HIM Coder I - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

In accordance with federal & state coding compliance laws, rules, regulations, and guidelines, use current ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically/manually record into the 3M 360 Encompass/Computer-Assisted Coding (CAC), 3M Coding & Reimburse System (3M-CRS), and the coding abstracting system (3M-HDM/ARMS ), all diagnoses, and minor invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary Visits: Laboratory; Radiology/Imaging; Clinic Visits; Radiation Oncology; Recurring Visits, etc.). Address OCE/NCCI/Medical Necessity edits within 3M-360/ARMS/CRS and those returned to HIM Coding from Patient Financial Services (PFS). Respond timely to all internal/external coding audit results and any feedback from other revenue cycle stakeholder Depts. Understands PFS coding/billing DNFB/DNFC processes & systems such as Oracle's Soarian Financials (SF) and CHC Assurance sufficiently to ensure claims drop timely with appropriate diagnosis/procedure codes. Performs other coding department related duties as assigned by HIM management staff.

Essential Duties:

• Outpatient Ancillary/Clinic Visit/Emergency Department coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions.
• Reviews the entire medical record; accurately classify and sequence diagnoses and procedures; ensure the capture of all documented conditions that coexist at the time of the encounter/visit, all medical necessity diagnoses, complications, co-morbidities, historical condition or family history that has an impact on current care or influences treatment, and all external causes of morbidity.
• Enter patient information into inpatient and outpatient medical record databases (ClinTrac/HDM). Ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements prior to billing interface and claims submission.
• Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.
• Assists in the correction of regulatory reports, such as OSHPD data, as requested.
• Attendance, punctuality, and professionalism in all HIM Coding and work related activities.
• Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions. Completes tasks accurately, legibly, and in a timely fashion.
• Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.
• Ability to achieve a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s).
• Ability to achieve a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s).
• Assist in ensuring that all medical records contain information necessary for optimal and accurate coding and abstracting.
• Recognizes education needs of based on monthly reviews and conducts self-improvement activities.
• Ability to act as a resource to coding and hospital staff on coding issues and questions.
• Ability to improve MS-DRG assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
• Ability to improve APR-DRG, SOI, and ROM assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
• Ability to improve APC/HCC assignments specific to medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.
• Maintains at minimum, expected productivity standards (See HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort.
• Works coding queues/task lists to ensure 95% of patient bills are dropped within 5 days after patient discharge/date of service.
• Works coding queues/task lists to ensures the remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service.
• Assist other coders in performance of duties including answering questions and providing guidance, as necessary.
• Assists Patient Financial Services (PFS), Patient Access, and other departments