A hospital medical coder turns records from every part of a critical access hospital into diagnosis and procedure codes. That means inpatient and swing bed stays, ER and observation visits, therapy and clinic visits. They ask providers about unclear notes and clear coding edits, so each claim is right the first time.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring a medical coder to code inpatient, swing bed, emergency, outpatient and clinic records for our critical access hospital. You'll assign ICD-10-CM, ICD-10-PCS, CPT and HCPCS codes from the record, query providers when documentation is unclear, and work coding edits and denials so claims go out clean and compliant.
2. Essential Duties and Responsibilities
Code inpatient, observation, swing bed, ED, outpatient and [rural health clinic] records using ICD-10-CM, ICD-10-PCS, CPT and HCPCS.
Assign ED facility levels using your hospital's criteria, and code infusions, injections and procedures.
Send clear, non-leading queries to providers when documentation is unclear or conflicting, following AHIMA and ACDIS query guidance.
Work coding edits and denials, including NCCI and medical necessity edits, with the business office.
Flag missing or mismatched charges to department leaders.
Keep up with coding updates and payer rules, and support internal and external coding audits.
3. Key Tasks / Daily Activities
Work the coding queue in [your encoder and EHR], oldest discharges first.
Read provider documentation for diagnoses, procedures and medical necessity.
Send and follow up on provider queries.
Clear claim edits and holds tied to coding.
Review the discharged-not-final-coded list with the business office.
4. Key Performance Indicators (KPIs)
Coding accuracy on audit: [your target].
Discharged not final coded backlog: [your target].
Query response rate: [your target].
Coding-related denials: [your target].
Charts coded per hour: [your target].
5. Required Qualifications and Skills
Completion of a coding or health information program, or [2+] years of hospital coding experience.
Working knowledge of ICD-10-CM, CPT and HCPCS guidelines, anatomy and medical terminology.
Experience with an encoder and a hospital EHR.
Close attention to detail across long records.
Discretion with patient records under HIPAA.
6. Preferred Experience
CCS from AHIMA for inpatient coding, or CPC or COC from AAPC for outpatient and clinic coding.
RHIT or RHIA credential.
Experience coding for a critical access hospital, swing beds or rural health clinics.
Experience with ED facility leveling and infusion coding.
7. Physical Requirements
Sit and work at a computer for most of the day, reading long records on screen.
Type and use a mouse for long periods.
With or without reasonable accommodation.
8. Work Environment and Schedule
Weekday schedule: [hours], with [remote or hybrid work after training, if you offer it].
Quiet office or approved home office with secure access to patient records.
Productivity and quality goals reviewed [monthly].
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new medical coder gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
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Why coding in a small rural hospital is its own job
One small team, sometimes a single person, codes every kind of record at a critical access hospital, often for the same patient in the same week. Large hospitals often split that work among inpatient, outpatient and ER coders.
Two procedure code sets on one desk
HIPAA rules set which codes go where. ICD-10-CM covers diagnoses in every setting. ICD-10-PCS is for procedures on hospital inpatients, while ER, observation, therapy and clinic procedures take CPT and HCPCS codes. A coder here switches between them all day, so they need inpatient and outpatient skills, not just one. Source: 45 CFR 162.1002, HIPAA medical code sets (Cornell LII).
Same patient, different rules
A patient may come through the ER, stay in observation, then be admitted. The official guidelines treat those records differently. On an acute inpatient stay, a diagnosis written as probable or suspected at discharge is coded as if confirmed. On ER, observation and clinic records it is not; the coder codes the symptoms or test results instead. So the coder checks the patient's status before anything else. Source: CMS and NCHS: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027.
Queries go to a small, changing medical staff
If locum or part-time providers cover your ER, the one who wrote a note may be gone before it's coded, so query fast. The AHIMA and ACDIS guidelines say a query shows the clinical facts from the record. A multiple-choice query offers only clinically supported answers plus "other", and no query mentions payment or quality scores. A verbal answer counts only once the provider writes it in the record. Source: ACDIS and AHIMA: Guidelines for Achieving a Compliant Query Practice (2022 update, 2023 addendum).
New codes every October
New ICD-10-CM and ICD-10-PCS codes take effect each October 1, and an April update can follow, as one did in 2026. CPT and HCPCS change on their own schedules. With no coding manager down the hall, the coder plans each update: new books or encoder files, a read of the changes for your services, and a check that the chargemaster and claim edits caught up. Source: CMS: ICD-10 code files.
The ER fills much of the queue
Each ER visit gets a facility level from your hospital's own written criteria, plus codes for infusions, injections, splints or stitches. The coder applies those criteria the same way every time. When the nursing notes don't back up a level, or a charge is missing, the coder tells the ER manager instead of guessing.
How much hospital medical coders make
The closest BLS group for hospital medical coders is medical records specialists. Medical records specialists who work for general medical and surgical hospitals earned a median of $28.59 an hour ($59,460 a year) in May 2025, according to the Bureau of Labor Statistics. That’s above the $51,140 median for medical records specialists in all industries. About 51,740 of the 194,720 medical records specialists in that survey work for general hospitals.
Hourly or salaried. If you pay for productivity, count only charts that pass your quality audit, so speed never gets ahead of accuracy.
General hospitals
$59,460$59,460 median Middle half $47,510–$74,850 10th–90th $39,610–$91,960
All industries
$51,140$51,140 median Middle half $43,490–$64,820 10th–90th $37,000–$81,150
$30k$40k$50k$60k$70k$80k$90k$100k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
General hospitals
$39,610
$47,510
$59,460
$74,850
$91,960
All industries
$37,000
$43,490
$51,140
$64,820
$81,150
These figures cover general medical and surgical hospitals of every size. Rural hospitals often pay less than city hospitals. Post a real range for your market in the ad.
Skills to hire for, and what you can teach
Hire for these
Codes both inpatient and outpatient records to the official guidelines
Reads a long chart and finds what the provider actually wrote
Writes a query that asks a question without steering the answer
Works a queue alone and knows when a case needs a second opinion
Keeps records private, at the office or on a home network
Teach these on the job
Your encoder, EHR coding queue and claim edit screens
Your ER facility level criteria
How your hospital marks observation, inpatient and swing bed status
Your rural health clinic's visit rules, if you run one
Which providers to query for what, and how each one prefers to get queries
Coders work in the EHR's coding queue and chart view, an encoder with built-in coding references, the query tool and claim edit reports. Tell candidates which encoder you use, whether the job can be remote, and whether it covers clinic or Method II professional coding.
Hospital medical coder interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
Your audit results and discharge volume give the baseline; the business office manager should see the numbers every month.
Coding accuracy on audit
Have an outside or peer auditor score a quarterly sample of charts, rating diagnoses, procedures and ER levels separately so you see where errors cluster.
Discharged not final coded backlog
Discharged accounts waiting on coding, and how long the oldest has waited. Keep accounts on hold for a query or missing documentation apart from ones nobody has reached.
Query response rate
Queries answered by your policy's deadline, out of all queries sent. Track it by provider, since one slow reply can hold a whole batch of claims.
Coding-related denials
Denials traced to a code, modifier or medical necessity edit each month. Review each with the coder and note whether it was a coding error or a gap in the notes.
Charts coded per hour
Charts finished per hour worked, with separate expectations for inpatient, ER, observation and clinic records, since an inpatient stay takes far longer than a clinic visit.
Career path
Medical records clerkLearns the chart, records requests and medical terms.
Medical CoderCodes every type of record the hospital produces.
Coding auditor or CDI specialistAudits other coders' work or works with providers on clearer notes.
Health information management directorRuns medical records and coding, often with an RHIT or RHIA.
CCS, CPC or COC: which credential fits a hospital coder?
It depends on what the coder will touch. AHIMA aims its CCS at coders who work both inpatient and outpatient records. AAPC's COC is built for hospital outpatient work, including ER visits and observation, and its CPC centers on physician and clinic coding. For a coder who handles everything here, a CCS fits best. A COC or CPC holder with inpatient training can also do the job.
How much does a hospital medical coder make?
Medical records specialists who work for general medical and surgical hospitals earned a median of $28.59 an hour ($59,460 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $47,510 and $74,850 a year. Pay also depends on your local market, experience and overtime.
Can we hire a newly certified coder?
You can, with a plan. AAPC adds an apprentice mark, CPC-A, for coders who pass without two years of experience. AHIMA suggests coding experience before the CCS exam. A new coder at a small hospital has no one nearby to check their work. Set up regular audits and a mentor for the first months, even if the mentor works for an outside coding firm.
Can a hospital coder work from home?
Many do, and the template allows it after training. Treat it like any other remote access to patient records. Use a hospital-managed computer, a secure login, a private workspace and a written policy the coder signs. Plan some time on site early on, so the coder meets the providers they'll be querying.
Should our coder also do the billing?
Keep the jobs apart where you can. A coder who also works denials may feel pressure to change a code just to get a claim paid. If one person must do both, have someone else review every code change made on a denied claim, and write down why each one changed.
