Certified Coding Specialist

Purpose:
Inpatient, Outpatient, OBGYN, Urology, and Plastics Coding. Ability to code using ICD9-CM and appropriately assign Principal Diagnosis, All secondary and/or Procedure codes for accurate and optimal DRG assignment. Performs audits to determine accuracy of code selection, DRG or APC assignment, POA indicator, charge accuracy. Creates and distributes coder performance data via 'report cards' monthly. Summarizes coder accuracy scores for Senior Managers. Identifies topics for training and education, researches topics and assists with the assembly of training materials. Responsible for training all coders and DRG Specialists. Assists with audit reviews including all Internal, External and RAC associated coding audits. Provides Statistical reports relating to DRG changes from outside audits and DRG Focus Reviews to consistently update the DRG Focus Review list to ensure coding accuracy and opportunity for reimbursement. Assists with chart reviews relating to Never Events; Serious Events and Hospital Acquired Conditions.

Responsibilities:
 

• Abstract required medical and demographic information from the medical record and enter the data into the system to ensure accuracy of the database. Responsible for correcting any data found to be in error after reviewing the medical record and comparing with system entries. Complete work assignments in a timely manner. Submit a monthly auditing/training schedule to the Manager. Submit completed Inpatient, SDS, and ED audit spreadsheets with details for each chart. Submit audit summaries for Inpatient, SDS and ED coding. Submit all educational documents for all patient types to Management. Perform reviews on Third Party Audit findings/outcomes and prepare report for HIM and Compliance
• Ensure the diagnoses and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG, APC or payment tier under the Prospective Payment system to guarantee accurate reimbursement on UPMC patients. Review coding for accuracy and completeness prior to submission to billing. Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-9-CM and CPT codes including modifiers for correct DRG/APC assignment and accurate reimbursement. Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/ or clarification to accurately complete the coding process. Utilize computer applications and resources essential to completing the coding process efficiently, such as QuadraMed encoder, Cerner and MARS to ensure timely billing.
• Assist with identifying continuing education needs and opportunities. Coordinate continuing education by contacting clinical staff and arranging in-services for the coding staff, as well as keeping current with other education being offered by AHIMA and other professional organizations. Assist with training new staff for inpatient, SDS and ED coding. Also coordinate re-training of staff as needed due to coding changes/updates, results of audits, etc. Communicate effectively with Patient Business Services, physicians and ancillary departments as necessary to submit accurate and timely billing.
• Review and evaluate focused UPMC DRG or APC medical records for accurate payment prior to billing to ensure that all documented principal and secondary diagnoses, complications and co-morbidities, and procedures are accurately coded . Perform internal quality assurance audits on inpatient, SDS, and ED coded records. Summarizes findings and report these to the Manager. Identify areas of coding weakness and develop training plans to address these. Provide audit findings to coding staff members electronically for coders to review. Discuss audit findings with each coder individually as needed for further clarification. Develop and present Inpatient/SDS/ED coding seminars for continuing coder education as
• Code Inpatient, SDS and ED charts as necessary. Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology. Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure. Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care and assign appropriate codes.