Coder II: Coding

Hoag•Newport Beach, CA

About The Position

The Coder II reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM codes to support diagnoses, procedures, and treatment results. Codes support billing, internal and external reporting, research, and regulatory compliance. The coder follows AHIMA ethical coding standards and official coding guidelines; verifies captured ICD-10-CM codes and physician abstraction; keeps current with coding guideline changes through study, education, meetings, and in-services; and participates in internal and external quality reviews. Other duties may be assigned. For Hoag Hospital Medical Coding, the coder resolves billing-related errors and assists with workflow changes and process-improvement projects. The role includes coding diagnoses, treatment, and procedures for outpatient procedures; coding for emergency department and observation services; identifying chargeable items and facility levels for emergency department visits; and potentially helping fiscal coders or billers work account edits. The coder collaborates with fiscal coding or revenue cycle staff on correct coding and modifier assignment. Remote work may be available if technology, productivity, and quality requirements are met and the Telecommuter Work Agreement is signed and followed. For Hoag Clinic Coding, the coder meets productivity and quality standards, including an accuracy rate of 95% or better; follows coding conventions; and serves as a coding consultant to Hoag providers. The coder identifies discrepancies that may affect quality of care or billing, serves as a resource and subject matter expert for other coding staff, and reviews coding charges and claim edits in Epic or another appropriate EMR, including correcting ICD-10 codes, modifiers, CPT, E/M, and procedure codes.

Requirements

High school diploma or equivalent.
For Hoag Hospital Medical Coding: completion of a certified coding program or graduation from a CAHIM-accredited HIT program.
For Hoag Hospital Medical Coding: two years of hospital acute-care emergency department and/or outpatient procedures and same-day surgery coding experience.
For Hoag Clinic Coding: at least two years of work experience as a medical coder.
For HASCH: two years of experience.
For Hoag Hospital Medical Coding: Certified Coding Specialist (CCS) certification required.
For Hoag Clinic Coding: one of the following certifications is required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist Physician-Based (CCS-P), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA).
For Home Health: one of the following certifications is required: Home Care Coding Specialist (HCS-D), CCS, or CPC.
For HASCH Administration: one of the following certifications is required: CCS-P, CPC, or COC.
For Cath Lab/IR: one of the following certifications is required: CCS or Certified Interventional Radiology Cardiovascular Coder (CIRCC).
Meet applicable productivity and quality requirements, including a 95% accuracy rate or better.

Nice To Haves

Hoag Clinic Coding: coding experience in multiple specialties, including OB/GYN, Urology, Oncology, Pain Management, Cardiology, General Surgery, Cardiothoracic, Neurosurgery, Neurology, and Orthopedics procedures.
Knowledge of E/M coding.
HASCH: graduation from a CAHIM-accredited HIT program and CCS or RHIT eligibility.
Spine and Ophthalmology coding experience.
Hoag Clinic Coding: Certified Urology Coder (CUC) certification.

Responsibilities

Review clinical documentation and diagnostic results and assign appropriate ICD-10-CM codes for diagnoses, procedures, and treatment results.
Verify that ICD-10-CM codes are correctly captured and that the physician is correctly abstracted.
Follow AHIMA ethical coding standards and official coding guidelines.
Keep current with coding guideline changes through self-study, assigned education, coding meetings, and in-services.
Participate in internal and external quality review meetings.
Resolve billing-related errors and assist with workflow changes and process-improvement projects, where applicable.
Code diagnoses, treatment, and procedures for outpatient procedures, emergency department services, and observation services, as applicable.
Identify chargeable items and facility levels for emergency department visits.
Assist fiscal coders or billers with account edits and work with fiscal coding or revenue cycle staff to review correct coding and modifier assignments, as applicable.
Meet ongoing productivity and quality standards, including 95% accuracy or better.
Follow coding conventions and consult with Hoag providers on coding matters, where applicable.
Identify coding discrepancies that may affect quality of care or billing.
Serve as a resource and subject matter expert for other coding staff, where applicable.
Complete coding charge reviews and claim edits in Epic or another appropriate EMR, including coding and correcting ICD-10 codes, modifiers, CPT, E/M, and procedure codes.
Perform other duties as assigned.