Employment Type:

Full time

Shift:

Description:

Provides high level technical competency and subject matter expertise analyzing physician/provider documentation in Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined DRGs (APR), Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI) to ensure accurate hospital reimbursement.   

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments.

Assigns appropriate code(s) by utilizing coding guidelines established by:

•           The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting

•           American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification

•           American Health Information Management Association (AHIMA) Standards of Ethical  

             Coding

•           Revenue Excellence/HM coding procedures and guidelines  

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.  

Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.

Codes Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR DRGs, POA, SOI & ROM indicators.

Reviews Inpatient health record documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.

Works Inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.

Adheres to Inpatient coding quality and productivity standards established by Revenue Excellence/HM.

Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.

Utilizes EMR communication tools to track missing documentation or Inpatient queries that require follow-up to facilitate coding in a timely fashion.

Works with HIM and Patient Business Services (PBS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement.

Maintains CEUs as appropriate for coding credentials as required by credentialing associations.

Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for Inpatient coding e.g., Hospital at Home.

Identifies, and attempts to problem solve, coding and/or EMR workflow issues that can impact coding.

Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.

Performs other duties as assigned by Leadership.

Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior

MINIMUM QUALIFICATIONS

Completion of an AHIMA-approved coding program or Associate’s degree in Health Information Management