HIM Coder II

Responsible for coding and abstracting diagnoses and procedures from patient charts using ICD-CM, ICD PCS and/or CPT-4/HCPCS codes for statistical and reimbursement purposes for all Billings Clinic inpatient and outpatient services. Alternatively, since Billings Clinic is an integrated delivery system, responsible for auditing or assigning CPT and E&M codes to clinic encounters by reading dictation, reviewing problem lists and intake forms, capturing primary and secondary ICD-CM diagnoses, adding HCPCS modifiers where necessary and verifying units of service for pharmacy items and supplies. Queries physicians to clarify clinical documentation. Educates physicians either concurrently or after-the-fact on coding and documentation and serves as an on-site resource for providers and staff. Calculates the MSDRG and APR- DRG. Ensures adherence to all Billings Clinic and regulatory compliance policies and procedures governing medical records coding, billing and reimbursement.

Essential Job Functions

• 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

Minimum Qualifications
Education

Experience

Certifications and Licenses