Coder IV Facility HB, Inpatient Facility Coding

Overview

Coder IV Facility HB, Inpatient Facility Coding

40 hours per week, day shift

JOB SUMMARY:  Responsible for assignment, review, and correction of ICD CM/PCS codes (Inpatient) and ICD-10-CM/CPT, Evaluation and Management codes (Outpatient) in the WakeOne health information system and the review/editing of associated facility charges.  Performs audit, quality review and improvement assignments as directed for Inpatient and Outpatient respective facility charges and reports on findings.  Identifies and assists management with the resolution of coding quality or process issues.  Data reported is used for statistical, financial and billing purposes and to meet licensure requirements. 

EDUCATION/EXPERIENCE:  Minimum of five years' of coding experience in an academic medical center or an equivalent combination of coding experience and education with demonstrated competency of knowledge base.  Coding QA background or similar experience preferred.  Satisfactory completion of college level courses in anatomy, physiology and medical terminology preferred.  EPIC health information system experience preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION:  Coding certification CCA, CIC, CPC-H, CPC, CCS, RHIT, or RHIA required

ESSENTIAL FUNCTIONS: 

1.            Ensures the timely and accurate coding and completion of patient accounts within established departmental accuracy and productivity standards.

2.            Applies correct ICD CM/PCS (Inpatient) and ICD CM/CPT codes (Outpatient) guidelines meeting departmental policy regarding compliant methods, timeframes, use of applications and productivity.

3.            Assists in demonstrating medical necessity for procedures performed by ensuring that all documented disease processes are coded.

4.            Demonstrates proficiency in utilizing official coding books as well as the electronic medical record, computer assisted coding/encoding software, and clinical documentation information systems to facilitate code assignment.

5.            Reviews facility charges as provided and edits where necessary to ensure charges are compliant and substantiated by provider documentation.

6.            May require frequent and close collaboration with multiple areas of the organization including providers, Professional Coding, and Finance for audit and problem-solving activities.

7.            Demonstrates full understanding and is compliant with correct coding initiative guidelines, regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS) and other payers, and the Joint Commission.

8.            Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.

9.            Queries physician when existing documentation is unclear or ambiguous following AHIMA guidelines and established policy. 

10.          Brings identified concerns to Manager Coding for resolution.

11.          Assigns the MS DRG and MCC/CCs that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department (Inpatient).

12.          Reviews department-specified reports daily to identify charts that need to be coded and prioritizes as per department-specific guidelines and within designated timelines. 

13.          Follows up to ensure that any edits that prevent an account from dropping are corrected within established timelines.

14.          Produces specific reports on a monthly basis per established parameters.

15.          Responds to inquiries from Patient Accounts or other departments as requested.  Communicates with Manager when trending request volumes impact productivity.

16.          Demonstrates continuous learning as evidenced by personally developed reference materials, online publications etc., to stay abreast of new and revised guidelines, practices and terminology, for reference and application.

17.          Participates in on site and/or external training workshops as opportunities arise.  Maintains credentials, if applicable, and submits written evidence of maintenance.

18.          Participates in training other coders and acts as a mentor, when assigned.

19.          Collaborates on cases where the final DRG and coded DRG differ, in order to resolve the difference (Inpatient).

20.          Works with the Health Records Specialists to identify opportunities for MS-DRG optimization when medically indicated (Inpatient).

21.          Participates in accurate data collection, evaluation and recommendations for process improvements.

22.          Participates as a member of the Clinical Documentation Management Program.

23.          Functions as an organizational coding expert, and additionally supports the Managers of Coding Quality and Integrity Review in auditing and training and re-training of coders as directed.  Special duties and projects may additionally be assigned in support of the department goals.  

SKILLS/QUALIFICATIONS:

• Ability to concentrate for extended periods.
• Knowledge of medical terminology and basic anatomy, physiology, pathophysiology, and pharmacology with ability to apply
• knowledge to the coding process.
• Demonstrates skill in coding classification systems, diagnosis, procedure selection, and sequencing guidelines.
• Knowledge of APC prospective payment system.
• Demonstrates competence in coding and correct extrapolation of official coding and select billing guidelines to specific coding situations.
• Ability to apply broad guidelines to specific coding situations; independently utilizing discretion and a significant level of analytic ability.
• Effective verbal and written communication and customer service skills.
• Ability to operate multiple Windows based software applications.
• Ability to solve problems, close attention to detail, make decisions independently, and manage multiple demands.

WORK ENVIRONMENT:

• Clean, comfortable, well-lit area
• Moderate noise environment

PHYSICAL REQUIREMENTS:

Amount of time spent performing the following activities:

0%          35%        65%                       

to            to            to                           

35%        65%        100%     N/A        Activity

X                                                             Standing

X                                                             Walking

                                X                             Sitting

X                                                             Bending

X                                                             Reaching with arms

                                X                             Finger and hand dexterity

                X                                             Talking

                X                                             Hearing

                                X                             Seeing

X                                                             Lifting, carrying, pushing and or pulling:

X                                                             20 lbs. maximum

                                                X             50 lbs. maximum

                                                X             100 lbs. maximum