Coding II - Inpatient - Coding & Reimbursement

Position Details

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 892 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Active - Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 80.00

Shift: Flexible Hours and/or Flexible Schedule

Location: 210 South Florida Avenue Lakeland, FL

Pay Rate: Min $24.73 Mid $30.92

Position Summary

Under the direction of the Coding and Clinical Documentation Improvement Manger , reviews clinical documentation and diagnostic results, as appropriate, to extract data and apply appropriate ICD-10-CM, CPT, and/or HCPCS codes and modifiers to outpatient encounters for reimbursement and statistical purposes. Communicates with physicians, physician advisor or other hospital team members as needed to obtain optimal documentation to meet coding and compliance standards. Abstracts clinical and demographic information in ICD-10 CM, CPT, and HCPCS codes and modifiers into the computerized patient abstract, Participates in ongoing continued education to assure knowledge and compliance with annual changes.

Position Responsibilities

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Standard Work Duties

• Determines whether the coding assigned was properly assigned based upon clinical indicators and review of the medical documentation and application of coding guidelines.
• Develop and apply appeal arguments to defend the coding and clinical decisions while being able to address and refute the coding determination made by the carrier/payer.
• Drafts appeal letters, including the coding argument with clinical and coding references, to support the coding decision. This may include providing additional medical record documentation.
• Identifies areas for education to improve complete and accurate coding and billing and provide feedback to management regarding trends or patterns noticed in the coding for discussion.
• Continued follow-up on denials as payers may continue to deny. Collaboration with Physician Advisor as required to continue appeal process.
• Continuously reviews changes in coding rules and regulations including in Coding Clinic, CMS, and other payer guidelines.
• Complete denials/appeals reports for leadership.
• Documents all findings in the denials management application and routes to the appropriate person in the workflow for follow-up.
• Assigns and sequence documents all findings in the denials management application and routes to the appropriate person in the workflow for follow-up.s diagnostic and procedural codes using appropriate classification systems utilizing official coding guidelines.
• Performs special projects and/or other duties as assigned.

Competencies & Skills

Nonessential:

• Computer Experience, especially with computerized encoder products and computer-assisted coding applications.
• Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision
• MS-DRG and APR-DRG methodology expertise required. Strong knowledge of ICD-10-CM, ICD-10-PCS, POAs, HACs, PSIs, SOIs, ROMs and mortality rates as well as physician queries.

Qualifications & Experience

Nonessential:

• Associate Degree

Essential:

• High School diploma with Associate Degree from accredited HIM program or certificate in coding from an accredited college.

Other information:

Certifications Essential: CCS

Certifications Preferred: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

Experience Essential: 2-5 years acute care hospital inpatient coding experience within the past five years.