Inpatient Medical Coding & AI Data Quality Specialist (CCS/CIC)

About the Role

Gramian Consultancy is a boutique consultancy specializing in IT professional services and engineering talent solutions. With a strong background in software engineering and leadership, we help companies build high-performing teams by matching them with professionals who truly fit their needs.

About the Role

We are seeking an experienced Inpatient Medical Coding Specialist with an active CCS or CIC credential to contribute to a project focused on improving the accuracy and clinical understanding of advanced AI systems. You will review and annotate inpatient medical records, assign and validate ICD-10-CM and ICD-10-PCS codes, determine principal and secondary diagnoses, and verify MS-DRG assignments. You will apply official inpatient coding guidelines, identify documentation gaps, and provide expert feedback on complex coding cases. The ideal candidate has hands-on inpatient coding experience, strong knowledge of UHDDS, POA indicators, CC/MCC classification, and current coding standards, and exceptional attention to detail. Prior AI experience is not required.

SENIORITY: Experienced / Specialist

LANGUAGE: Strong written and verbal English

LOCATION: Remote — United States

Key Responsibilities

Annotate and review inpatient medical records, including admission notes, progress notes, operative reports, consultations, laboratory and imaging results, and discharge summaries.

• Assign accurate ICD-10-CM and ICD-10-PCS codes based on clinical documentation and applicable coding guidelines.

• Identify principal and secondary diagnoses and sequence codes according to official inpatient coding conventions.

• Assign Present on Admission (POA) indicators and validate MS-DRG assignments, including the identification of Complications or Comorbidities (CCs) and Major Complications or Comorbidities (MCCs).

• Apply UHDDS definitions, ICD-10-CM/PCS Official Guidelines for Coding and Reporting, and relevant AHA Coding Clinic guidance.

• Identify hospital-acquired conditions (HACs), patient safety indicators, and documentation inconsistencies where applicable.

• Collaborate with project stakeholders to clarify coding requirements, resolve documentation ambiguities, and maintain data integrity.

• Provide structured feedback on coding guidelines, complex cases, and recurring errors to support workflow improvements and AI model training.

• Ensure all coding annotations are accurate, complete, consistent, and aligned with current coding standards.

Requirements

• Active AHIMA Certified Coding Specialist (CCS) or AAPC Certified Inpatient Coder (CIC) credential.

• Hands-on experience with inpatient medical coding.

• Strong knowledge of ICD-10-CM, ICD-10-PCS, and MS-DRG methodology.

• Understanding of principal diagnosis selection, secondary diagnosis reporting, code sequencing, POA indicators, CC/MCC classification, and applicable inpatient coding guidelines.

• Experience reviewing clinical documentation and resolving complex coding challenges.

• Strong written and verbal communication skills.

• Excellent attention to detail and the ability to apply coding rules consistently.

• Access to current ICD-10-CM/PCS code sets, official coding guidelines, and appropriate MS-DRG grouper tools.