Inpatient Hospital Reimbursement & Coding Specialist III, Remote

Erlanger Health System•Chattanooga, TN

1d•Remote

About The Position

Utilizing an electronic medical record and computerized encoder, this role assigns and sequences diagnosis and procedure codes and present on admission indicators on inpatient or outpatient encounters based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, encoder software guidance and Health Information Management (HIM) policies and procedures. The position requires coding all types of adult and pediatric Inpatient cases including long length of stays, mortality, trauma, L&D, NICU, and normal newborns, as well as all types of outpatient cases including ED, outpatient, OBS, and Same Day Surgery.

Requirements

Knowledge of Anatomy and Physiology, Disease Pathology, and Medical Terminology.
Knowledge of coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-10-CM coding.
Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
Accurate translation of written procedure descriptions to accurately assign ICD 10 PCS procedure codes for inpatient and CPT/HCPCs codes for outpatient accounts.
Ability to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of submitted department charges.
Knowledge of clinical content standards.
Validation of coding certification, i.e., specialty focus such as ICD-10-CM coding, ICD-10-PCS, CPT coding, and billing practices from an accredited program.
Must demonstrate knowledge of coding to support this position.
Ability to follow standard practices in coding and reimbursement.
Demonstrate the knowledge of optimization of coding for reimbursement.
Computer literate in a windows environment, also basic word processing skills, knowledge of MS Office and a basic graphics package.
Possess excellent communication skills both written and oral.
Demonstration of sound judgment and organizational ability.
Ability and knowledge to maintain a quality and quantity standard in coding.
Must have 4 years of coding experience in an acute care hospital.
RHIT, RHIA, CCS, CPC, or CPC-H

Nice To Haves

BS or AS degree in Health Information Management Administration or Health Information Technician from an accredited program.
Level 1 Academic medical center experience

Responsibilities

Reviews inpatient or outpatient medical records to assign and sequence all appropriate diagnosis and procedures codes utilizing encoder software and following by proficiently translating diagnostic statements, procedure descriptions, physician orders, and other pertinent documentation.
Reviews Medicare Severity Diagnosis Related Groups (MSDRGs) and All Patient Refined Diagnosis Related Groups (APRDRGs) on inpatient cases or Ambulatory Payment Classification (APCs) on outpatient cases for appropriate code assignment.
Reviews and validates accuracy of Admission-Discharge-Transfer (ADT) data fields; abstracts admission type, point of origin, discharge disposition, physicians, procedure dates and on inpatient cases present on admission (POA) indicators.
Reviews appropriate coding work queues daily to address coding edits and needed corrections and follows procedure to notify billing as needed.
Reviews accounts and performs needed correction for internal audits and external denials.
Works in conjunction with Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable diagnosis, procedure and/or physician order when documentation or valid order is incomplete, vague, or ambiguous.
Follows charge verification processes and routing accounts based on missing, incomplete, or inaccurate charging for outpatient coders.
Adheres to Health Information Management (HIM) Coding policies.
Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.
Validates reason for visit for OP coding and admit diagnosis for IP coding.
Adheres to Det Norske Veritas (DNV) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.
Maintains coding certification and knowledge referencing diagnosis and procedural coding classification system coding guidelines and regulatory changes.
Contacts the appropriate department or physician for assistance in obtaining physician clarification of Diagnoses and procedures.
Participates in performance improvement initiatives as assigned.
Consistently meets or exceeds productivity and quality standards as defined by department Leadership.
Demonstrates the knowledge and skills necessary to optimally code inpatient or outpatient encounters (based on team assigned).
Demonstrates knowledge of the various payment schemes for inpatient encounters or outpatient encounters.
Demonstrates the ability to be flexible as to the type of encounter to be coded.
Demonstrates the ability to work in a self-directed team by taking and giving direction and sharing in the responsibility of the team.
Displays the ability to be self-motivated, be able to evaluate the scope of each day's work, and display time management skills to accomplish assigned work.
Works effectively in a remote work capacity.
Provides management with annual/biannual proof of certification and completes annual/biannual required continuing education.
Performs any other tasks as assigned.