Coder III : Medical Coding
About The Position
The Coder III reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM, ICD-10-PCS, and CPT codes to support diagnoses, procedures, and treatment results. These codes are utilized for billing, internal and external reporting, research, and regulatory compliance activities. The role adheres to the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and follows all official coding guidelines. This position also resolves billing-related errors, assists with workflow changes and process improvement projects, and meets ongoing productivity and quality standards of 95% accuracy rate or better. The 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. They abstract all required information from records, including the correct discharge disposition and OSHPD required information, and assign correct MS-DRG and APR-DRG, Present on Admission (POA) indicators, and identify Hospital Acquired Conditions (HAC). Additionally, the Coder III queries physicians when documentation is unclear or conflicting, serves as a coding consultant to Hoag providers, identifies discrepancies impacting quality of care or billing, and acts as a resource and subject matter expert to other coding staff. The role involves completing coding charge reviews and claim edits in Epic or other EMR systems, coding and correcting ICD-10 codes, modifiers, and CPT E/M and procedure codes, and reviewing and communicating with providers on E/M Leveling/Coding. The Coder III also codes specialty-specific outpatient surgeries/same-day procedures.
Requirements
- Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
- Adheres to all official coding guidelines.
Responsibilities
- Reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM, ICD-10-PCS, and CPT codes.
- Verifies that all ICD-10-CM and CPT codes are correctly captured.
- Verify that physician is correctly abstracted.
- 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.
- Performs other duties as assigned.
- Resolves billing related errors and assists with workflow changes and process improvement projects.
- Meets ongoing productivity and quality standard of 95% accuracy rate 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 OSHPD 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.
- Follows all coding conventions and serves as a coding consultant to Hoag providers.
- Identifies discrepancies that may impact quality of care and/or billing issues.
- Serves as a resource and subject matter expert to other coding staff.
- Completes coding charge review and claim edits in Epic or other appropriate EMR system which would entail coding and correcting ICD-10 codes, modifiers, and CPT E/M and procedure codes.
- Reviews and communicates with providers on E/M Leveling/Coding.
- Codes specialty specific outpatient surgeries/same day procedures.
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What This Job Offers
Career Level
Senior
Education Level
No Education Listed
