Inpatient Medical Record Coder - Stony Brook University : Job Details

Inpatient Medical Record Coder

Stony Brook University

Job Location : Stony Brook,NY, USA

Posted on : 2025-05-05T00:59:11Z

Job Description :
Inpatient Medical Record Coder

Position Summary: At Stony Brook Medicine, the Medical Record Coder will be responsible for selecting and assigning accurate codes from the current version of coding systems including ICD-10 CM, ICD-10 PCS, CPT, and HCPCS codes.

Duties of a Medical Record Coder may include the following:

  • Demonstrates proficiency with Microsoft Office Applications, Citrix, and Adobe Reader in using required computer systems with minimal assistance.
  • Reviews medical records and documentation to determine appropriate codes for services and diagnoses.
  • Utilizes coding resources and reference materials to ensure accuracy.
  • Follows HIPAA regulations and maintains privacy standards.
  • Uses facility encoder interfacing with hospital mainframe and/or EMR, including remote settings.
  • Maintains knowledge of laws, regulations, and industry guidance impacting compliant coding.
  • Meets productivity and quality goals for coding.
  • Ensures confidentiality of medical record data and supports HIM department projects.
  • Assigns and sequences ICD-10-CM/PCS diagnostic and procedural codes for designated service lines, with knowledge of MS-DRG and NYS APR DRG grouping logic.
  • Performs documentation assessment and review for accurate clinical data abstraction to meet regulatory and compliance standards.
  • Performs other duties as assigned.

    • Qualifications:

    • Required: Associate's degree in a non-clinical healthcare-related field (e.g., HIM, Health Sciences, Health Informatics) and at least 5 years of inpatient coding experience, or in lieu, 8 years of inpatient coding experience. CCS certification required.
    • Preferred: Bachelor's degree in a related field and 10+ years of inpatient coding experience, preferably in an academic medical center.

    Additional notes include application requirements, employment conditions, and benefits, such as salary range ($62,424 - $75,949), and details about the application review process.

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