Inpatient-Outpatient Professional Coder

SCHEDULE: Full-time; 40 hours per week; Monday - Friday; 8:00 am - 5:00 pm

The Certified Professional Coder is responsible for the review, interpretation, coding and abstracting of medical record information according to the standard and current classification systems; identifies and applies appropriate diagnoses, procedural, HCPCS and modifier codes to obtain accurate assignment for proper reimbursement and data collection in the inpatient and/or outpatient setting.

Coding certification is required through AHIMA or AAPC as a RHIA, RHIT, CCS, CCS-P, CPC, CCA and CPC-H. An incumbent shall also be considered if he/she is registry eligible or actively working toward accreditation or registration; or is currently enrolled in a certified coding program with certification to follow. Certification required within 12 months of employment. Prefer one year of experience in coding inpatient and/or outpatient records with the use of ICD-10-CM, CPT and HCPCS classification systems. Knowledge of coding software, medical terminology, abbreviations, anatomy and physiology; major disease processes and pharmacology; classification systems, ICD-10-CM nomenclature, CPT and ICD-10-PCS and HCPCS nomenclature, coding rules, guidelines and proper sequencing. Knowledge of coding conventions and rules established by the American Medication Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid Services (CMS), for assignment of diagnostic and surgical procedure codes. Knowledge of HIPAA standards affecting medical records and the impact on reimbursement and accreditation. Knowledge of ethical coding principles and revenue cycle activities; principles and revenue cycle activities; principles and practices of medical file and record management. Skill in reading medical records, both written and electronic and finding and resolving documentation discrepancies; operating computerized medical coding and information processing systems; operating a personal computer and utilizing a variety of software applications; linking diagnosis to services and applying appropriate codes to diagnoses, procedures and supplies; using analytical and research modality skills to define and solve problems; interpreting and applying ethical coding standards, federal and state regulations and laws; rules; policies and procedures; and professional practice standards for health care organization coding compliance program activities; effective verbal and written communication with peers, practitioners, clinical staff and patients; skill in oral communication and presenting information to providers.

Ethical coding in accordance with the applicable International Classification of Diseases manual, the AMA Current Procedural Terminology manual, and/or Healthcare Common Procedure Coding System manual. Extract pertinent patient data to determine and assign appropriate diagnostic code(s) or diagnosis related group (DRG), applicational procedural code(s), applicable modifier(s), applicable ambulatory payment classification (APC) and identify secondary complications and co-morbidity conditions. Maintains compliance to the official inpatient and/or outpatient coding guidelines, third party payor guidelines including Medicare and Medicaid requirements, as well as the rules and regulations of the medical facility, state and federal government; including but not limited to correct sequencing of code(s), appropriate application of modifier(s), national and local coverage determinations, appropriate documentation for E/M level selection. Evaluate the quality of clinical documentation on a continuous basis to identify inconsistent or incomplete documentation for patient encounters that impact proper code selection, identify educational needs, ensure support of physician professional fees, including but not limited to, outpatient evaluation and management (E/M) services. Provide feedback and education to practitioners, clinical staff, business office and HIM department regarding changes in methodology and documentation requirements for optimizing reimbursement. Stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function; remain abreast of coding changes affecting facility reimbursement. Demonstrate competency in the use of computer applications, particularly the coding and abstracting software and hardware in use by the HIM department. Note: This is a partial list of key job areas. For a complete job description, contact HR.