Medical Coder/Coding Specialist III- Remote PRN

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Join Team Tidelands and help people live better lives through better health!

Position Summary:  Responsible for assigning diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM and ICD-10-PCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes work to meet deadlines and goals. Maintains and expands knowledge of coding and sequencing guidelines to ensure coding compliance and accuracy. Responses to audits, provides consultation on projects, and be the primary point of contact for CDI and other team members when the supervisor/manager is not available.

Position Responsibilities & Functions

• Assigns and sequences codes for the inpatient record using ICD-10-CM and PCS codes as defined in the Uniform Hospital Discharge Data Set (UHDDS), based on the American Health Information Management Association (AHIMA) and organization-specific guidelines for reimbursement, statistical purposes, core measure reviews, and data collection.

• Reviews all documentation from Qualified Medical Providers (QMPs) to assign all significant diagnoses. Additionally, all documentation from nurses must be reviewed to assign correct codes.

• Ensure all documentation reviewed supports diagnosis in the health information record so all significant diagnoses and procedures are captured correctly for reimbursement, statistical research, Severity of Illness (SOI) and Risk of Mortality (ROM), best Diagnostic Related Group (DRG) outcome, and accurate assignment of present on admission (POA) indicators.

• Consistently meets coding quality and productivity standards established by the coding department.

• Must be able to do a clear and concise query to the physician when there is conflicting documentation in the medical record. Must be able to identify and place accounts to the correct status/hold when additional documentation is required for accurate and complete coding.

• Have knowledge of payer guidelines related to MUE, Medical Necessity, LCD/NCD requirements and HIPAA/Compliance in order to take correct actions to allow for payer processing for payment.

• Collaborate with Clinical Documentation Integrity (CDI) team as part of the clinical documentation validation, to provide the most accurate and complete diagnoses. Works with the CDI team to validate the DRG, SOI/ROM, and Hierarchical Condition Category (HCC). Forward queries created by the CDI Team to obtain the most accurate DRG. This provides outcomes for the organization as well as accurate reimbursement for benchmarking.

• Works closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions.

• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.

• Review and resolve account checks, clearinghouse rejection errors, denials, and charge review edits daily.

• Assist Patient Financial Service (PFS) with written appeal letters, dispute determination responses, and redetermination to support reimbursement of services rendered.

• Collaborate with the Compliance/Quality Team when alerted to coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations.

• Work with HIM operations as needed to clarify queries and documentation needs for the completion of the medical record.

• Verify accurate abstracting of discharge disposition.

• Collaborates with Quality and CDI to ascertain that chart are at the highest level possible for SOI/ROM, especially in mortality cases for benchmarking purposes based on documentation. Query for unclear or conflicting documentation

• May also support the department by participating in audit reviews, mentoring, and training other coders and any other task that promotes the success of the department and fellow staff.

• Safeguards confidential and privileged patient information.

Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Working Environment:

• Office and Hospital Work Environment or Works in a private office space in the coder’s home in compliance with Tideland Health’s Remote/Telecommuter Policy.

• Must be able to work in a sitting position, use a computer and answer the telephone.

• Includes the ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments if appropriate.

QUALIFICATIONS

Experience:   

Minimum of 2 years of coding/abstracting experience in hospital inpatient coding or successful completion of Tidelands Health coding cross-training program

Education:

High school graduate or equivalent, is required.

Associate or Bachelor’s degree in Health Information, Nursing, or other related fields, or formal coding classes completed and passed preferred.

Licensure/Certification:

AHIMA or AAPC-approved coding credentials required:

• Registered Health Information Technician (RHIT)

• Registered Health Information Administrator (RHIA)

• Certified Coding Specialist (CCS)

• Certified Inpatient Coder (CIC)

Knowledge/Skills/Abilities:

• Analyze clinical data and interpret information.

• Assign ICD-10-CM, CPT and/or HCPCS codes to complex diagnoses and procedures in an integrated system of inpatient records.

• Knowledge of MS-DRG and APR DRG classification and reimbursement structures

• Understanding of appropriate level of care orders

• Solid knowledge of hospital documentation, and coding workflows and terminology; Solid understanding of and ability to apply Coding Clinic and other coding guidelines.

• Proficient at writing AHIMA-compliant physician queries

• Adept at comparing documentation, code assignment, and charge in the financial system for accuracy and completeness and elevating concerns to the appropriate manager

• Proficient in researching and responding to Business Office questions and/or questions by the payer

• Works collaboratively with CDI, Quality, and other facility leadership

• Functional knowledge of facility EMR, 3M encoder, CDI tool, and other support software

• Ability to use office equipment and automated systems/applications at an acceptable level of proficiency

• Strong analytical capabilities.

• Strong organizational skills.

• Advanced ability to function independently and be a self-starter

• Outstanding research skills and ability to use independent judgment to solve problems

• Handle multiple priorities.

• Listen and acknowledge ideas and expressions of others attentively.

• Converse clearly using appropriate verbal and body language.

• Collaborate with others to achieve a common goal through mutual cooperation.

• Influence others for positive and productive outcomes.

Physical Requirements: Light Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.