Coder III (Hospital Billing): Medical Coding

Hoag•Costa Mesa, CA

About The Position

The Coder (Hospital Billing) reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM and ICD-10-PCS codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. Abides by the standards of Ethical Coding as set forth by the American Health information Management Association (AHIMA) and adheres to all official coding guidelines. Responsibilities Verifies that all ICD-10-CM and ICD-10-PCS codes are correctly captured. Verifies that physician and other key information is correctly abstracted. Resolves billing related errors and assists with workflow changes and process improvement projects. Meets ongoing productivity and quality accuracy rate of 95% or better. Coder III assigns codes for diagnoses, treatment, and procedures for inpatient surgeries. Determines the correct principal diagnosis, co-morbidities, complications, secondary conditions, and surgical procedures. Abstracts correctly all required information from record including the correct discharge disposition and HCAI required information. Assigns correct MS-DRG and APR-DRG and correct Present on Admission (POA) indicators and identifies (HAC) Hospital Acquired Conditions. Queries physicians per established policy and procedure when documentation is not clear or conflicting. Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings. Has strong interpersonal skills and is able to work effectively with members of the coding and Clinical Documentation Improvement (CDI) teams. Performs other duties as assigned.

Requirements

High school diploma or equivalent required.
Medical Coding - Hoag Hospital: Completion of a certified coding program or graduate of a CAHIM accredited HIT program required.
Five years of progressive inpatient coding experience in an acute care facility.
Medical Coding - Hoag Hospital: Certified Coding Specialist (CCS)

Nice To Haves

Adept coding experience (ICD-10-CM/ICD-10-PCS) in multiple specialties to include but are not limited to: OB/GYN, Urology, Oncology, Pain Management, Cardiology, Neurology, and Orthopedics.
Knowledge of the elements of disease processes and related procedures.
Strong clinical knowledge and understanding of pathology / physiology of disease processes.
Experience working in EPIC- EMR.
Coding - Hoag Clinic: Certified Urology Coder (CUC)

Responsibilities

Verifies that all ICD-10-CM and ICD-10-PCS codes are correctly captured.
Verifies that physician and other key information is correctly abstracted.
Resolves billing related errors and assists with workflow changes and process improvement projects.
Meets ongoing productivity and quality accuracy rate of 95% or better.
Assigns codes for diagnoses, treatment, and procedures for inpatient surgeries.
Determines the correct principal diagnosis, co-morbidities, complications, secondary conditions, and surgical procedures.
Abstracts correctly all required information from record including the correct discharge disposition and HCAI required information.
Assigns correct MS-DRG and APR-DRG and correct Present on Admission (POA) indicators and identifies (HAC) Hospital Acquired Conditions.
Queries physicians per established policy and procedure when documentation is not clear or conflicting.
Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services.
Participates in internal and external quality review meetings.
Has strong interpersonal skills and is able to work effectively with members of the coding and Clinical Documentation Improvement (CDI) teams.
Performs other duties as assigned.