HIM Coder I or II

Billings Clinic•Billings, MT

About The Position

The HIM Coder is responsible for coding and abstracting diagnoses and procedures from patient charts using ICD-CM, ICD-PCS, and/or CPT-4/HCPCS codes for statistical and reimbursement purposes across Billings Clinic inpatient and outpatient services. Depending on the assigned area, the role may audit or assign CPT and E&M codes to clinic encounters by reviewing dictation, problem lists, and intake forms; capture primary and secondary ICD-CM diagnoses; add HCPCS modifiers; verify service units; and query physicians to clarify clinical documentation. The coder educates physicians on coding and documentation, serves as an on-site resource for providers and staff, calculates MS-DRG and APR-DRG, and ensures compliance with applicable coding, billing, and reimbursement policies. The position requires maintaining coding accuracy and productivity standards, validating data before billing and claims submission, and identifying and reporting compliance concerns. Coders may be cross-trained across clinic specialties and hospital services. Clinic coders may train on reimbursement functions and clinic auditing; hospital coders may code outpatient and outpatient surgery services and begin inpatient coding training.

Requirements

High school graduate or equivalent.
Prior training in anatomy, medical terminology, and coding.
Clinic assignment: 2 years of coding experience in a physician clinic involving multiple specialties and basic reimbursement experience.
Hospital assignment: 2 years of coding experience in a hospital involving all patient types and third-party and government payers.
At hire, hold one of the following: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS); an equivalent combination of education and experience may be considered.
Any required license or certification must be current and in good standing.
Demonstrated knowledge of coding and reimbursement methodologies and medical-record information systems.
Ability to perform complex coding requirements in the assigned clinic or hospital area, work with minimal supervision, and proactively identify reimbursement issues.
Ability to research complex coding issues, use independent judgment, and make recommendations for scenarios outside established procedures.
Interpersonal skills to communicate with physicians, payers, and staff, handle complex inquiries, assist with training, and respond professionally to difficult situations.
Ability to incorporate cultural diversity and age-appropriate care into communications and services.

Responsibilities

Review medical records to identify principal and secondary diagnoses and procedures.
Assign appropriate ICD-CM and/or CPT-4/HCPCS codes to encounters using reference tools and computerized encoding systems.
Follow applicable coding, insurance billing, reimbursement, and regulatory compliance policies and procedures.
Maintain or exceed 95% coding accuracy based on audit findings and meet department productivity standards.
Ensure data accuracy before billing interface and claims submission, including discharge disposition, modifiers, codes, performing provider, date of service, POA, and NCCI requirements.
Collect medical-record data to complete discharge data abstracts for specialized studies.
Query physicians to clarify clinical documentation and provide physicians and non-physician providers with coding and documentation education and feedback.
Calculate MS-DRG and APR-DRG.
Identify and report regulatory, compliance, reimbursement, or other concerns to the appropriate manager, director, or Corporate Compliance Department.
Maintain current knowledge of coding and abstracting information, technologies, and guidelines.
Meet mandatory organizational and departmental requirements and maintain competency in relevant environmental, employee, and patient safety standards.
Support and model behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct, and service expectations.
Perform other duties as assigned or needed to meet department or organizational needs.
Cross-train in assigned clinic or hospital coding functions, which may include multiple specialties, outpatient services, outpatient surgery, reimbursement functions, clinic auditing, and inpatient coding.
For applicable advanced-level duties, monitor high-dollar discharges, investigate complex coding issues, formulate recommendations for unusual scenarios, and serve as a resource to Level I coders.