Medical Coder

Position Objective:

The Inpatient Medical Coder under the supervision of the Manager of Coding and Data Quality accurately codes hospital inpatient accounts for the purpose of appropriate reimbursement, research, statistics and compliance to federal and state regulations in accordance with established ICD-10-CM/PCS coding classification systems.

Essential Job Duties:

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1.     Analyzes inpatient cases, identifies and assigns ICD-10 diagnostic and PCS procedural codes for the purpose of reimbursement, research and compliance with federal and state regulations. Demonstrates comprehensive knowledge of coding nomenclature to ensure accurate MS-DRG MCC/CC and APR-DRG/SOI/ROM and POA assignments.

1. Utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed. Sends coding queries to providers and communicates with CDIS’ when provider queries are clinical in nature.
2. Monitors assigned work on a daily basis in order to facilitate the billing process within the established timeframes within work queues. Codes and abstracts records within timeframes established for each patient type.
3. Maintain a high level of accuracy in code assignments to prevent claim denials, billing errors, and potential legal issues. Receives routine feedback on metrics.
4. Review medical records, including patient histories, examination findings, diagnoses, and treatment plans, to extract pertinent information for code assignments.
5. Communicates with various departments within the hospitals regarding billing and registration issues. Refers any problems to management timely, providing clear details.
6. Complies with AHIMA standards of ethical coding and coding compliance guidelines, including adherence to HIPAA (Health Insurance Portability and Accountability Act) privacy regulations.
7. Utilizes coding references, software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignments.
8. Participate in ongoing education, training, and certification programs to enhance coding proficiency and maintain credentials. Participates in bi-monthly meetings related to DRG mismatches with CDIS.

Demonstrates support and compliance with Luminis Health Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections assigned by the manager.

Required Minimum Education. The minimum level of education for this position includes:

High School graduate or equivalent. Formal ICD-10-CM and CPT training required. Associates or Bachelor’s degree preferred.

Required Minimum Experience:

 Minimum of one (1) year of inpatient acute care coding experience or two (2) years of acute care outpatient coding experience required. Experience with ICD-10-CM/ICD-10-PCS, MS-DRG/APR-DRG methodologies, inpatient reimbursement, and coding guidelines is preferred.

Required License/Certifications:

Candidates must possess a Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) credential; CCS is preferred at the time of hire and, if not held, must be obtained within one (1) year of employment.

Knowledge, Skills, Abilities:

Strong analytical and organizational skills; filing systems; ability to prioritize workloads; meet deadlines and work effectively under pressure; excellent customer service skills; general office procedures; ability to problem solve and work with minimal supervision; familiar with basic medical terminology; computer experience; typing ability.

Working Conditions, Equipment, Physical Demands:

Light work. Exerting up to twenty pounds of force occasionally, and/or up to ten pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.

There is reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.