Department:
Status:
Benefits Eligible:
Hours Per Week:
Schedule Details/Additional Information:
The IP Prebill Coder Specialist conducts high‑risk, second‑level reviews to ensure accurate and compliant inpatient coding before claim submission. The role analyzes complex, high‑acuity cases—including spinal fusions, strokes, high‑risk DRGs, sepsis, and CAR‑T therapies—using advanced coding expertise to validate documentation, optimize code assignment, and mitigate financial and compliance risk.
Education Required:
Associate's Degree in Health Information Management or Associate degree in related field.
Experience Required:
Typically 7 years' experience inpatient coding in acute care tertiary facility
Schedule:
Monday - Friday 1st shift 40 hours a week.
Certification desired:
Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA).
Remote opportunity:
Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY
Pay Range
$28.55 - $42.85Major Responsibilities:
This role will have all responsibilities of coder I, II and III in addition to: reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.
Adhere to organizational and internal department policies and procedures to ensure efficient work processes.
Responsible for coding high dollar and long length of stay cases for all patient types.
Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
Serves as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations.
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
Collaborates with the Clinical Documentation Improvement and Quality teams, to ensure a match in the DRG and reconciles each Medicare case with the working DRGs from a CDI perspective.
Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding.
Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested.
Attends meetings with clinical teams regarding updates in codes for complex specialties.
Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
Meets and exceeds departmental quality (95% or more) and productivity standards (100%). Achieves productivity expectations to support discharged not final billed (DNFB).
Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.