HIM Coder II

• Maintains detailed knowledge of and ensures adherence

to all applicable Billings Clinic and regulatory compliance policies/procedures

governing medical record coding, insurance billing, and reimbursement

methodologies in all aspects of the job. Actively seeks out clarification

and/or updated information to ensure most current guidelines are followed.

Review of medical records for documentation to identify the principal diagnosis

and/or procedure and all applicable secondary diagnosis and procedures

Assigning the appropriate ICD-CM and/or CPT-4/HCPCS codes for each encounter

utilizing ICD-10 and CPT-4 reference tools.

Utilizing the computerized encoding system and/or coding books to facilitate

accurate coding and sequencing of diagnosis and procedures by following all

regulatory compliance policies and procedures governing medical records coding,

billing and reimbursement.

• Maintains or exceeds 95% coding accuracy based on audit findings.

• Maintains or exceeds department productivity standards for assigned areas of

coding.

• Identifies and reports any regulatory or compliance concerns to Coding

Resources Manager, Director and/or Billings Clinic Corporate Compliance

Department.

• Ensures data accuracy prior to billing interface and claims submission.

(i.e., discharge disposition, appropriate use of modifiers, CPT, ICD,

performing provider, date of service, POA, NCCI and other coding and

abstracting requirements).

• Collects data from the medical record to complete a discharge data abstract

on each encounter for specialized studies.

• Communicate with physicians/Non-Physician Providers to provide coding and

documentation education and feedback.

• Identifies needs and sets goals for own growth and development; meets all

mandatory organizational and departmental requirements. Maintains knowledge of

current information and technologies for coding and abstracting arena.

• Maintains competency in all organizational, departmental and outside agency

environmental, employee or patient safety standards relevant to job performance.

• Supports and models behaviors consistent with Billings Clinic’s mission,

vision, values, code of business conduct and service expectations. Meets all

mandatory organizational and departmental requirements. Maintains competency in

all organizational, departmental and outside agency standards as it relates to

the environment, employee, patient safety or job performance.

• Performs all other duties as assigned or as needed to meet the needs of

the department/organization.

• Cross-Training:

Clinic: Able to perform diagnosis, E/M and procedure coding for a variety of

specialties, both hospital professional and clinic encounters. Will begin

training on reimbursement functions by attending department meetings with

Coding Resources staff, provide feedback to physicians on hospital professional

charges. May begin auditing clinic encounters.

Hospital: Able to perform coding for all outpatient services and outpatient

surgery services. Begin inpatient coding training.

• Knowledge:

Demonstrated and in-depth knowledge and interrelations of coding and

reimbursement methodologies and medical record information systems normally

acquired as a graduate of an approved medical records program and/More than 2

years of on the job experience. Fully understands the ramifications and outcome

of coding decisions and the financial impact to the organization.

• Analytical Skills:

Clinic: Ability to perform complex coding requirements across several

specialties within the physician clinic and will be trained on all specialties

Hospital: Ability to perform complex coding requirements within the hospital

for ancillary services and outpatient surgery area.

Takes action with minimal input or supervision. For situations outside the

normal guidelines and/or procedures, formulates recommendations for review and

consideration by the management team.

Able to proactively identify reimbursement issues

• Independent Judgement:

Ability to determine proper procedures for resolving complex coding issues with

minimal supervision

Empowered to utilize independent judgment to investigate and research pertinent

data and formulate an action plan. Monitors all high dollar discharges to

ensure high levels of coding quality.

Presents recommendations for review and consideration by the management team

for problem scenarios outside of established procedures

• Interpersonal Skills:

Ability to incorporate cultural diversity and age-appropriate care into all

communication and assigned services.

Interpersonal skills that enable the incumbent to respond to a variety of

complex inquiries and requests from payers and physicians.

Ability to deal with difficult situations maturely and professionally.

Interpersonal skills to assist with training and to respond to questions and

assist with problem resolution from level I coders.

• Supervision of Others:

May serve as a resource to Level I staff responding to procedural questions and

assisting with problem resolution.

Assists management team in maintaining high-quality coding functions by

application and adherence to coding practices, guidelines, and standards.

• Process Improvement / Quality Assurance / Risk Management:

Quality Standards

Must successfully meet and maintain established productivity and quality

standards

Compliance & Regulatory Requirements

Maintains and applies detailed knowledge and understanding of all applicable

Billings Clinic and regulatory compliance policies and procedures governing

medical records coding, insurance billing and reimbursement methodologies.

Identifies and reports issues or concerns to Manager, Director or Billings

Clinic Corporate Compliance Department.

• Criteria/Role/Activity:

Minimum Qualifications

Specialty certification in addition to core coding credentials desirable or to

be obtained within two (2) years of hire or as agreed upon with the Manager. (

CCS, RCC, ROCC, etc.)

Experience

Coding training and experience related to technical specialty such as

Interventional Radiology, IP Facility, Radiation Oncology, Cardiac Cath lab, or

multiple areas/specialties of coding to provide coverage in multiple areas.

government regulations

commercial payer guidelines and regulations

billing practices

auditing practices

• Cross-Training:

Assigned to one of the specialty areas: Radiation Oncology, Interventional

Radiology, Cardiac Cath Lab and Inpatient Facility , Coding Float,

Cirius/Denials

May provide backup to other areas of the Coding Resources department.

Minimum Qualifications

Education

• Minimum High School or GED High school graduate or equivalent

• Prior training in Anatomy, Medical Terminology and Coding

Experience

• Clinic: 2 years of coding experience with a physician clinic dealing with multiple specialties and basic reimbursement experience.

• Hospital: 2 years of coding experience within a hospital dealing with all patient types and all third-party and government payers.

Certifications and Licenses

• Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) at hire

Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.