HIM Coding Specialist

Hillsboro Area Hospital•Hillsboro, IL

About The Position

The HIM Coding Specialist performs coding and abstracting for inpatient and outpatient medical records accurately and in a timely manner to optimize reimbursement across all payer classes. The role works billing edits in the EMR and claim scrubber and is normally scheduled Monday through Friday. The specialist analyzes patient records, assigns diagnosis and procedure codes according to established guidelines, abstracts required data, and ensures timely code entry. The position supports accurate reimbursement, data collection, and clinical data analysis by reviewing charges, resolving documentation questions with providers and clinical team members, and ensuring documentation meets medical necessity guidelines. The specialist also maintains knowledge of HIPAA, hospital and department policies, coding references, and applicable legal requirements. The role includes organizing and prioritizing work to meet turnaround-time, productivity, and quality requirements; participating as a Health Information Management team member; and helping orient and train new staff. The employee must complete required education and training, protect patient confidentiality, follow safety requirements and Hillsboro Health Standards of Behavior, and participate in corporate compliance training and activities.

Requirements

High school diploma or equivalency, with college courses in medical terminology, anatomy, and coding.
At least 1 year of experience in the medical coding field.
Knowledge of reimbursement systems and Medicare regulations.
Excellent customer service skills.
Coding certification through AAPC or AHIMA.

Responsibilities

Support and promote an environment consistent with the hospital’s Mission, Vision, and Values.
Analyze patient records for principal and secondary diagnoses and procedures, and assign appropriate codes according to established guidelines.
Maintain current knowledge of HIPAA and medical-record best practices.
Abstract required data for patient records and enter codes in a timely manner.
Facilitate medical-record data flow to support accurate and prompt reimbursement, data collection, and clinical data analysis.
Represent Health Information Management as a team member and attend meetings as directed.
Review assigned charges for accuracy and validity and add charges needed for billing accuracy.
Collaborate with physicians regarding diagnoses and procedures, and follow up when provider documentation is insufficient or unclear.
Ensure documentation is appropriate to meet medical necessity guidelines.
Organize and prioritize assigned work to meet work demands and turnaround-time requirements.
Maintain coding productivity and quality.
Identify inconsistencies and discrepancies in medical-record documentation and report them appropriately.
Communicate with clinical team members regarding documentation.
Use coding reference materials, including coding books and the 3M encoder, appropriately and efficiently.
Follow general hospital and department policies and procedures, including those for release of information, medical-record amendments, and other legal requirements.
Assist in orienting and training new department staff.
Complete and maintain required education and training, comply with HIPAA, and protect patient confidentiality.
Follow lawful safety and health requirements, use required protective equipment, and promptly report safety concerns, injuries, illnesses, and near misses in SafetyZone.
Follow Hillsboro Health Standards of Behavior.
Attend required training or meetings under the Corporate Compliance Plan and Code of Conduct, and understand when to contact the Corporate Compliance Officer about potential fraud or abuse concerns.