Code inpatient hospital discharge and outpatient accounts for the purpose of reimbursement, research and compliance with federal regulation according to diagnosis, operation, and procedure using the current ICD, CPT and DRG coding classification systems. Perform second level coding audits for accuracy of accounts coded by Coder I and/or Coder II positions to ensure coding compliance and accuracy for high profile accounts such as HACs, mortality, payer DRG audits, Coder/CDI DRG mismatches, and other quality performance measures. Coordinate and facilitate communication between HIM CDI staff and HIM coding staff to complete provider queries to ensure appropriate and complete provider follow up and documentation. Facilitate teamwork between HIM CDI and coding staff for a cooperative learning environment to arrive at the appropriate working DRG and final DRG for reimbursement. Ensure adherence to Hospital and Departmental Policies and Procedures. No patient care assignment.
CODE - Identify and assign preliminary codes for hospital discharge records and outpatient records for the purpose of reimbursement, research and compliance with federal regulations according to diagnosis(es), operation(s), and procedure(s) using the current version of ICD, CPT, and DRG classification systems
RESEARCH - Research compliance with federal regulations according to diagnosis, operation, and procedure using the current version ICD, CPT, and DRG classification systems
CODE - Abstracts statistical data for discharge records using hospital's abstracting system
CODE - Performs data entry for determining correct DRG
COMPLIANCE â Identify the need to clarify documentation in medical records and initiate communication with physician, nurse, or patient care coordinator by utilizing the appropriate query tools in order to capture the documentation in the medical record that accurately supports the patientâs severity of illness, risk of mortality, and/or appropriate DRG
ABSTRACTS â Utilize monitoring tools to track the progress of the Documentation Improvement Program and identified quality indicator tracking elements, interpret tracking information and report findings to Coding Management, HIM Executive Director, Quality Management, Utilization Review/Case Management and UNMH providers as requested
PHYSICIAN COMMUNICATION â Communicate with physicians to obtain/clarify specific principal diagnoses or comorbidities and complications; request clarification of existing documentation. Facilitate assertive, tactful, and cooperative communication skills when encountering resistance due to perception that information is adequately documented. Assist with development of CDI standard Query templates. Attend department meetings with CDI staff, and participate in providing CDI tools to medical specialties and appropriate provider documentation of clinical activities
COORDINATION â Coordinate and facilitate communication between Health Information Management, Utilization Review/Case Management, Quality Management, Physician Leadership (i.e. Executive Medical Director for Patient Safety & Quality, UR physicians, etc.) as needed to acquire, interpret, and transmit accurate diagnostic and procedure documentation. Keep Coding Management and Executive Director HIM informed of potential and/or actual problems identified during the review process and operations of the program
REPORTS â Compile and assist in the communication and distribution of physician profiling reports provided in conjunction with the Coding and Clinical Documentation Improvement Programs
RELATED WORK - Perform related duties and responsibilities as required
AUDIT - Develop, oversee and conduct various routine and special audits, research and correct data to maintain integrity of programs
QUERY - Identify and complete appropriate queries to providers when more specific or clarifying documentation is needed to accurately code IP discharges. Maintain department query standards and expectations as outlined in department policies and procedures
High School Diploma or GED equivalent
2 years directly related experience
One of the following:
Addendum - CCS within 6 months of position
Certified Coding Specialist (CCS)
Certified Professional Coder (CPC)
Certified Interventional Radiology and Cardiovascular Coder (CIRCC)
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Working Conditions Requirements:
No or min hazard, physical risk, office environment
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.