Coder Senior

LCMC Health

About The Position

The Coding Senior applies appropriate ICD-10-CM/PCS and CPT diagnostic and procedural codes and determines MS-DRG and APR-DRG assignments for inpatient records across multiple specialties. The role may also apply ICD-10 diagnostic and CPT procedure codes to ambulatory records across multiple specialties. The Coding Senior may be assigned any of the coding functions performed by a Coding Specialist I. The position navigates patient health records and other systems to determine codes, group assignments, and required modifiers; validates charges against documentation; and communicates with clinical staff, physicians, office staff, and Clinical Documentation Improvement Specialists about documentation issues. It identifies and helps resolve coding concerns, tracks items requiring follow-up, and meets established quality and productivity standards. The role also maintains confidentiality and current knowledge of coding, reimbursement, regulatory, and ethical requirements, and performs other duties as assigned by leadership.

Requirements

High school diploma/GED or equivalent and 3 years of work experience; or an associate degree and 1 year of experience; or a diploma/certification in coding and 1 year of experience.
Comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding, MS-DRG or APC grouping, and charge description master components for charging functions.
Knowledge of third-party reimbursement regulations and billing practices.
Experience utilizing encoding/grouping software.
Ability to use standard desktop and Windows-based computer systems, including basic email, internet, and computer navigation.
High ethical standards.
Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG, and APC coding principles and guidelines.
Experience in ICD-10-CM/PCS coding and reimbursement training.
Knowledge of Prospective Payment System methodology for inpatient, outpatient, ambulatory, and provider-based clinic encounters.
Knowledge of hospital and professional coding, including provider-based billing.
Knowledge of Joint Commission and CMS documentation regulations.
Experience with concurrent coding reviews.
Knowledge of privacy and security regulations, confidentiality, laws, and access and release of information practices.
Experience assisting with and identifying learning needs and providing training to coding staff.
Strong analytical abilities and problem-solving skills.
Excellent oral, written, and interpersonal communication skills.
Ability to organize and set priorities to meet objectives in a timely manner.
Ability to adapt to change and handle challenges proactively and with poise.
Ability to collaborate effectively with physicians and managerial staff at all levels.

Nice To Haves

Associate's degree in HIM or a similar field, completion of an AHIMA-approved coding program, or completion of an AAPC coding program.
Registered Health Information Technician certification from CCHIIM-AHIMA.
Registered Health Information Administrator certification from CCHIIM-AHIMA.
Certified Coding Specialist certification from CCHIIM.

Responsibilities

Apply appropriate ICD-10-CM/PCS and CPT diagnostic and procedural codes and determine MS-DRG and APR-DRG assignments for inpatient records across multiple specialties.
Apply appropriate ICD-10 diagnostic and CPT procedure codes to ambulatory records across multiple specialties, as assigned.
Navigate patient health records and other computer systems and sources to determine diagnosis and procedure codes, MS-DRG and APC assignments, and required modifiers.
Validate charges by comparing them with health record documentation as necessary.
Communicate with clinical staff, physicians, office staff, and Clinical Documentation Improvement Specialists regarding documentation issues or needs related to inpatient, outpatient, or ambulatory coding.
Identify concerns, notify appropriate leadership, and provide resolution to moderate to complex problems.
Track missing documentation, charges, physician queries, and other issues requiring follow-up to support timely coding.
Meet or exceed coding quality and productivity standards established by the coding department.
Adhere to LCMC confidentiality requirements concerning the release of individual or aggregate patient information.
Maintain current knowledge of coding and reimbursement guideline and regulatory changes.
Maintain working knowledge of applicable coding and reimbursement laws, regulations, the Code of Ethics, and organizational policies and procedures.
Perform other duties as assigned by leadership.