Medical Coder/Coding Specialist

Employee Type:

Regular

Work Shift:

Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Position Summary: Responsible for assigning diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM and ICD-10-PCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes work to meet deadlines and goals. Maintains and expands knowledge of coding and sequencing guidelines to ensure coding compliance and accuracy. Responses to audits, provides consultation on projects, and be the primary point of contact for CDI and other team members when the supervisor/manager is not available.

Position Responsibilities & Functions

• Assigns and sequences codes for the inpatient record using ICD-10-CM and PCS codes as defined in the Uniform Hospital Discharge Data Set (UHDDS), based on the American Health Information Management Association (AHIMA) and organization-specific guidelines for reimbursement, statistical purposes, core measure reviews, and data collection.

• Reviews all documentation from Qualified Medical Providers (QMPs) to assign all significant diagnoses. Additionally, all documentation from nurses must be reviewed to assign correct codes.

• Ensure all documentation reviewed supports diagnosis in the health information record so all significant diagnoses and procedures are captured correctly for reimbursement, statistical research, Severity of Illness (SOI) and Risk of Mortality (ROM), best Diagnostic Related Group (DRG) outcome, and accurate assignment of present on admission (POA) indicators.

• Consistently meets coding quality and productivity standards established by the coding department.

• Must be able to do a clear and concise query to the physician when there is conflicting documentation in the medical record. Must be able to identify and place accounts to the correct status/hold when additional documentation is required for accurate and complete coding.

• Have knowledge of payer guidelines related to MUE, Medical Necessity, LCD/NCD requirements and HIPAA/Compliance in order to take correct actions to allow for payer processing for payment.

• Collaborate with Clinical Documentation Integrity (CDI) team as part of the clinical documentation validation, to provide the most accurate and complete diagnoses. Works with the CDI team to validate the DRG, SOI/ROM, and Hierarchical Condition Category (HCC). Forward queries created by the CDI Team to obtain the most accurate DRG. This provides outcomes for the organization as well as accurate reimbursement for benchmarking.

• Works closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions.

• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.

• Review and resolve account checks, clearinghouse rejection errors, denials, and charge review edits daily.

• Assist Patient Financial Service (PFS) with written appeal letters, dispute determination responses, and redetermination to support reimbursement of services rendered.

• Collaborate with the Compliance/Quality Team when alerted to coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations.

• Work with HIM operations as needed to clarify queries and documentation needs for the completion of the medical record.

• Verify accurate abstracting of discharge disposition.

• Collaborates with Quality and CDI to ascertain that chart are at the highest level possible for SOI/ROM, especially in mortality cases for benchmarking purposes based on documentation. Query for unclear or conflicting documentation

• May also support the department by participating in audit reviews, mentoring, and training other coders and any other task that promotes the success of the department and fellow staff.

• Safeguards confidential and privileged patient information.

Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities, and activities may change at any time with or without notice.

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