Revenue Cycle Coder

Huron Consulting Group•Chicago, IL

29d

About The Position

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise. The Coder-Inpatient provides high level technical competency and subject matter expertise analyzing physician/provider documentation in Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined DRGs (APR), Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI) to ensure accurate hospital reimbursement. Organizational business needs may require this coder to also code other outpatient health records.

Requirements

Current permanent U.S. Work Authorization required.
Three (3) years of current acute care or Inpatient coding experience is required.
Extensive, comprehensive working knowledge of medical terminology, Anatomy and Physiology, diagnostic and procedural coding and MS-DRG, APR DRG assignment.
Must be proficient in identifying POA, SOI and ROM indicators for Inpatient records as well as HACs and PSIs to ensure accurate hospital reimbursement.
Ability to use a standard desktop/laptop, email and other Windows applications, if needed, Internet and web-based training tools preferred.
Strong oral and written communication skills. Ability to communicate effectively with individuals and groups representing diverse perspectives.
Ability to research, analyze and assimilate information from various sources based on technical and experience-based knowledge.
Must exhibit critical thinking skills, strong problem- solving skills and the ability to prioritize workload.
Excellent organizational and customer service skills. Ability to perform frequent detailed tasks and provide productivity standard driven results.
Ability to adapt to change and be flexible with work priorities and interruptions.
Must be comfortable functioning in a virtual, collaborative, shared leadership environment with minimal supervision and able to exercise independent judgement.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Huron.
Required Certifications: Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Documentation Improvement Practitioner (CDIP)

Nice To Haves

Current experience utilizing encoding/grouping software and Computer Assisted Coding (CAC) is preferred.
Registered Health Information Administrator (RHIA) preferred
Encoder experience (3M/Solventum, Encoder Pro, Codify) preferred
Epic experience preferred
Cerner experience preferred
Meditech experience preferred

Responsibilities

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments.
Assigns appropriate code(s) by utilizing coding guidelines established by: o The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting o American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification o American Health Information Management Association (AHIMA) Standards of Ethical o Coding o Revenue Excellence/HM coding procedures and guidelines
Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors, practices, and decisions.
Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.
Codes Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR DRGs, POA, SOI & ROM indicators.
Reviews Inpatient health record documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.
Works Inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
Adheres to the Inpatient coding quality and productivity standards established by the organization.
Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
Utilizes EMR communication tools to track missing documentation or Inpatient queries that require follow-up to facilitate coding in a timely fashion.
Works with HIM and Patient Financial Services (PFS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement.
Maintains CEUs as appropriate for coding credentials as required by credentialing associations.
Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for Inpatient coding e.g., Hospital at Home.
Identifies, and attempts to problem solve, coding and/or EMR workflow issues that can impact coding.
Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.
Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Performs abstracting of additional data elements.
Performs other duties as assigned by Leadership.