Coder - HIM

JOB SUMMARY

The Health Information Management (HIM) Coder impacts Memorial’s Healthcare quality initiatives and reimbursement through the assignment of the most accurate and optimal diagnosis and procedural codes to individual patient health information for data retrieval, analysis, and claims processing. Under the direction of the Health Information Management (HIM) Coding and Clinical Documentation Integrity (CDI) Manager, this position will code and analyze physician documentation contained in health records (electronic, paper or hybrid) to determine the appropriate principal diagnosis, secondary diagnoses, and procedures codes to accurately capture MS-DRG assignment. Use the Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers in accordance with coding rules and regulations. The coding information is used to determine APC’s (Ambulatory Payment Classification) for data quantitative analysis, quality research and claim submission. It is necessary that the candidate abides by the Standards of Ethical Coding as set forth by AHIMA and strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

PRIMARY JOB RESPONSIBILITIES :

• Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.
• Codes accounts in work lists appropriately based on priority.
• 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.
• Meet and sustain productivity metrics established by the Manager while maintaining high accuracy rate.
• Seeks out missing information and creates complete records, including items such as disease and procedure codes, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons, and appropriate signatures / authorizations. Refers inconsistent patient treatment information / documentation to coding quality analysis, supervisor or individual department for clarification / additional information for accurate code assignment.
• Investigates and tracks unbilled accounts to determine reason for incomplete status and works with appropriate resources for completion.
• Queries physicians and other healthcare providers when there is conflicting, incomplete, or ambiguous information in the health record. Comply with industry standards “Guidelines for Achieving a Compliant Query Practice” when composing queries.
• Accountable for Claim Edits review and respond to NCCI, OCE, LCD & NCD edits.
• Abides by and stays current with Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting, American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, and American Health Information Management Association (AHIMA) Standards of Ethical Coding.
• Maintains appropriate, and demonstrates adequate use of, multiple software applications, including 3-M, Meditech (Expanse), scanning software, etc.
• Completes assigned tasks in appropriate timeframe and adjusts to increased workload.
• Problem solves and brings concerns to Manager for resolution when appropriate.
• Actively contributes to the morale and teamwork of the staff and facility and always presenting a positive attitude and patient-minded vision, with patient satisfaction as the continuing goal.
• Follows established procedures for specific coding modalities, examples – concurrent and retrospective coding.
• Assists with training / orientation of new employees and students.
• Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.
• Efficient and productive in a remote work environment.
• Other duties as assigned.

JOB SPECIFICATIONS

EDUCATION

EXPERIENCE

PI262385583