Coder Inpatient

Omega Healthcare Management Services•Boca Raton, FL

1d•Remote

About The Position

Under limited supervision the Coder Inpatient reviews medical records and performs coding on all diagnoses, procedures, and DRG. The Coder Inpatient uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder Inpatient will be charged with maintaining the confidentiality of patient records and procedures.

Requirements

Inpatient coder with a minimum of 3 years of recent experience in a trauma level 1 academic acute care setting.
Able to code both medical and surgical cases for all acute care specialties (cardio, neuro, orthro, pulm, gen med, gen surg, etc.) as well as OB and psyche.
Must be experienced with Epic and 3M.
Experienced with sending provider queries using Epic templates.
Able to meet production expectation of 2 charts per hour.
Able to maintain 95% accuracy in all coding (DRG, Pdx, PCS, SOI, ROM, etc.).
Able to initially train between 8a-4:30p MST.
Able to pick up new workflows and technology easily
Good written and verbal communication
Successful completion of an AAPC or AHIMA-approved Coding Certificate Program and a minimum of two to four years of current production coding experience in acute care
Must have the following certificates and/or licenses: CPC, COC, CIC, RHIA, RHIT, CCS, and/or CCS-P.
Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes.
Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation.

Responsibilities

Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee and clinical medical records.
Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing.
Utilizes technical coding principals and DRG/APC reimbursement expertise to assign appropriate codes.
Abstracts and codes pertinent medical data into multiple software programs and/or encoders.
Follows official coding guidelines to review and analyze health records.
Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations.
Extracts pertinent data from the patient’s health record, and determines appropriate coding for reports and billing documents.
Identifies codes for reporting medical services, procedures performed by physicians.
Enters codes into various computer systems dependent upon the various clients.
Track and document productivity in specified systems, maintain productivity levels as defined by the client.
Maintain 95% quality rating
Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.