Hospital Coding Specialist, Sr

Orlando Health•Orlando, FL

About The Position

The Hospital Coding Specialist, Sr is responsible for complete and accurate coding of inpatient hospital visits at all levels across the Orlando Health system for billing and regulatory compliance. The role reviews clinical documentation and assigns diagnosis and procedure codes, supports appropriate DRG assignment and reimbursement, and works with physicians and healthcare teams to resolve documentation issues. The specialist also supports audits, documentation enhancement, billing, quality initiatives, team guidance, and process improvement while maintaining coding accuracy, productivity, confidentiality, and compliance with applicable policies and coding standards.

Requirements

Bachelor's or associate degree in Health Information Management, or completion of a coding certificate program.
Computer literacy.
Knowledge of medical terminology, anatomy, and physiology.
Score of 90% or better on the Orlando Health senior-level coding skills test.
Maintain one of the following certifications: CCS (Certified Coding Specialist), CPC (Certified Professional Coder), or COC (Certified Outpatient Coder).
Five years of previous hospital inpatient and/or outpatient coding experience.

Nice To Haves

One year of teaching hospital coding experience.
RHIA (Registered Health Information Administrator) certification preferred.
RHIT (Registered Health Information Technician) certification preferred.

Responsibilities

Review clinical documentation and assign diagnosis and procedure codes for inpatient visits across multiple facilities using ICD-10-CM/PCS and applicable systems and applications.
Sequence principal and secondary diagnoses and procedures appropriately for MS and APR-DRG assignment in accordance with coding conventions, official guidelines, and CMS guidance.
Query physicians to clarify documentation discrepancies and inconsistencies, including those involving diagnoses, complications, comorbid conditions, and procedures.
Apply appropriate present-on-admission codes and discharge diagnosis status, and abstract information into hospital information systems.
Complete concurrent reviews for documentation enhancement and interim billing.
Assist coding liaisons and management with medical record reviews for third-party audits, denied claims, medical necessity, pre-bill reviews, and focused audits.
Communicate cooperatively with physicians, office personnel, patients, guests, and healthcare team members.
Collaborate with Clinical Document Excellence, Quality Management, and other departments on DRG assignment, compliance, and reimbursement.
Apply knowledge of mortality and other coding-related quality initiatives and key performance indicators.
Use critical thinking, problem-solving, and process-improvement skills while balancing reimbursement considerations with regulatory compliance.
Maintain and share expertise in coding guidelines, procedures, medical necessity and CCI edits, the APC reimbursement system, current coding changes, and standards of care.
Provide coding guidance to the coding team and coordinate information and workflow independently within the corporate functional area.
Work with coding and other teams to meet corporate and departmental goals, and track and trend opportunities for physician education.
Coordinate with Patient Accounting and ancillary areas to support appropriate and timely billing.
Collect and provide data for statistical reports as required.
Maintain department productivity standards and participate in quality audits while maintaining at least 95% accuracy.
Assist with precepting new team members as needed and cross-train in coding areas based on department needs.
Demonstrate strong customer service and verbal and written communication skills.
Comply with AHIMA and AAPC Standards of Ethical Coding and official coding guidelines, and protect patient confidentiality.
Maintain punctual attendance and comply with Orlando Health policies and applicable standards.
Work as a team member to solve problems, support a positive work environment, pursue professional development, and attend required meetings.
Perform other duties as assigned.