Coder – Inpatient

Role Overview

• Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and ICD-10-PCS codes for billing, internal and external reporting, research, and regulatory compliance.
• Demonstrate knowledge of reimbursement methodologies and apply these to assigned charts to optimize reimbursement and/or resolve regulatory edits.
• Resolve error reports associated with billing process, identify and report error patterns, and, when necessary, assist in design and implementation of workflow changes to reduce billing errors.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines, and keeps abreast of coding changes and interpretation of codes.
• Complies with RRH & HIM department policies & procedures
• Perform detailed review of Inpatient record documentation to identify & assign diagnosis & procedure codes using ICD-10-CM and ICD-10-PCS.
• Meets established departmental productivity guidelines with 95% accuracy on a consistent basis.
• Utilizes Care Connect, UDS and Clintegrity systems proficiently to obtain ICD10 codes and DRG assignment.
• Formulates compliant Physician Coding Queries when documentation is inadequate, ambiguous or unclear for coding purposes
• Enters and/or updates data accurately including Present on Admission (POA) indicators, Point of Origin, Discharge Disposition and other identified data.
• Manages problematic workflow edits and other technical issues to ensure timely resolution specific to coding A/R days
• Corrects failed claim errors to billing edits, accounts misclassified and/or other errors identified through various auditing processes in a timely manner.
• Attends RGHS, HIM Department and Coding Team meetings and training sessions as required.
• Ensure timely reporting for external regulations
• Completes other duties as assigned by HIM leadership.
• Provide assistance to customers (physicians, clinical quality staff) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.

Requirements

• One of the following certifications is required: Applicable advance coding certification credential includes: Certified Coding Specialist (CCS), Certified Coding Specialist
• Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder Apprentice CPC-A, or a specialty coding certification.
• Candidate with Associate degree from the and accredited American Health Information Management Associates (AHIMA) are required to sit for the Registered Health Information Technician (RHIT) exam within 1 year of hire
• At least 2 years of progressive coding experience in a hospital or multi-specialty physician practice setting preferred.
• For HOMECARE: Homecare Diagnosis Coding Specialist (HCS-D) certification required within 16 months of hire. Grandfather Clause:
• If hired on or before September 30, 2018, 2 years of relevant work experience and one of the following coding certification credentials: Certified Coding Specialist (CCS), Certified Coding Specialist
• Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder
• Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or a specialty coding certification and Associate’s degree in Health Information Management are required.