all cases especially those with clinical documentation clarifications/queries. Provides education to providers on responding to queries in the medical record and other CDI topics.
Meets program quality and productivity guidelines and standards.
Participates in Coding/CDI meetings and CDI H3W work group.
Requirements
Associates Degree or equivalent experience.
Nice to have: Certified Clinical Documentation Specialist (CCDS)
Nice to have: Certified Clinical Documentation Professional (CDIP)
Clinical leader supporting Premier Health’s goals to advance documentation accuracy, revenue integrity, and quality performance across the health system.
Responsibilities
Provide secondary review of complex CDI and Coding queries escalated by the CDI and Coding teams
Review and resolve escalations involving Query disagreement, Clinical Validation, or incomplete response
Partner with the CDI Manager to establish standardized escalation criteria and ensure timely resolution of all high-impact queries
Conduct focused “second-look” reviews of no-CC/MCC or CC-only cases to identify missed documentation opportunities and support CMI improvement
Serve as a liaison between the CDI, Coding, and Physician teams to promote consistency in documentation practices
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