Coder IV - Coding Integrity Specialist

About Us

Xtensys, a recently established managed service provider, delivers cutting-edge technology to health systems, starting in NY and expanding beyond. Owned by two industry leaders focused on innovation in rural and community health, we are rapidly growing with several major initiatives underway. We seek a skilled Remote Coder IV, Coding Integrity Specialist to join our team of 500 and support our exciting journey. We value people and are building a culture to match. If you're a collaborative, innovative, and strategic leader, we’d love to talk.

Job Summary

The Coding Integrity Specialist is responsible for ensuring the accuracy, compliance, and integrity of clinical coding practices within the hospital. This role serves as a subject matter expert on coding standards and guidelines, with responsibilities that include conducting coding audits, providing staff education, managing work queues, and developing performance metrics such as coder report cards with a driving principal to create and retain high performing individuals. The specialist works closely with coders, clinical documentation improvement (CDI) staff, denials team, revenue cycle and other stakeholders to support accurate reimbursement, regulatory compliance, and data quality.

Duties/Responsibilities

• Auditing & Compliance
• Conduct routine and focused coding audits to assess accuracy, completeness, and adherence to ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding guidelines.
• Identify trends, errors, or patterns in coding that may impact revenue or compliance.
• Provide written and verbal feedback on audit results to individual coders and leadership.
• Support internal and external audit readiness and assist in audit response activities as needed.
• Review and respond to external coding audits as requested for compliant support and justification of the coded claim.
• Education & Training
• Develop and deliver training materials and educational sessions based on audit findings, coding updates, regulatory changes, or performance needs.
• Serve as a coding resource for staff questions, updates, and ongoing education.
• Mentor and support coders in applying correct coding practices and navigating complex cases.
• Performance Reporting
• Create and maintain coder "report cards" and dashboards to track accuracy, productivity, and improvement areas.
• Analyze performance data to identify strengths and opportunities across individuals and the department.
• Collaborate with leadership to implement performance improvement plans as needed.
• Claim Edit Work Queues
• Responsible for Claim Edit work queues and managing claims to clear edits and errors
• Identify bottlenecks or inefficiencies in workflows and recommend solutions.
• Maintains coding credential(s) and required continuing education credits.
• Maintains confidentiality of all patient information.
• Other duties as needed to meet the needs of the organization/department.
  
  

Education

Required Skills/Abilities/Education/Experience:

Two-year degree in Health Information Management required, Bachelors preferred. RHIT or RHIA credential required.

Experience

• Five or more years of combined experience in coding and auditing. Two or more years of supervisory/auditing experience preferred. Working knowledge of ICD10 CM/PCS and CPT coding classification. Knowledge of DRG’s, APC’s and APG’s.
• Excellent written and verbal communication skills
  
  

Licensure: Certification with AHIMA (RHIT, RHIA, CCS)

Physical Requirements: Light physical effort, typical office job. Work in comfortable positions. Flow of work intermittent.