Him Coder (Otpt)

FDIHB•Fort Defiance, AZ

4d•Onsite

About The Position

This position is responsible for retrieving information from the RPMS, reviewing medical records to ensure correct diagnosis and procedural codes are assigned by FDIHB providers. The Him Coder will assign and categorize codes using various classification systems and guidelines, abstract necessary information by auditing patient care components and electronic health records, and perform quantitative analysis to ensure record completeness and accuracy. The role involves performing quality data entry, audits, and medical reviews, ensuring the validity and disposition of clinical records, and maintaining the confidentiality of patient health information in accordance with federal regulations. The Him Coder will also work with clinical staff to coordinate workflow, monitor areas for improvement, and prepare reports. Additionally, the position requires staying updated on coding regulations and best practices, and performing other assigned duties.

Requirements

Two (2) years of outpatient coding experience in a healthcare setting.
If no outpatient coding experience, must have a Registered Health Information Technician (RHIT) Certification.
Completion Certificate from a University/College or Technical school related to Medical Billing and Coding course (must have certification within one (1) year).
High School Diploma or Equivalency (HSE).
Coding Certification by the American Health Information Management Association (AHIMA) or, the American Academy of Professional Coders (AAPC), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist Physician-based (CCS-P) or Coding Certification by the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Coder – Apprentice (CPC-A), Certified Outpatient Coding (COC), Certified Inpatient Coder (CIC).
Valid, unrestricted insurable driver’s license.
Resumes and references are required.

Nice To Haves

Navajo/Indian Preference: Applicants who meet the minimum qualifications and are enrolled members of the Navajo Nation will be given primary preference. Members of other federally recognized Indian tribes will be given secondary preference.

Responsibilities

Retrieves information from the RPMS and reviews medical records to ensure correct diagnosis and procedural codes are assigned.
Assigns and categorizes codes using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, coding guidelines, and other relevant policies.
Uses the 3M Grouper System to assist in classifying diagnoses and verifying coding accuracy.
Abstracts information by auditing patient care components and Electronic Health records for E&M levels, CPT, and HCPCS codes.
Performs quantitative analysis to ensure the presence of all component parts of the record and evaluates records for internal consistency, completeness, and accuracy.
Identifies inconsistencies or discrepancies among medical documentation and discusses them with appropriate staff and physicians.
Performs quality data entry of protected patient health information into RPMS and 3M Grouper systems.
Performs audits and medical reviews by running error listings and data reports.
Reviews and completes zero reports and RPMS Audit list reporting to capture missed data and errors.
Ensures the validity, completion, and disposition of all clinical records briefs.
Maintains confidentiality of health information in accordance with federal regulations.
Works with clinical staff in coordinating workflow and ensuring up-to-date codes are maintained in RPMS.
Surveys potential risk areas and identifies inconsistencies or discrepancies within medical records, discussing them with appropriate providers for corrective action.
Monitors specific areas for improvement by recognizing potential risks related to compliance issues.
Documents findings and prepares reports to present to the immediate supervisor.
Performs quality assurance/performance functions for the department.
Prepares reports and presents to staff and the Quality Assurance Committee as needed.
Completes all RCM Queries within 24 hours upon receipt.
Uses coding guidelines and resources including Encoder (3M), ICD-10 CM, ICD 10-PCS, CPT, HCPCS, RPMS user’s guide, PDR, Privacy Act, HIPAA regulations, medical dictionaries, TMS policies and procedures, JCAHO/CMS, Revenue Cycle Management Compliance Plan, Health Records guidelines, and written/oral policies and procedures.
Conducts quality control and improvement reviews by tracking inadequate documentation, communicating software/hardware problems, and maintaining deficiency and productivity logs.
Works with clinical providers on clinical documentation improvement and coordinates with providers to correct deficiencies.
Maintains the integrity of patient information, protecting it from unauthorized disclosures, breaches, or alterations/destruction.
Complies with FDIHB policies governing user access of accounts and ensures confidentiality.
Reports any security breaches or potential breaches to the immediate supervisor.
Keeps abreast of the latest concepts and techniques in coding, regulations, and related resources.
Continues pursuit and development of job-related individual interests and specialty areas.
Performs other duties as assigned.