Review the complete electronic and scanned medical records of discharged patients. Assigns ICD-10-CM diagnosis and ICD-10-PCS procedure codes from documentation in the medical record.
Abstracts coded data and patient information into the coding abstracting system in use by BILH (examples of information include attending physician, surgeon, surgery dates, disposition, discharge date, and infant birth weight).
Applies ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHA Coding Clinic Advice when coding inpatient records, and facility-specific guidelines.
Sequences the assigned codes using 3M software, and exercises all principles of assigning and sequencing ICD-10-CM and ICD-10-PCS codes for comprehensive coding and appropriate DRG assignment.
Participates in training programs, including educational sessions for ICD-10-CM and ICD-10-PCS coding guidelines and updates.
Follows hospital-specific guidelines to identify and facilitate prompt resolution of documentation, abstracting and/or other account problems.

Minimum of an Associate degree in Health Information Management or Completion of an AHIMA or AAPC Coding Certification program, required
RHIA, RHIT, or CCS from AHIMA or a CIC from AAPC, required
Minimum 3 years of ICD-10-CM, ICD-10-PCS Inpatient coding assignment, required
Medical terminology
Proficient in Microsoft Office Excel, Word, and PowerPoint applications
Knowledge and understanding of current ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting
Knowledge of medical records content and management
Working knowledge of the Electronic Health Record (EHR) either through experience or education, including experience working with structured data and database management
Strong written communication skills
Knowledge of laws and regulations about health information and patient confidentiality

Inpatient Coder 3

Key skills