Wallingford

Gaylord Hospital•Wallingford, CT

2d•Hybrid

About The Position

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation. We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve. Our Mission: To enhance health, maximize function, and transform lives. Our values: Integrity, Compassion, Accountability, Respect and Excellence. These values guide us in providing quality patient care and transforming the lives of our patients. The Inpatient Coding Specialist reviews documentation in the electronic medical record and assigns ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes in accordance with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and in compliance with the ICD-10 Official Guidelines for Coding and Reporting, regulatory requirements, and Gaylord Hospital policy. Inpatient Coding Specialist will perform physician queries, obtain documentation clarification, and provide education to clinical staff on documentation requirements and DRG assignment. Works in collaboration with Clinical Documentation Integrity Specialist. Participates in quality monitoring and annual education/training.

Requirements

Associate's degree or equivalent from a two-year College or technical school (Health Information Management), Bachelor’s degree preferred.
Minimum 3 years of direct inpatient hospital coding-related experience.
CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist), RHIT or RHIA through AHIMA preferred or CPC (Certified Coding Professional).
Expertise with ICD-10-CM / ICD-10-PCS code assignment and Official Coding Guidelines.
Current with official coding guidelines and attend continuing education necessary to maintain coding certification;
Proficient with electronic medical records and utilizing coding references and electronic software applications.
Must have an extensive knowledge of the CMS Hospital Prospective Payment System and DRG assignment.

Responsibilities

Review inpatient medical record and assign appropriate principal and secondary diagnosis and procedure codes upon patient admission, concurrently throughout stay, and final code upon discharge in accordance with Official Coding Guidelines and regulatory requirements
Utilize knowledge of Anatomy & Physiology, Pharmacology, and medical terminology to analyze physician and other clinical documentation to determine and support appropriate ICD-10-CM diagnosis and ICD-10-PCS procedure.
Apply knowledge of Inpatient Prospective Payment System (PPS) to ensure accurate DRG assignment and appropriate reimbursement for inpatient admissions.
Communicate DRG assignment and changes to clinical staff.
Work in collaboration with the Utilization Management team to ensure timely code assignment to obtain working DRG.
Review clinical documentation in coordination with Clinical Documentation Integrity Specialist to ensure clinical documentation contains specificity, is accurate and complete
Formulate a physician query to send to the provider to obtain missing documentation, specificity and/or additional clarification necessary to complete the coding process.
Works collaboratively with Patient Financial Services to ensure accurate and timely claim submission.
Assist with payer requests for case review or DRG validation.
Draft correspondence to payer to support code assignment and appeal DRG downgrade.
Provide education and feedback to physicians and clinical staff
Attend medical staff meetings or conduct physician in-service to provide training on coding or documentation requirements or changes.
Act as subject matter expert on ICD-10-CM code assignment and serves as a resource for the organization for questions related to ICD-10 diagnosis coding and DRG assignment.
Generate/complete monthly reports including Case Mix Index, Top DRG assignments, short-stays, DNFB, etc.
Track monthly data to analyze trends or changes throughout the year.
Perform internal quality assurance audits to verify accurate diagnosis code assignment for both inpatient and outpatient services.
Assist with annual external coding compliance audits.