JOB SUMMARY Responsible for assigning diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-9-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Responds to audits, conducts coding or provides consultation on projects, and may be the primary point of contact to CDI team when coding supervisor/manager is not available. Mentors staff and assists with questions. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. ESSENTIAL DUTIES AND RESPONSIBILITIES
Coding: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA).
Abstracting: Reviews medical records to determine accurate required abstracting elements (facility/client specific elements) including appropriate discharge disposition.
Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by per facility.
Average coding quality standard of => 95% accuracy per monitoring period.
Does not meet =<95% accuracy
Meets => 95% accuracy
Exceeds => 95.01% accuracy
Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls
Qualifications : KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge of MS-DRG classification and reimbursement structures
Understanding of appropriate level of care orders
Working knowledge of Value Based Purchasing (VBP)
Proficient at writing AHIMA complaint 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 question by the payer
Ability to mentor less experienced staff in all areas of coding. Assists in the training of new and transitioning coding staff
Ability to establish and maintain effective working relationships as required by the duties of the position
Ability to concentrate and accomplish tasks with explicit accuracy
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency
Functional knowledge of facility EMR, encoder and other support software
EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job.
Three to five years experience performing medical record coding in acute care setting required.
High school graduate or equivalent is required.
Associate or Bachelors Degree in Health Information, Nursing, or other related field, or formal coding classes completed and passed preferred. Years of coding experience would be considered in lieu of educational requirements.