Hospital Coding Specialist I

West Tennessee Healthcare•Jackson, MS

About The Position

The Hospital Coding Specialist I codes and optimizes electronic medical records. The employee works an assigned eight-hour shift, five days a week, and is subject to call back and overtime as required by the hospital. The role reviews electronic medical records to identify treated diagnoses and significant procedures, assigns and sequences ICD-10-CM and CPT codes and modifiers, and ensures accurate transfer of coding information into the coding and billing application. It uses coding references and payer guidelines to support compliant, accurate coding and medical necessity. The specialist identifies documentation opportunities, completes physician queries when clarification is needed, supports coding audits, resolves coding and reimbursement denials and edits, and keeps current with coding and billing changes and applicable policies. The position also uses an abstracting application to maintain physician and discharge information, completes required training and education, responds professionally to work requests, meets productivity and accuracy standards, and maintains coding certification. Related responsibilities may be assigned or directed.

Requirements

Current RHIA, RHIT, CCS, or CCA certification from AHIMA, or obtain certification within the first year of employment.
Knowledge of Health Information Management practices, coding, and coding guidelines, acquired through RHIA, RHIT, CCS, or CCA certification.
Experience coding diagnostic outpatient, emergency department, ancillary outpatient, or physician office records.
By the end of the three-month training period, ability to code at least 125 diagnostic outpatient records, 100 ancillary outpatient records, and 90 emergency room records per day.
Extensive knowledge of computer applications, including Microsoft Windows and computerized equipment.
Ability to navigate computer software and hardware and recognize potential issues.
Strong knowledge of ICD-10 Official Guidelines for Coding and Reporting from CMS and NCHS, AMA CPT Coding Guidelines, and AHIMA Standards of Ethical Coding.

Responsibilities

Review electronic medical records and identify treated diagnoses and significant procedures.
Use coding software to assign ICD-10-CM diagnosis codes, CPT procedure codes, and modifiers when indicated, ensuring coding and APC accuracy.
Sequence diagnosis and procedure codes according to applicable primary and additional code definitions.
Use online coding references, CMS Local Coverage Determinations, and other payer guidelines to support appropriate code assignment, compliance, billing, and medical necessity.
Ensure diagnosis and procedure codes, modifiers, procedure dates, and surgeons are accurately transferred from coding software to the coding and billing application.
Identify and communicate documentation opportunities and complete physician queries when clarification is needed.
Use the abstracting application to enter or update consulting physicians, discharge dispositions, and the attending physician.
Review and respond to internal and external coding audits in a timely manner.
Review and resolve coding and reimbursement-related denials and edits to support timely claim submission.
Stay informed about changes in coding and billing and comply with federal, state, and hospital policies.
Complete assigned online training and education activities on time and attend required onsite meetings.
Respond professionally and promptly to emails and requests from supervisors, managers, and other hospital employees.
Meet required productivity and accuracy standards.
Maintain coding certification.
Perform related responsibilities as required or directed.