Connecticut Children’s is seeking a detail-oriented DRG Coder to ensure accurate and compliant coding of inpatient pediatric medical records. As a DRG Coder, you will assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to optimize DRG reimbursement, support data quality, and facilitate accurate claims processing. You will work closely with providers, patient financial services, and clinical teams to clarify documentation, resolve coding questions, and contribute to continuous quality improvement initiatives. This role offers an opportunity to make a meaningful impact on pediatric care while growing your career in a leading children’s health system.

Why Join Connecticut Children’s as a DRG Coder

At Connecticut Children’s, the DRG Coder ensures consistent and efficient inpatient claims processing, improving both financial performance and patient care. You’ll join a supportive environment that values accuracy, education, and professional growth while helping children across Connecticut and neighboring states.

Key Responsibilities of a DRG Coder

Coding and Abstraction

Assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to inpatient records, creating DRG or APC group assignments.
Review patient records and query physicians when documentation is unclear, incomplete, or ambiguous.
Monitor coding work queues for visits including rehabilitation, emergency, and specialty services.
Perform coding and charge capture for facility services, including ED and IV procedures.

Documentation and Compliance

Continuously evaluate clinical documentation for completeness, consistency, and accuracy.
Ensure compliance with CMS, AHIMA, and professional coding standards.
Maintain knowledge of coding guidelines, reimbursement requirements, and regulatory reporting.
Assist in compiling data for regulatory agencies, accreditation, and quality improvement projects.

Billing and Quality Assurance

Review charges for accuracy, medical necessity, and correct posting.
Monitor unbilled account reports and assist with coding-related denials or appeals.
Collaborate with patient financial services to resolve coding or billing questions.
Participate in special projects, training, and continuous quality improvement initiatives.

Qualifications and Education

Associate degree or equivalent experience; completion of an AHIMA-approved coding certificate program preferred.
Certification required within one year of hire: RHIA, RHIT, CCS, CCS-P, CCA, or AAPC credential.
Strong knowledge of ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II coding guidelines.
Familiarity with Evaluation & Management, surgical coding, and modifier use.
Experience analyzing complex medical records and ensuring accurate DRG assignment.

Skills and Expertise

Proficiency with Windows-based applications and coding software.
Strong verbal, written, and interpersonal communication skills.
Ability to type at least 40 wpm and manage multiple priorities effectively.
Excellent attention to detail and ability to meet productivity and compliance standards.
Knowledge of anatomy, medical terminology, and pediatric care nuances.
Ability to maintain confidentiality and work in a fast-paced healthcare environment.

About Connecticut Children’s

Connecticut Children’s is Connecticut’s only health system fully dedicated to children, offering care across more than 30 pediatric specialties. Our mission includes research, education, community partnerships, and a commitment to diversity, equity, and inclusion. We aim to provide exceptional pediatric care in locations closer to home while fostering a supportive environment for our team members.

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Medical Coder