Job Description

Hospital Based Coder II, Full Time, Opportunity for Remote Environment, Health Information Management

Summary:

Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing and compliance.

Detailed responsibilities:

• Reviews encounters to assign and sequence appropriate diagnoses and procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.

• Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Research electronic medical record for any additional diagnoses documented to meet medical necessity.

• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.

• Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM) coding policies and procedures.

• Conducts, audits and/or coding reviews with various health care professionals to ensure all documentation is accurate for physician billing.

• For hospital encounters, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing.

• Communicates with insurance companies about coding errors and disputes for physician billing.

• Reviews and validates accuracy of data in Admission-Discharge-Transfer (ADT) fields following HIM coding policies and procedures.

• Adjusts and adapts to continual changes in the coding field. Practices ethical coding per AHIMA Standards of Ethical Coding.

• Meets and maintains HIM coding quality and productivity standards. Submits daily productivity report to HIM manager by defined deadline.

• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.

• Enhances and maintains coding knowledge and skills for physician billing.

• Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.

• Performs all other duties as requested.

Education:

• High School Diploma or Equivalent

Credentials:

• Coding Certification (RHIT, RHIA, CCS)

Other information:

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills including Microsoft Office applications, computerized encoder and electronic medical record systems. Ability to perform job duties using an electronic medical record system. Requires a strong proficiency and understanding of Medical Terminology, Anatomy & Physiology, Pathophysiology and Pharmacology. Knowledge of coding classification systems and procedures. Possesses a strong foundation in coding and clinical knowledge with ability to review, research and code diagnoses and procedures with a high level of complexity.

Required Work Experience:

• Two (2) years hospital-based outpatient coding experience and Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS).

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