Under general supervision of the Director, the Coder III creates consistency and efficiency in inpatient and outpatient claims processing and data collection to appropriately optimize DRG and APC reimbursement and facilitate data quality in hospital inpatient services. Maintains flow of coding operations in the department and maintains patient confidentiality at all times.
ESSENTIAL JOB FUNCTIONS
Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position.
- Assists Director in coordinating activities of coding and clerical employees analyzing, compiling, coding, filing and data entry of medical records.
- Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for inpatient and outpatient encounters.
- Monitors records per doctor to ascertain status on completeness and in the absence of the Director takes action as indicated by hospital policy.
- Assists in training and educating medical record employees on departmental functions, changes in coding procedure/process changes, confidentiality, and other departmental issues as needed.
- Extracts required information from source documentation and enters into encoder and abstracting system.
- Performs data quality review on records to validate the ICD and CPT codes, DRG or APC group appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all DRG mandates and reporting requirements. Monitors Medicare and other DRG bulletins and manuals and reviews the current RAC Work plans for DRG risk areas.
- Evaluates the quality of clinical documentation to trend incomplete or inconsistent documentation for inpatient encounters that impact the code selection and resulting DRG groups and payment. Brings identified concerns to medical staff or Director for resolution.
- Queries physicians when code assignments are questionable or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
- Provides educational opportunities for facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology, and disease processes, appropriate to the job description and function as it relates to the DRG and other clinical data quality management factors.
- Develops reports and collects and prepares data for studies involving inpatient stays for clinical evaluation purposes and financial impact and profitability as required.
- Performs concurrent review, DRG assignment of inpatients and attends weekly case management meeting, when needed.
- Attends coding and reimbursement workshops and bring back information to the appropriate departments. Communicates any coding updates published with coding staff and other relevant positions.
- Demonstrates competence in use of computer applications and DRG/APC Grouper software, Medicare edits, and all other coding and abstracting software and hardware currently in use in the department.
- Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the charge master or as requested from the billing office.
- Evaluates, records, and responds to the Peer Review Organization (PRO) DRG change and denial notices. Provides appropriate documentation from required source to the PRO when appealing a PRO decision.
- Monitors unbilled accounts report for outstanding or uncoded discharges to reduce accounts receivable days for inpatients.
- Abides by the HMH Legal Compliance Code of Conduct.
- Maintains a safe work environment and reports safety concerns appropriately.
- Maintains patient confidentiality and appropriate handling of PHI.
- Performs all other related duties as required and assigned.
LATITUDE, CONTACTS/INTERACTIONS
All positions of Huntsville Memorial Hospital are part of an interdisciplinary team, and as such, participate in the care and service delivery process through effective interaction with other team members. Primarily interacts with hospital staff, medical staff, patients, and visitors.
Requirements
Education: Associates degree in a health information services discipline required.
Experience: Two years of coding experience required.
License/Certification: Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) required.
Required Skills: Proficient in ICD and CPT coding systems, coding inpatients, outpatients, ambulatory surgery, and ER visits. Demonstrates knowledge of DRGs, APCs, and official coding guidelines.
PHYSICAL DEMANDS AND WORKING CONDITIONS
Frequent: sitting, standing, walking, & reaching.
Occasional: lifting, carrying, bending, & squatting,
Visual and hearing acuity required. Work is inside, with good ventilation and comfortable temperature.
Possible exposure to: toxic/caustic chemicals or detergents, communicable diseases, blood borne pathogens.
Benefits
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off
- Short Term & Long Term Disability
- Training & Development
- Wellness Resources
